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Abstract Introduction Groin hernia repairs (GHRs) with mesh is today gold standard procedure in western countries. Yet, foreign body reaction and mesh infection are feared complications. This study aimed to investigate the incidence and risk factors for mesh removal due to foreign body reaction and mesh infection following GHR. Method This is an observational nationwide populations-based register-study with the use of prospectively collected data from the Swedish Hernia Register (SHR). All patients ≥ 15 years old with a GHR registered in SHR between 1992 and 2022 were eligible. Primary outcome was the prevalence of re-surgery with mesh removal. Secondary outcome was risk factors for re-surgery with mesh removal. Result Out of 363 664 GHRs during this 30-years long study-period, 211 (0.058%) had a re-surgery with mesh removal. The share of female GHRs was higher in the mesh removal group (15.2 %) compared to the non-mesh removal group (7.9 %). Adjusted multivariate Cox regression analysis for the risk of re-surgery with mesh removal, demonstrated significantly increased hazard ratios for women (2.80, CI 1.70-4.63), emergency GHR (3.43, CI 1.94-6.03), open anterior GHR (2.76, CI 1.61-4.72), combined anterior/posterior GHR (3.98, CI 1.84-8.57) and for patients below the total median of 63 years old (2.61, CI 1.78-3.81). Combined anterior/posterior GHR consisted domintely of mesh plug repairs. Discussion The groin tissue tolerance for implanted mesh following GHR is considered high where re-surgery for mesh removal due to foreign body reaction and mesh infection is rare. Women, younger patients, emergency repairs and surgical method of repair were associated risk factors for such re-surgery.
Melkemichel et al. (Thu,) studied this question.