A comparison of suture repair with mesh repair for incisional hernia

Background Incisional hernia is an important complication of abdominal surg ery. Procedures for the repair of these hernias with sutures and with mesh have been reported, but there is no consensus about which type of procedure is best. Methods Between March 1992 and February 1998, we performed a multicenter tr ial in which we randomly assigned to suture repair or mesh repair 200 patie nts who were scheduled to undergo repair of a primary hernia or a first rec urrence of hernia at the site of a vertical midline incision of the abdomen of less than 6 cm in length or width. The patients were followed up by phy sical examination at 1, 6, 12, 18, 24, and 36 months. Recurrence rates and potential risk factors for recurrent incisional hernia were analyzed with t he use of life-table methods. Results Among the 154 patients with primary hernias and the 27 patients wit h first-time recurrent hernias who were eligible for the study, 56 had recu rrences during the follow-up period. The three-year cumulative rates of rec urrence among patients who had suture repair and those who had mesh repair were 43 percent and 24 percent, respectively, with repair of a primary hern ia (P=0.02; difference, 19 percentage points; 95 percent confidence interva l, 3 to 35 percentage points). The recurrence rates were 58 percent and 20 percent with repair of a first recurrence of hernia (P=0.10; difference, 38 percentage points; 95 percent confidence interval, -1 to 78 percentage poi nts). The risk factors for recurrence were suture repair, infection, prosta tism ( in men), and previous surgery for abdominal aortic aneurysm. The siz e of the hernia did not affect the rate of recurrence. Conclusions Among patients with midline abdominal incisional hernias, mesh repair is superior to suture repair with regard to the recurrence of hernia , regardless of the size of the hernia. (N Engl J Med 2000; 343:392-8.) (C) 2000, Massachusetts Medical Society.