The DOI matches its Crossref record; 36 of the 36 references it cites were found in a registry or an index; none of the 28 sources its claims cite is checked for support yet.
Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair: A Randomized Clinical Trial
Open accessAbstract
Importance: Although multiple versions of polypropylene mesh devices are currently available on the market for hernia repair, few comparisons exist to guide surgeons as to which device may be preferable for certain indications. Mesh density is believed to impact patient outcomes, including rates of chronic pain and perception of mesh in the abdominal wall. Objective: To examine whether medium-weight polypropylene is associated with less pain at 1 year compared with heavy-weight mesh. Design, Setting, and Participants: This multicenter randomized clinical trial was performed from March 14, 2017, to April 17, 2019, with 1-year follow-up. Patients undergoing clean, open ventral hernia repairs with a width 20 cm or less were studied. Patients were blinded to the intervention. Interventions: Patients were randomized to receive medium-weight or heavy-weight polypropylene mesh during open ventral hernia repair. Main Outcomes and Measures: The primary outcome was pain measured with the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short Form 3a. Secondary outcomes included quality of life and pain measured at 30 days, quality of life measured at 1 year, 30-day postoperative morbidity, and 1-year hernia recurrence. Results: A total of 350 patients participated in the study, with 173 randomized to receive heavy-weight polypropylene mesh (84 [48.6%] female; mean [SD] age, 59.2 [11.4] years) and 177 randomized to receive medium-weight polypropylene mesh (91 [51.4%] female; mean [SD] age, 59.3 [11.4] years). No significant differences were found in demographic characteristics (mean [SD] body mass index of 32.0 [5.4] in both groups [calculated as weight in kilograms divided by height in meters squared] and American Society of Anesthesiologists classes of 2-4 in both groups), comorbidities (122 [70.5%] vs 93 [52.5%] with hypertension, 44 [25.4%] vs 43 [24.3%] with diabetes, 17 [9.8%] vs 12 [6.8%] with chronic obstructive pulmonary disease), or operative characteristics (modified hernia grade of 2 in 130 [75.1] vs 140 [79.1] in the heavy-weight vs medium-weight mesh groups). Pain scores for patients in the heavy-weight vs medium-weight mesh groups at 30 days (46.3 vs 46.3, P = .89) and 1 year (30.7 vs 30.7, P = .59) were identical. No significant differences in quality of life (median [interquartile range] hernia-specific quality of life score at 1 year of 90.0 [67.9-96.7] vs 86.7 [65.0-93.3]; median [interquartile range] hernia-specific quality of life score at 30 days, 45.0 [24.6-73.8] vs 43.3 [28.3-65.0]) were found for the heavy-weight mesh vs medium-weight mesh groups. Composite 1-year recurrence rates for patients in the heavy-weight vs medium-weight polypropylene groups were similar (8% vs 7%, P = .79). Conclusions and Relevance: Medium-weight polypropylene did not demonstrate any patient-perceived or clinical benefit over heavy-weight polypropylene after open retromuscular ventral hernia repair. Long-term follow-up of these comparable groups will elucidate any potential differences in durability that have yet to be identified. Trial Registration: ClinicalTrials.gov Identifier: NCT03082391.
Overview
CoChat Summary
TL;DR
In this multicenter randomized clinical trial of 350 patients undergoing open retromuscular ventral hernia repair, medium-weight polypropylene mesh did not improve pain, quality of life, mesh sensation, or recurrence compared with heavy-weight mesh at 1 year. The authors conclude medium-weight mesh showed no patient-perceived or clinical benefit over heavy-weight mesh in this setting.
Key findings
- Primary outcome: NIH PROMIS Pain Intensity Short Form 3a scores were identical between heavy-weight and medium-weight mesh at 30 days (46.3 vs 46.3; P = .89) and 1 year (30.7 vs 30.7; P = .59).
- Hernia-specific quality of life (HerQLes) at 1 year was similar: median 90.0 (IQR, 67.9-96.7) for heavy-weight vs 86.7 (IQR, 65.0-93.3) for medium-weight (P = .41).
- Composite 1-year hernia recurrence was similar: 8% heavy-weight vs 7% medium-weight (P = .79). Mesh sensation (“Do you feel your mesh?”) was reported by 33 (19.1%) vs 32 (18.1%) patients (P = .93).
- Thirty-day outcomes were comparable, including surgical site infection (4.8% vs 5.5%) and surgical site occurrence (12.0% vs 9.9%).
Methods
- Multicenter randomized clinical trial conducted March 14, 2017, to April 17, 2019, with 1-year follow-up; 10 surgeons at 4 institutions enrolled 350 patients undergoing elective, open, clean, retromuscular ventral hernia repair with hernia width ≤20 cm and primary fascial closure.
- Patients were randomized 1:1 to medium-weight (40-60 g/m²) or heavy-weight (>75 g/m²) polypropylene mesh via central concealed REDCap randomization; patients were blinded to mesh weight.
- Primary outcome was 1-year pain by NIH PROMIS Pain Intensity Short Form 3a; secondary outcomes included 30-day morbidity, 1-year hernia recurrence, and HerQLes quality of life. Analysis was intent-to-treat using nonparametric tests, regression models, and bootstrap CIs.
Limitations
- The authors state the findings apply only to flat sheet polypropylene placed in a retromuscular position and are not generalizable to intraperitoneal mesh placement; mesh weight varied within each category because products were not standardized across sites.
- The authors note the trial focused on patient-reported outcomes and temporarily ignored hernia recurrence, did not evaluate chronic pain syndromes, and planned long-term follow-up to assess durability.
- Evident from the text: 16 patients per group were lost to follow-up (10% heavy-weight, 9% medium-weight), and recurrence assessment was challenging, with disagreement among blinded CT assessors and differing recurrence rates by detection method (e.g., HRI 30.1% vs 35.0%; physical examination 1.2% vs 2.3%; CT 1.7% vs 1.7%).
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Claims the paper makes
0 Valid · 0 Not valid · 17 Not checked · 46 Own results and interpretations
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was a reduction in median pain by 33% from baseline scores in both groups at 1 year after surgery (from 46.3 to 30.7 in the heavy-weight mesh group and 46.3 to 30.7 in the medium-weight mesh group) as well as a baseline-adjusted difference in expected 30-day pain scores of -0.25 (95% CI, -1.8 to 1.34) and in 1-year pain scores of -0.37 (95% CI, -2.15 to 1.29).”
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were considerably more hernia recurrences using the HRI definition (30% in the heavy-weight mesh group vs 35% in the medium-weight mesh group) compared with 3% overall for physical examination and 3% overall for CT.”
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The odds of recurrence adjusted for baseline risk were 1.0 (95% CI, 0.4-2.2) for consensus, 1.2 (95% CI, 0.7-1.9)for maximum sensitivity, and 2.0 (95% CI, 0.4-14.3)for maximum specificity.”
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Results
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Pain scores for patients in the heavy-weight vs medium-weight mesh groups at 30 days (46.3 vs 46.3, P = .89)and 1 year (30.7 vs 30.7,P = .59)were identical.”
- Also stated in: § Results · plain
“No significant differences were found in 30-day outcomes in the heavy-weight vs medium-weight mesh groups (median [interquartile range] NIH PROMIS pain T score at 30 days, 46.3 [43.5-54.5]vs 46.3 [43.5-52.7];mean [interquartile range] hernia-specific quality of life score at 30 days, 45.0 [24.6-73.8]vs 43.3 [28.3-65.0])(Table 2).”
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No significant differences in quality of life (median [interquartile range] hernia-specific quality of life score at 1 year of 90.0 [67.9-96.7]vs 86.7 [65.0-93.3];median [interquartile range] hernia-specific quality of life score at 30 days, 45.0 [24.6-73.8]vs 43.3 [28.3-65.0])were found for the heavy-weight mesh vs medium-weight mesh groups.”
- Also stated in: § Results · plain
“Likewise, the median (IQR) HerQLes scores were similar at baseline (35.0 [20.0-48.3]vs 36.7 [22.5-58.3]),30 days (45.0 [24.6-73.8]vs 43.3 [28.3-65.0]),and 1 year (90.0 [67.9-96.7]vs 86.7 [65.0-93.3]) in the heavy-weight vs medium-weight mesh groups (Table 3).”
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Results · plain
34 more claims
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Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source doesn’t support the claim as written.
In the citing paper
“Regarding open, clean retromuscular VHR, heavyweight polypropylene has distinct advantages over mediumweight mesh.”
From “Long-term outcomes of ventral hernia repair using heavyweight non-woven polypropylene mesh” (2026) · cites this paper as [1]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn the citing paper
“A recent multicenter clinical trial comparing heavyweight (> 75 g/m2) and mediumweight (40–60 g/m2) polypropylene mesh in open ventral hernia repairs (VHR) showed comparable patient-reported and clinical outcomes at 30 days and one year postoperatively [1].”
From “Long-term outcomes of ventral hernia repair using heavyweight non-woven polypropylene mesh” (2026) · cites this paper as [1]
In the citing paper
“We demonstrated comparable rates of SSO (17%) and SSI (5.2%) at 30 days with Surgimesh WN to that previously reported for heavyweight mesh by Krpata et al. (12% and 4.8% respectively) [1].”
From “Long-term outcomes of ventral hernia repair using heavyweight non-woven polypropylene mesh” (2026) · cites this paper as [1]
In the citing paper
“Compared to mediumweight polypropylene, heavyweight polypropylene has similar outcomes with regard to pain scores and abdominal wall-specific quality of life at one year [1].”
From “Long-term outcomes of ventral hernia repair using heavyweight non-woven polypropylene mesh” (2026) · cites this paper as [1]
In the citing paper
“At one year postoperatively, Krpata et al. reported clinical hernia recurrence rates and pragmatic hernia recurrence rates of 1.2% and 8.1%, respectively, in patients undergoing VHR with TAR and implantation of heavyweight KP mesh [1].”
From “Long-term outcomes of ventral hernia repair using heavyweight non-woven polypropylene mesh” (2026) · cites this paper as [1]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Statistical Analysis
“All patients were analyzed on an intent-to-treat basis after randomization and included in the final analysis.”
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Methods
“Sixteen patients in each group were lost to follow-up, comprising 10% of the heavy-weight mesh group and 9% of the mediumweight mesh group and were not included in the final 1-year analysis regarding our primary outcome.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| Wound debridement | 1 (1.2) | 5 (2.7) | | |”
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Conclusions
Reported 1.2 · recomputed 0.598802
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Discussion
“identical rates of mesh sensation (21%) for ventral hernia repair regardless of mesh weight.”
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Results
“with 33 patients (19.1%) in the heavy-weight mesh group and 32 patients (18.1%) in the medium-weight mesh group answering yes”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Conclusions
“| Outcome | (n = 167) | (n = 182) | P value | |”
§ Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair A Randomized Clinical Trial > Results
“177 Medium weight 172 30-d Analysis”
Citations
Cites
Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., Amtmann, D., Bode, R., Buysse, D., Choi, S., et al. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.04.011 · Cited by 5,128
RELIEVING PAIN IN AMERICA: A BLUEPRINT FOR TRANSFORMING PREVENTION, CARE, EDUCATION, AND RESEARCH
Simon, L. S. (2012) · Military Medicine · doi:10.7205/milmed-d-16-00012 · Cited by 2,655
RELIEVING PAIN IN AMERICA: A BLUEPRINT FOR TRANSFORMING PREVENTION, CARE, EDUCATION, AND RESEARCH
Simon, L. S. (2012) · Journal of Pain & Palliative Care Pharmacotherapy · doi:10.3109/15360288.2012.678473 · Cited by 2,203
A comparison of suture repair with mesh repair for incisional hernia.
Luijendijk, R. W., Hop, W. C. J., van den Tol, M. P., de Lange, D. C. D., Braaksma, M. M. J., IJzermans, J. N. M., Boelhouwer, R. U., de Vries, B. C., Salu, M. K. M., Wereldsma, J. C. J., et al. (2000) · New England Journal of Medicine · doi:10.1056/nejm200008103430603 · Cited by 1,508
Classification of primary and incisional abdominal wall hernias
Muysoms, F. E., Miserez, M., Berrevoet, F. C., Campanelli, G., Champault, G., Chelala, E., Dietz, U. A., Eker, H. H., Nakadi, I. E., Hauters, P., et al. (2009) · Hernia · doi:10.1007/s10029-009-0518-x · Cited by 1,503
Long-term recurrence and complications associated with elective incisional hernia repair.
Kokotovic, D., Bisgaard, T., & Helgstrand, F. (2016) · JAMA · doi:10.1001/jama.2016.15217 · Cited by 391
The Argument for Lightweight Polypropylene Mesh in Hernia Repair
Cobb, W. S., Kercher, K. W., & Heniford, B. T. (2005) · Surgical Innovation · doi:10.1177/155335060501200109 · Cited by 364
Krpata, D. M., Schmotzer, B. J., Flocke, S., Jin, J., Blatnik, J. A., Ermlich, B., Novitsky, Y. W., & Rosen, M. J. (2012) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2012.06.412 · Cited by 297
Self-citationOutcomes of synthetic mesh in contaminated ventral hernia repairs.
Carbonell, A. M., Criss, C. N., Cobb, W. S., Novitsky, Y. W., & Rosen, M. J. (2013) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2013.07.382 · Cited by 282
Self-citationK., J., U., K., A., P., P., G., M., N., & V., S. (2001) · Hernia · doi:10.1007/s100290100019 · Cited by 233
Cited by
A Review of Abdominal Meshes for Hernia Repair—Current Status and Emerging Solutions
Najm, A., Niculescu, A.-G., Gașpar, B. S., Grumezescu, A. M., & Beuran, M. (2023) · Materials · doi:10.3390/ma16227124 · Cited by 71
Petro, C. C., Thomas, J. D., Tu, C., Krpata, D. M., Beffa, L., Rosen, M. J., & Prabhu, A. S. (2022) · Journal of the American College of Surgeons · doi:10.1097/xcs.0000000000000171 · Cited by 33
Self-citationDeNoto, G., Ceppa, E. P., Pacella, S. J., Sawyer, M. A. J., Slayden, G., Takata, M. C., Tuma, G. A., & Yunis, J. P. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10214998 · Cited by 28
Maskal, S., Miller, B., Ellis, R., Phillips, S., Prabhu, A., Beffa, L., Krpata, D., Rosenblatt, S., Rosen, M., & Petro, C. (2023) · Surgical Endoscopy · doi:10.1007/s00464-023-10039-4 · Cited by 23
Self-citationEllis, R. C., Petro, C. C., Krpata, D. M., Beffa, L., Miller, B. T., Montelione, K., Maskal, S. M., Tu, C., Huang, L., Lau, B., et al. (2023) · JAMA Surgery · doi:10.1001/jamasurg.2023.1786 · Cited by 24
Self-citation
Metadata
- Authors
- Krpata, D. M., Petro, C. C., Prabhu, A. S., Tastaldi, L., Zolin, S., Fafaj, A., Rosenblatt, S., Poulose, B. K., Pierce, R. A., Warren, J. A., Carbonell, A. M., Goldblatt, M. I., Stewart, T. G., Olson, M. A., & Rosen, M. J.
- Affiliations
- Cleveland Clinic (US)
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
- The Ohio State University Wexner Medical Center (US)
- Vanderbilt University (US)
- Prisma Health (US)
- Medical College of Wisconsin (US)
- Weill Cornell Medicine (US)
- Corresponding author
- Krpata, David M.
- ORCID
- Venue
- JAMA Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2021-12-01
- Volume
- 156
- Issue
- 12
- Pages
- 1085
- ISSN
- 2168-6254 (ISSN-L)
- PMC
- PMC8444061
- OpenAlex
- W3201555788
- Semantic Scholar
- cba2e898d1e6a544f6f636de3a6a7a3b77337f8f
- Cited by
- 78
- References
- 36
- Citations by year
- 2026: 19 · 2025: 22 · 2024: 11 · 2023: 18 · 2022: 5 · 2021: 2
- FWCI
- 8.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Surgery (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Health Sciences › Medicine › Surgery › Abdominal Surgery and Complications
- Health Sciences › Medicine › Surgery › Stoma care and complications
- Keywords
- ventral hernia repair, polypropylene mesh, mesh weight, mesh density, chronic pain, postoperative pain, quality of life, hernia recurrence, postoperative morbidity
- MeSH terms
- Patient Reported Outcome Measures, Female, Hernia, Ventral, Humans, Male, Middle Aged, Pain Measurement, Postoperative Pain, Polypropylenes, Prosthesis Design, Surgical Mesh
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