Long-term Outcomes of Mesh Versus Non-Mesh Repair for Incisional Hernia in Indian Patients: A Comparative Cohort Study

Background: Incisional hernias are common complications after laparotomy, with reported incidences up to 10–15%^[1,2]. Mesh repair has become standard to reduce recurrence^[3,4], but mesh may cause complications (infection, pain)^[5,3]. This study compares long-term outcomes of mesh versus suture (non-mesh) repair in an Indian patient cohort. Material and Methods: We conducted a retrospective cohort study of 350 adults undergoing elective incisional hernia repair at two tertiary-care centers (2020–2023). Patients were grouped by repair type: mesh (onlay or sublay polypropylene) or primary suture. We collected demographics, operative details, and outcomes. Recurrence, reoperation, and complications (seroma, infection, pain) were analyzed using chi-square tests. Kaplan–Meier analysis compared recurrence-free survival between groups. A p-value <0.05 was considered significant. Results: 200 patients had mesh repair and 150 had suture repair. Baseline factors (age ~50 years, sex, BMI, comorbidities) were similar in both groups (Table 1). Mesh patients had longer mean operative time (120 vs 90 minutes, p<0.001) and hospital stay (5.2 vs 4.0 days, p<0.001). Mesh repair produced significantly fewer recurrences at a mean follow-up of 48 months: 20 patients (10.0%) in the mesh group versus 38 (25.3%) in the suture group (p=0.001). Reoperation for recurrence was also lower with mesh (7.5% vs 20.0%, p=0.002). However, seroma formation was higher after mesh repair (15.0% vs 3.3%, p=0.001), while wound infection (10.0% vs 8.0%) and chronic pain (12.5% vs 13.3%) rates did not differ significantly. Kaplan–Meier curves showed significantly improved recurrence-free survival with mesh (log-rank p<0.001). Conclusion: In this Indian cohort, mesh repair of incisional hernia led to significantly lower long-term recurrence and reoperation rates than suture repair, despite higher early seroma incidence. These findings align with literature that mesh reduces recurrence^[6,1]. We recommend mesh reinforcement for most incisional hernias in our population. Future studies should assess patient-centered outcomes and optimize mesh technique to minimize complications.

Keywords: Incisional hernia; mesh repair; suture repair; hernia recurrence; long-term outcomes.