Design: Nationwide survey- and register-based cohort
Population: 2,348 Danish adults after elective incisional hernia repair, 2014 to 2024
Primary outcome: Patient-reported pain, foreign-body sensation, recurrence and physical impact
Effect: Foreign-body sensation onlay 37.1% vs retromuscular 30.3% (difference 6.8 points, 95% CI 0.9 to 12.8)

A Danish nationwide cohort linked an Abdominal Hernia questionnaire to the national ventral hernia register for elective incisional hernia repairs between 2014 and 2024. 2,348 of 2,827 patients responded (83%). Mesh was onlay in 28%, retromuscular in 28%, preperitoneal in 13% and intraperitoneal with defect closure in 31%. Published in Annals of Surgery on 15 October 2026.

After adjustment, onlay mesh was associated with more foreign-body sensation than retromuscular mesh (37.1% vs 30.3%; difference 6.8 percentage points, 95% CI 0.9 to 12.8). There were no differences between positions in severe chronic pain, self-reported recurrence or physical impact on daily life.

This is observational and position was chosen by surgeons for reasons that may also affect outcomes. It suggests that, from the patient's point of view, mesh position matters less than surgical debate implies, with foreign-body sensation the one complaint that differed.

Tell patients that some sensation of the mesh is common after incisional hernia repair
Expect similar chronic pain and recurrence reports across mesh positions
Consider retromuscular placement where foreign-body sensation is a particular concern
Use patient-reported outcome measures when auditing hernia repairs

Why it matters

It gives surgeons patient-reported evidence to set expectations whatever position they choose.

The statistics, in plain English

A 6.8-point difference with an interval from 0.9 to 12.8 means the true gap could be very small or moderate. 'No difference' in pain and recurrence here means none was detected, not that the positions are proven equal.