- Design
- Nationwide survey- and register-based cohort
- Population
- 2,348 patients after elective incisional hernia repair in Denmark, 2014–2024
- Primary outcome
- Severe chronic pain, foreign-body sensation, recurrence, physical impact
- Effect
- Foreign-body sensation onlay 37.1% vs retromuscular 30.3%, difference 6.8 points (0.9–12.8)
This Danish nationwide study linked a patient questionnaire to the national ventral hernia database for everyone undergoing elective incisional hernia repair between 2014 and 2024. Of 2,827 eligible patients, 2,348 responded (83%). Mesh was placed onlay in 28%, retromuscular in 28%, preperitoneal in 13% and intraperitoneal in 31%.
After adjustment, onlay mesh was associated with more foreign-body sensation than retromuscular mesh (37.1% vs 30.3%, difference 6.8 points, 95% CI 0.9–12.8). Severe chronic pain, self-reported recurrence and physical impact did not differ between positions.
This is observational, so surgeon choice and hernia complexity may account for some of the difference. It suggests that on patient-reported measures the mesh plane matters less than often assumed, and that the trade-off is mainly about sensation rather than pain or recurrence.
- Tell patients that a third report feeling the mesh, whatever its position.
- Onlay placement was associated with modestly more foreign-body sensation than retromuscular.
- Severe chronic pain and self-reported recurrence did not differ between mesh positions.
- Choose the plane on technical and patient factors; patient-reported outcomes do not strongly favour one.
Why it matters
It gives surgeons patient-reported data on an often-debated choice, and the differences are smaller than expected.
Don't overread it
Observational; patients were not randomised to mesh position.
The statistics, in plain English
A difference of 6.8 percentage points means about 7 more patients in every 100 noticing the mesh with onlay. The lower end of the interval (0.9) is close to zero, so the true difference could be small.
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