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Ventral hernia repair and mesh use in females of childbearing age

  • 2022 SAGES Oral
  • Published:
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A substantial knowledge gap exists in understanding sex as a biological variable for abdominal wall hernia repair, which also extends to hernia repair practices in females of childbearing age. We sought to determine the incidence of mesh repairs in females of childbearing age and to characterize factors associated with mesh use.


Using a statewide hernia-specific data registry, we conducted a retrospective study identifying females of childbearing age, defined as 18–44 per CDC guidelines, who underwent clean ventral hernia repair between January 2020 and Dec 2021. The primary outcome was mesh use. Multivariable logistic regression was used to examine factors associated with mesh use. To further delineate whether childbearing status may affect decision to use mesh, we also examined mesh practice stratified by age, comparing women 18 to 44 to those 45 and older.


Eight hundred and thirty-six females of childbearing age underwent ventral hernia repair with a mean age of 34.8 (6.2) years. Mesh was used in 547 (65.4%) patients. Mesh use was significantly associated with minimally invasive approach [aOR 29.46 (95% CI 16.30–53.25)], greater hernia width [aOR 1.50 (95% CI 1.20–1.88)], and greater BMI [aOR 1.05 (95% CI 1.03–1.08)]. Age was not significantly associated with mesh use [aOR 1.02 (95% CI 0.99–1.05)]. Compared to 1,461 female patients older than 44 years old, there was no significant association between childbearing age and mesh use [aOR 0.77 (95% CI 0.57–1.04)].


Most females of childbearing age had mesh placed during ventral and incisional hernia repair, which was largely associated with hernia size, BMI, and a minimally invasive surgical approach. Neither chronologic patient age nor being of childbearing age were associated with mesh use. Insofar as existing evidence suggests that childbearing status is an important factor in deciding whether to use mesh, these findings suggest that real-world practice may not reflect that evidence.

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Correspondence to Dana Telem.

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Dr. Mary Shen has no disclosures. Dr. Ryan Howard receives unrelated funding from the Blue Cross Blue Shield of Michigan Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK108740-05). Dr. Anne Ehlers receives unrelated funding from the Association for Academic Surgeons and SAGES. Ms. Lia Delaney and Mr. Quintin Solano have no disclosures. Dr. Michael Englesbe receives unrelated funding from the Michigan Department of Health and Human Services, the National Institute on Drug Abuse, and salary support from Blue Cross Blue Shield of Michigan. The Michigan Surgical Quality Collaborative is funded as part of the Blue Cross Blue Shield of Michigan Value Partnership program. Dr. Justin Dimick receives grant funding from the NIH, AHRQ, Blue Cross Blue Shield of Michigan Foundation, and is a cofounder of ArborMetrix, Inc. Dr. Dana Telem receives funding from AHRQ K08HS025778-01A1 and receives consulting fees from Medtronic. The content of this study is solely the responsibility of the authors and does not necessarily reflect the official views of Blue Cross Blue Shield of Michigan. No funder or sponsor had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Dr. Shen and Dr. Howard had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Shen, M.R., Howard, R., Ehlers, A.P. et al. Ventral hernia repair and mesh use in females of childbearing age. Surg Endosc 37, 3084–3089 (2023).

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