Incidence of autoimmune disease after hernia surgery with a mesh implant: national retrospective cohort study

Background Some patients report experiencing various systemic symptoms after surgical placement of a (polypropylene (PP)) mesh implant, including fatigue, arthritis, and myalgia. As these complaints could resemble systemic symptoms of autoimmune disease (AID), there are concerns that mesh implants could induce such disorders. The aim of this study was to identify the incidence of AID after mesh implantation, compared with controls in whom no mesh was implanted.Methods In this national retrospective cohort study, approximately 4 million people insured with Dutch health insurer Co & ouml;peratie VGZ were screened for operative procedure reimbursements for inguinal and incisional hernia repair, between January 2015 and January 2019. Patients who underwent cholecystectomy were included as controls, as no mesh is implanted during this procedure. Patients were followed from 2 years before surgery to 3 years after surgery. The primary outcome was the difference in the incidence of AID after mesh implantation, compared with surgery without mesh. Propensity score matching for age, sex, and socioeconomic status was performed to reduce selection bias.Results The cohort included 19 464 inguinal/incisional hernia patients (86.0% male) and 18 259 cholecystectomy patients (31.8% male). After matching, both groups consisted of 1500 patients. The incidence of new AID during follow-up was not statistically different between the two groups (1.1% for the intervention group and 1.5% for the control group; P = 0.520).Conclusion Based on this cohort study, mesh implants do not increase the medium-term risk of developing AID.A national retrospective cohort study on the incidence of autoimmune disease diagnoses after hernia surgery with mesh implants, compared with abdominal surgery without implants, as registered through operative procedure reimbursements. Groups were matched for relevant risk factors and the most common procedures before autoimmune disease diagnosis were identified.What is already known: Inguinal and incisional hernia repairs are common operations. Polypropylene mesh is frequently used in hernia repair as it reduces risk of hernia recurrence. However, some concern exists about a potential association between mesh implants and autoimmune diseases. Consequently some patient groups have called for mesh-free options to be offered. Legal claims for compensation have been brought by some patients treated with mesh who have developed autoimmune diseases.What is new: This study compared the incidence of autoimmune diseases in patients undergoing hernia repair with mesh versus those undergoing cholecystectomy (without mesh). The findings demonstrate that mesh use is not associated with a higher incidence of autoimmune diseases.Potential impact on future practice: By providing evidence that mitigates fears about mesh-related autoimmune issues, this research can reassure patients and promote informed decision-making, potentially leading to a reduction in litigation related to hernia mesh procedures.