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Literature Selections

Study on Mesh in Adolescent Inguinal Hernia Repair Reveals Low Use, Low Recurrence, and Selective Indications

Selection prepared by Christopher DuCoin, MD, FACS

November 11, 2025

acs-store-journalperiodical.jpg

Heller K, Ochoa BV, Eldredge RS, Padilla BE, on behalf of the Pediatric Inguinal Hernia Collaborative Group. Evaluation of Mesh Placement in Adolescents Undergoing Inguinal Hernia Repair: A Multicenter Retrospective Cohort Study. J Am Coll Surg. November 06, 2025.

20 US pediatric centers reviewed 708 adolescents (12–17 years) undergoing primary inguinal hernia repair by pediatric surgeons, each with at least 3 years of follow up. Mesh was uncommon (7.8%) and used mostly in open cases (approximately 85%). Recurrence was rare overall (1.3%) and, on simple comparisons, did not differ by mesh use, though event counts were few. 

Patients who received mesh were typically older and heavier; on regression, greater age and weight independently predicted mesh placement. Operative details were heterogeneous, and hernia type (direct versus indirect) was inconsistently recorded. Median follow up was 53 months.

For adolescent hernia practice, these data support high ligation without mesh for most patients, reserving mesh for select adolescents who are essentially adult-sized or appear to have a weakened inguinal floor. The retrospective design, low recurrence numbers, and the likelihood of patients aging out of pediatric follow-up limit certainty. Longer surveillance and prospective classification of hernia type would sharpen guidance.

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