{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:27:21Z","timestamp":1786944441637,"version":"build-2736575974"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Centre for Clinical Research S\u00f6rmland"},{"DOI":"10.13039\/501100007051","name":"Uppsala University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007051","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Eskilstuna"},{"name":"Region Stockholm"},{"name":"The Swedish Hernia Registry"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite lower prevalence after laparoscopic approach, chronic postoperative inguinal pain (CPIP) remains a major concern. Large-scale comparisons of various mesh\u2013fixation combinations with respect to CPIP risk are scarce. This study evaluated the association between commonly used mesh\u2013fixation combinations and CPIP after laparoscopic groin hernia repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This comparative cohort study analysed prospectively collected data from the nationwide Swedish Hernia Registry, including virtually all adult patients undergoing unilateral laparoscopic groin hernia repair in Sweden over a 6-year 4-month period. One year after surgery, a patient-reported outcomes survey assessed CPIP, defined as pain in the operated groin during the preceding week that affected daily activities. This study also classified all patients who underwent reoperation within the first 15 months as CPIP-positive respondents. Multivariable logistic regression estimated adjusted odds ratios for mesh\u2013fixation combinations recorded in &amp;gt; 100 procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 15 360 eligible patients, 10 525 (68.5%) responded (mean age 59 years; 32.0% women). Three mesh types (flat heavyweight, flat lightweight, and \u2018three-dimensional\u2019) and five fixation modes (absorbable tacks, metal tacks, fibrin glue, self-gripping micro-hooks, and non-fixation) yielded 12 analyzable combinations. The lowest odds of CPIP were observed with three options: heavyweight flat mesh without fixation (reference category; adjusted odds ratio 1.0), lightweight mesh with fibrin glue (adjusted odds ratio 1.0, 95% confidence interval 0.75 to 1.4), and lightweight mesh with self-gripping micro-hooks (adjusted odds ratio 0.94, 95% confidence interval 0.61 to 1.4).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Heavyweight flat mesh without fixation was associated with one of the lowest odds of CPIP, while representing the simplest and least costly alternative. Together with previous registry evidence indicating low recurrence risk, these findings support considering this option as a pragmatic default strategy in laparoscopic groin hernia repair.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag073","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T11:42:41Z","timestamp":1778067761000},"source":"Crossref","is-referenced-by-count":0,"title":["Mesh\u2013fixation combinations and chronic postoperative inguinal pain after laparoscopic groin hernia repair: nationwide cohort study"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3287-1743","authenticated-orcid":false,"given":"Bengt","family":"Novik","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"2026081701213628400_zrag073-B1","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1001\/jamasurg.2025.2502","article-title":"Reoperation for chronic postoperative inguinal pain","volume":"160","author":"Huy","year":"2025","journal-title":"JAMA Surg"},{"key":"2026081701213628400_zrag073-B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10029-017-1668-x","article-title":"International guidelines for groin hernia management","volume":"22","author":"HerniaSurge Group","year":"2018","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B3","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1097\/SLA.0000000000004735","article-title":"Treatment of inguinal hernia: systematic review and updated network meta-analysis of randomized controlled trials","volume":"274","author":"Aiolfi","year":"2021","journal-title":"Ann Surg"},{"key":"2026081701213628400_zrag073-B4","doi-asserted-by":"crossref","DOI":"10.1093\/bjsopen\/zrad080","article-title":"Update of the international HerniaSurge guidelines for groin hernia management","volume":"7","author":"Stabilini","year":"2023","journal-title":"BJS Open"},{"key":"2026081701213628400_zrag073-B5","doi-asserted-by":"crossref","DOI":"10.1093\/bjsopen\/zraf134","article-title":"Long-term outcomes of Lichtenstein and laparoscopic primary unilateral inguinal hernia repair: registry-based propensity score-matched analysis","volume":"10","author":"Albrecht","year":"2026","journal-title":"BJS open"},{"key":"2026081701213628400_zrag073-B6","doi-asserted-by":"crossref","DOI":"10.1093\/bjs\/znae164","article-title":"Global access to technologies to support safe and effective inguinal hernia surgery: prospective, international cohort study","volume":"111","author":"National Institute for Health and Care Research (NIHR) Global Health Research Unit on Global Surgery","year":"2024","journal-title":"Br J Surg"},{"key":"2026081701213628400_zrag073-B7","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/s10029-025-03428-2","article-title":"Preoperative predictors of chronic pain after laparoendoscopic groin hernia repair: a Swedish Hernia Registry study","volume":"29","author":"Novik","year":"2025","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B8","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1016\/S0142-9612(98)00115-X","article-title":"Functional and morphological evaluation of different polypropylene-mesh modifications for abdominal wall repair","volume":"19","author":"Klosterhalfen","year":"1998","journal-title":"Biomaterials"},{"key":"2026081701213628400_zrag073-B9","first-page":"73","article-title":"Shaped preformed prosthesis in the parietal repair of inguinal hernias by trans-peritoneal laparoscopy [in French]","volume":"17","author":"Pajotin","year":"1996","journal-title":"Le journal de coelio-chirurgie"},{"key":"2026081701213628400_zrag073-B10","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s10029-007-0317-1","article-title":"Laparoscopic resorbable mesh fixation. Assessment of an innovative disposable instrument delivering resorbable fixation devices: I-ClipTM. Final results of a prospective multicentre clinical trial","volume":"12","author":"Lepere","year":"2008","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B11","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1007\/s00464-005-0391-3","article-title":"Fibrin glue for securing the mesh in laparoscopic totally extraperitoneal inguinal hernia repair: a study with a 40-month prospective follow-up period","volume":"20","author":"Novik","year":"2006","journal-title":"Surg Endosc"},{"key":"2026081701213628400_zrag073-B12","doi-asserted-by":"crossref","first-page":"139","DOI":"10.4103\/0972-9941.27726","article-title":"Tension free open inguinal hernia repair using an innovative self gripping semi-resorbable mesh","volume":"2","author":"Chastan","year":"2006","journal-title":"J Minim Access Surg"},{"key":"2026081701213628400_zrag073-B13","doi-asserted-by":"crossref","first-page":"226","DOI":"10.4240\/wjgs.v7.i10.226","article-title":"Mesh implants: an overview of crucial mesh parameters","volume":"7","author":"Zhu","year":"2015","journal-title":"World J Gastrointest Surg"},{"key":"2026081701213628400_zrag073-B14","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1097\/SLA.0000000000002326","article-title":"The importance of registries in the postmarketing surveillance of surgical meshes","volume":"268","author":"K\u00f6ckerling","year":"2018","journal-title":"Ann Surg"},{"key":"2026081701213628400_zrag073-B15","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.jss.2019.09.061","article-title":"Lack of regulations and conflict of interest transparency of new hernia surgery technologies","volume":"247","author":"Olavarria","year":"2020","journal-title":"J Surg Res"},{"key":"2026081701213628400_zrag073-B16","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1097\/SLA.0000000000003831","article-title":"Heavyweight mesh is superior to lightweight mesh in laparo-endoscopic inguinal hernia repair: a meta-analysis and trial sequential analysis of randomized controlled trials","volume":"273","author":"Bakker","year":"2021","journal-title":"Ann Surg"},{"key":"2026081701213628400_zrag073-B17","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1007\/s10029-023-02919-4","article-title":"Efficacy and safety of mesh non-fixation in patients undergoing laparo-endoscopic repair of groin hernia: a systematic review and meta-analysis","volume":"27","author":"Kobayashi","year":"2023","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B18","doi-asserted-by":"crossref","first-page":"3433","DOI":"10.1007\/s00464-024-10866-z","article-title":"The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair","volume":"38","author":"Woo","year":"2024","journal-title":"Surg Endosc"},{"key":"2026081701213628400_zrag073-B19","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/s10029-025-03427-3","article-title":"Association of mesh weight with adverse outcomes: a cohort study including 123,880 inguinal hernia repairs","volume":"29","author":"Cowan","year":"2025","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B20","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1001\/jamasurg.2025.4328","article-title":"Mesh weight in reoperation for recurrence after laparoscopic inguinal hernia repair","volume":"160","author":"Deveci","year":"2025","journal-title":"JAMA Surg"},{"key":"2026081701213628400_zrag073-B21","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1097\/XCS.0000000000000060","article-title":"Association of mesh and fixation options with reoperation risk after laparoscopic groin hernia surgery: a Swedish Hernia Registry study of 25,190 totally extraperitoneal and transabdominal preperitoneal repairs","volume":"234","author":"Novik","year":"2022","journal-title":"J Am Coll Surg"},{"key":"2026081701213628400_zrag073-B22","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s10029-025-03397-6","article-title":"Similar recurrence rates among the 10 most used meshes for laparoscopic groin hernia repair: a nationwide register-based cohort study","volume":"29","author":"Andresen","year":"2025","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B23","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1001\/jamasurg.2025.4543","article-title":"Postmarket surveillance of mesh performance after inguinal hernia repair","volume":"160","author":"Brill","year":"2025","journal-title":"JAMA Surg"},{"key":"2026081701213628400_zrag073-B24","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s10029-025-03344-5","article-title":"Transabdominal pre-peritoneal hernia repair: risk of operation for recurrence depends on choice of both mesh and fixation device. A study from the Danish Hernia Database","volume":"29","author":"Mortensen","year":"2025","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B25","doi-asserted-by":"crossref","first-page":"2679","DOI":"10.1007\/s00464-008-9936-6","article-title":"Biomechanical properties of lightweight versus heavyweight meshes for laparoscopic inguinal hernia repair and their impact on recurrence rates","volume":"22","author":"Hollinsky","year":"2008","journal-title":"Surg Endosc"},{"key":"2026081701213628400_zrag073-B26","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"2026081701213628400_zrag073-B27","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies conducted using observational routinely-collected health data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"2026081701213628400_zrag073-B28","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.2147\/CLEP.S335765","article-title":"Assessing the validity and cover rate of the national Swedish Hernia Register","volume":"13","author":"Axman","year":"2021","journal-title":"Clin Epidemiol"},{"key":"2026081701213628400_zrag073-B29","author":"Novik"},{"key":"2026081701213628400_zrag073-B30","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1002\/bjs.10652","article-title":"Patient-reported rates of chronic pain and recurrence after groin hernia repair","volume":"105","author":"Lundstr\u00f6m","year":"2018","journal-title":"Br J Surg"},{"key":"2026081701213628400_zrag073-B31","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1007\/s00268-018-4863-8","article-title":"The short-form Inguinal Pain Questionnaire (sf-IPQ): an instrument for rating groin pain after inguinal hernia surgery in daily clinical practice","volume":"43","author":"Olsson","year":"2019","journal-title":"World J Surg"},{"key":"2026081701213628400_zrag073-B32","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.surg.2019.11.011","article-title":"Chronic pain and risk for reoperation for recurrence after inguinal hernia repair using self-gripping mesh","volume":"167","author":"Axman","year":"2020","journal-title":"Surgery"},{"key":"2026081701213628400_zrag073-B33","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1002\/bjs.11755","article-title":"Patient-reported chronic pain after open inguinal hernia repair with lightweight or heavyweight mesh: a prospective, patient-reported outcomes study","volume":"107","author":"Melkemichel","year":"2020","journal-title":"Br J Surg"},{"key":"2026081701213628400_zrag073-B34","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/SLA.0000000000005194","article-title":"Chronic pain after groin hernia surgery in women: a patient-reported outcome study based on data from the Swedish Hernia Register","volume":"275","author":"Jakobsson","year":"2022","journal-title":"Ann Surg"},{"key":"2026081701213628400_zrag073-B35","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/SLA.0000000000002104","article-title":"Critical view of the myopectineal orifice","volume":"266","author":"Daes","year":"2017","journal-title":"Ann Surg"},{"key":"2026081701213628400_zrag073-B36","doi-asserted-by":"crossref","first-page":"8291","DOI":"10.1007\/s00464-023-10237-0","article-title":"No evidence for fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials","volume":"37","author":"Riemenschneider","year":"2023","journal-title":"Surg Endosc"},{"key":"2026081701213628400_zrag073-B37","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/SLA.0000000000002649","article-title":"Higher recurrence rate after endoscopic totally extraperitoneal (TEP) inguinal hernia repair with Ultrapro lightweight mesh: 5-year results of a randomized controlled trial (TULP-trial)","volume":"268","author":"Roos","year":"2018","journal-title":"Ann Surg"},{"key":"2026081701213628400_zrag073-B38","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/s10029-017-1724-6","article-title":"Comparison of hernia registries: the CORE project","volume":"22","author":"Kyle-Leinhase","year":"2018","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B39","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s10029-018-1837-6","article-title":"Pitfalls in interpretation of large registry data on hernia repair","volume":"22","author":"Schwab","year":"2018","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B40","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/S0140-6736(16)31402-7","article-title":"Surgical registries for advancing quality and device surveillance","volume":"388","author":"Sedrakyan","year":"2016","journal-title":"Lancet"},{"key":"2026081701213628400_zrag073-B41","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1007\/s00595-018-1664-5","article-title":"Decreasing prevalence of chronic pain after laparoscopic groin hernia repair: a nationwide cross-sectional questionnaire study","volume":"48","author":"\u00d6berg","year":"2018","journal-title":"Surg Today"},{"key":"2026081701213628400_zrag073-B42","doi-asserted-by":"crossref","first-page":"101459","DOI":"10.1016\/j.cpsurg.2024.101459","article-title":"Higher rate of chronic pain in young men after open mesh vs nonmesh repair of elective primary unilateral indirect inguinal hernia: a nationwide questionnaire study","volume":"61","author":"Reistrup","year":"2024","journal-title":"Curr Probl Surg"},{"key":"2026081701213628400_zrag073-B43","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1097\/SLA.0000000000003065","article-title":"Smaller inguinal hernias are independent risk factors for developing chronic postoperative inguinal pain (CPIP): a registry-based multivariable analysis of 57,999 patients","volume":"271","author":"Hoffmann","year":"2020","journal-title":"Ann Surg"},{"key":"2026081701213628400_zrag073-B44","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s10029-024-03235-1","article-title":"Is mesh pore size associated with the outcome in laparo-endoscopic inguinal hernia repair? \u2013 a registry-based multivariable analysis","volume":"29","author":"K\u00f6ckerling","year":"2025","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B45","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1016\/j.jpain.2021.04.008","article-title":"Sex differences, sleep disturbance and risk of persistent pain associated with groin hernia surgery: a nationwide register-based cohort study","volume":"22","author":"Bjurstr\u00f6m","year":"2021","journal-title":"J Pain"},{"key":"2026081701213628400_zrag073-B46","doi-asserted-by":"crossref","first-page":"14836","DOI":"10.3389\/jaws.2025.14836","article-title":"Inguinal hernia repair using absorbable biosynthetic mesh versus permanent polypropylene mesh: a preliminary comparative study of 1-year outcomes","volume":"4","author":"K\u00f6ckerling","year":"2025","journal-title":"J Abdom Wall Surg"},{"key":"2026081701213628400_zrag073-B47","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1001\/jamasurg.2025.4071","article-title":"Biological vs synthetic mesh in laparoendoscopic inguinal hernia repair: the BIOLAP randomized clinical trial","volume":"160","author":"Seefeldt","year":"2025","journal-title":"JAMA Surg"},{"key":"2026081701213628400_zrag073-B48","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s10029-019-02036-1","article-title":"Effect of direct defect closure during laparoscopic inguinal hernia repair (\u201cTEP\/TAPP plus\u201d technique) on post-operative outcomes","volume":"24","author":"Usmani","year":"2020","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B49","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s10029-022-02724-5","article-title":"Does closure of the direct hernia defect in laparoscopic inguinal herniotomy reduce the risk of recurrence and seroma formation?: a systematic review and meta-analysis","volume":"27","author":"Petersen","year":"2023","journal-title":"Hernia"},{"key":"2026081701213628400_zrag073-B50","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s10029-024-03201-x","article-title":"Causes of chronic pain unrelated to surgical trauma after groin hernia repair: a prospective cohort study","volume":"29","author":"Kroon","year":"2024","journal-title":"Hernia"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/4\/zrag073\/68695960\/zrag073.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/4\/zrag073\/68695960\/zrag073.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:21:59Z","timestamp":1786944119000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrag073\/8724745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":50,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrag073","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,3]]},"article-number":"zrag073"}}