Hernia mesh scoring systems are heterogeneous, flawed, and lack validation across 85 animal studiesCurrent scoring systems fail to measure hernia mesh performance

BackgroundAbdominal wall hernia repairs are moving towards bespoke care, with mesh tailored to individual circumstances. To date, no universal system in common use has allowed objective benchmarking of hernia meshes. The aim of this paper was to perform a scoping review on scoring systems utilised in the existing literature to assess in vivo abdominal wall hernia mesh behaviour in animal models.MethodsA scoping review was performed as per PRISMA-ScR guidelines with study protocol established a priori. The PubMed and Scopus databases were searched on 15 January 2024, using keyword combinations and derivatives of hernia, mesh, integration, and incorporation. Grey literature and citation list searches were also performed. Non-English papers, human studies, non-research papers, and papers by the present author group were excluded. Due to delays with peer review, the search was updated on 31 December 2025. Data were extracted and a narrative synthesis was performed.ResultsA total of 85 studies met the inclusion criteria, with 165 scoring systems identified, assessing seven key areas. The scoring systems were heterogeneous and inherently flawed in design. No single system met the minimum recommendations proposed by Keating et al. for adequate assessment of the mesh–tissue interface. No scoring system reported validation studies or provided reports of inter-rater and intra-rater reliability.ConclusionThe scoring systems existing in the literature, while numerous, currently do not appear to satisfy the clinical purpose of benchmarking mesh performance to guide mesh selection for tailored hernia care. It remains to be seen whether pre-clinical benchmarking data coupled with hernia clinical quality registries may be a potential practical solution.