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Incisional hernia repair with prosthetic mesh is necessary to reduce the high recurrence rate. Standard meshes have been suggested to be overengineered, and there is conflicting results about the application of lightweight and standard mesh in incisional hernia repair. The aim of this study was to compare the clinical outcomes following the use of lightweight mesh and standard mesh in open incisional hernia repair.A systematic literature review was undertaken to identify studies comparing the outcomes of lightweight mesh and standard mesh in incisional hernia repair with the open sublay technique.The present meta-analysis pooled the effects of outcomes of total 1002 patients enrolled into 5 comparative trials. The use of lightweight mesh in incisional hernia repair was associated with a reduction of chronic pain (OR=0.24; 95% CI, 0.10, 0.57). Statistically, there was no difference in the postoperative recurrence between the 2 groups (RD=0.00; 95% CI, −0.03, 0.03), no difference in the incidence of hematoma (OR=1.0; 95% CI, 0.54, 1.85), seroma (OR=0.83; 95% CI, 0. 52, 1.31), wound infection (OR=0.96; 95% CI, 0. 60, 1.54), stiff abdomen, and foreign body sensation (OR=0.33; 95% CI, 0. 02, 4.31). Furthermore, quality of life and health status between the 2 kinds of mesh groups were also similar.In the procedure of open incisional hernia repair, the use of lightweight mesh seems to be associated with less chronic pain, and without the increase of recurrence and other postoperative complications. However, based on the short-term follow-up of the included studies, long-term well-designed RCTs are needed to evaluate the real outcomes.