Using mesh for hernia repairs
Controversial…..as I write this (August 2019) I am also working on a longer ‘update’ to put the whole mesh issue in perspective. In the meanwhile more….
Mesh changed hernia surgery. Before mesh appeared, or started to be used routinely, the possibility of the hernia coming back, ‘a recurrent hernia‘, was fairly high, even for straightforward hernia operations. It is difficult to get good reliable figures – surgeons rarely followed up their cases long-term, but I would estimate that the figure for recurrent inguinal hernia was probably in excess of 20%. One-fifth of all hernia repairs would fail !
Hernia recurrence was the main ‘outcome‘ that surgeons were interested in. “What is your recurrence rate” – surgeons would always ask of each other.
At the time that mesh came into use although the specialist hernia clinic, the Shouldice Clinic in Toronto, was achieving a recurrence rate about 2%, very very few others were achieving results anywhere near this
The Shouldice surgeons were really specialised, and were not allowed to operate unsupervised until they had carried out over 500 repairs with another surgeon. Earl Shouldice, the founder, had developed a method of repair that worked for them. But it was still the surgeon and not the repair techniques that was important. See specialist
Using mesh routinely, as advocated byIrving Lichtenstein, seriously lowered the recurrence rate after hernia repair.
At the moment there are about 200 different meshes on the market, with manufacturers competing to sell their particular product.
Four examples below –
SW = standard weight mesh
LW = Lightweight mesh – note the larger pore size compared with SW
ULW = Ultra lightweight mesh – slightly larger pore size than LW, and about 30% of this will dissolve
SA = Self-adhesive mesh (you can just see the ‘roughness’ of the velcro style tiny hooks