Is Mesh Necessary in Hernia Surgery?

Is Mesh Necessary in Hernia Surgery?

Hernia surgery is a common procedure, and one question that often arises is whether mesh (also known as a net or screen) is essential for the repair. Dr. Suprashant Kulkarni, a renowned general laparoscopic and robotic surgeon at Lokmanya Group of Hospitals, addresses this concern in his explanation.

Understanding Hernia And The Need For Repair

A hernia occurs when there is a gap or weakness in the abdominal wall, causing internal organs or tissues to protrude. In most cases, this defect requires surgical intervention to close the gap. Traditionally, hernia repairs were done by simply stitching the opening together. However, this method has limitations.

Why Not Just Stitch The Gap?

Stitching alone is not always sufficient. Dr. Kulkarni explains that daily pressures like lifting, coughing, and even bathroom use can put strain on the repair. This constant stress can lead to a recurrence of the hernia in about 30% of cases. With such a high recurrence rate, stitching alone isn't considered the most effective solution.

The Evolution Of Hernia Surgery: From Silk To Polypropylene Mesh

In the past, surgeons attempted to use different materials to repair hernias, including skin, muscle, and even thin layers of bone. However, these materials didn’t hold up well and would often break down, causing the hernia to return.

The breakthrough came in the 1930s when nylon was introduced, followed by polypropylene in the 1950s and 1960s. Polypropylene mesh revolutionized hernia repair because it allowed tissue to grow into the mesh, providing a strong and durable barrier. This development significantly reduced the chances of a recurrence, bringing the rate down to less than 1%.

The Benefits And Risks Of Using Mesh

While polypropylene mesh is the most widely used and successful solution, it’s not without risks. Some patients may experience allergic reactions, though this is rare. The main advantage of using mesh is that it reduces the likelihood of recurrence dramatically compared to traditional stitching methods.

Can Hernia Surgery Be Done Without Mesh?

In certain situations, hernia surgery can be performed without mesh. For example, in cases where the hernia defect is smaller than one centimeter, a repair may be done using only sutures. However, in larger defects (e.g., 5 to 10 centimeters or more), mesh is often necessary to ensure a strong, long-lasting repair.

Dr. Kulkarni emphasizes that without mesh, closing a large gap is difficult, if not impossible, and the chances of recurrence are higher. Hence, mesh is typically the preferred option in most hernia repairs today.

Emerging Alternatives: The Future Of Hernia Surgery

In recent years, a new type of biodegradable mesh known as Polyhydroxybutyrate (PHB) has been introduced. This mesh is synthetic, made from bacterial-derived materials, and can naturally absorb into the body over time. PHB mesh is still being researched, and its use is primarily in specific cases, such as when there is a risk of infection or contamination during surgery.

Conclusion

In conclusion, while hernia surgery can be done without mesh in some cases, the use of mesh has significantly improved the success rate of repairs, especially for larger hernias. The recurrence rate after mesh repair is much lower, and the risks of allergic reactions are minimal. With ongoing advancements in materials like PHB, the future of hernia surgery looks promising.

FAQ’s

1 . What is a hernia?
A hernia is a condition where an organ or tissue pushes through a weak spot in the abdominal wall, creating a bulge.

2. Is mesh always necessary for hernia repair?
Mesh is often recommended for larger hernias, as it reduces the chances of recurrence. However, small hernias may sometimes be repaired without mesh.

3. What are the risks of using mesh in hernia surgery?
The primary risk is an allergic reaction, but this is rare. Mesh complications are typically minimal when properly placed.

4. How long has polypropylene mesh been used in hernia surgery?
Polypropylene mesh has been used for over 60 years and has become the standard material for most hernia repairs.

5. Can hernia surgery be done without mesh?
Yes, small hernias may be repaired without mesh, but for larger defects, mesh is usually needed to ensure a durable repair.

6. What is biodegradable mesh?
Biodegradable mesh, like Polyhydroxybutyrate (PHB), is a new material that absorbs into the body over time and may be used in specific cases, such as when there's a risk of infection.

7. What is the success rate of mesh-based hernia repairs?
Mesh repairs have a success rate of over 99%, with recurrence rates dropping to less than 1% when mesh is used.