Mesh or No Mesh? ...That is the question.
Hernias require surgery to repair. Hernia repair is common, so much so that it accounted for 4.16 Billion surgeries worldwide in 2017, and it is projected to grow to 6.37 Billion surgeries by 2025. Inguinal hernias are the most common type, and make up 75% of all hernias (90% of all hernias in men and 40% of hernias in women. It is estimated that there are 500,000-750,000 inguinal hernia repairs performed in the US every year.
Hernia surgery has been described going back to at least as early as 1145 BC, as it was discovered that the Egyptian mummy of Ramses V was found to have evidence of a groin hernia repair over 3100 years ago!!
Over all of these years, we have been constantly looking for the best way to repair a hernia, and hernia repair has therefore been constantly evolving. The methods of repair have especially changed over the last 30 years. So what has changed so much? The advent of mesh used in hernia repair has revolutionized hernia repair.
Why? That question is still being asked and studied today.
To Mesh or not to Mesh? …That is the question.
One of the landmark studies was published in the British Journal of Surgery in 2002 and was titled “Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia.” In this studied 300 patients who were randomized to either a repair with mesh or a repair without using mesh. They followed these patients after surgery from 1993 to 1996, at 1 week and at 1, 6, 12, 18, 24 and 36 months. The measured clinical outcome, quality of life and costs. What they found was a very significant 3-year recurrence rate (failure rate, or the rate at which the hernia cam back). They found that for the No-mesh repair group, there was a 7% recurrence rate, and for the Mesh repair group, there was only a 1% recurrence rate. There were no differences in clinical variables, quality of life and costs.
So, their conclusion was that Mesh repair of primary inguinal hernia is superior to Non-mesh repair with regard to hernia recurrence and is cost-effective. Postoperative complications, pain and quality of life did not differ between groups.
And there you have it……………
Vrijland WW, van den Tol MP, Luijendijk RW, Hop WC, Busschbach JJ, de Lange DC, van Geldere D, Rottier AB, Vegt PA, IJzermans JN, Jeekel J. Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg. 2002 Mar;89(3):293-7. doi: 10.1046/j.0007-1323.2001.02030.x. PMID: 11872052.