Mesh changed hernia surgery
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….
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 recurrrence rate” surgeons would always ask of each other.
The specialist hernia clinic, the Shouldice Clinic in Toronto, was achieving a recurrence rate about 2%. Their 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 by Irving 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