Does every hernia demand a mesh repair? A critical review

Conclusion

In accordance with the experiences gained in other surgical fields the use of implants should be restricted to those patients, where there is an unequivocal indication. The indiscriminate use of biomaterials in every case of hernia at every age disregards the certain and usually severe complications of the extended contact of the body with alloplastic materials.

To minimise future risks in hernia repair we favour at this point of time the following concept:

• - The principal treatment of a primary inguinal hernia should be the suture repair in the Shouldice technique under local anaesthesia, alternatively in case of a small indirect hernia the narrowing of the internal ring according to Zimmermann.

• - In patients with an increased risk of a recurrence, i.e. a large direct hernia, any signs of a collagen disorder, an incisional or a re-recurrent hernia, the indication for a mesh repair according to the above-mentioned principles is given.

• - The treatment of a full-scale incisional hernia always has to take into account a possible inability of the patient to form stable scars and therefore demands a reinforcement with nonabsorbable meshes.

Hopefully, the development of special “hernia meshes” and a better identification of patients at risk will help to tailor the operative technique for a repair to the specific needs of the individual patient. Until then, with respect to the enormous importance of hernia repair in surgery, we should avoid impredictable risks and remain on the “safe side” of evidence-based medicine.