European Counterpoint to Chapter 12

Abstract

Hernia repair in Europe and the United Kingdom is similar to that in the United States. By far the most common hernia repaired with a mesh prosthesis is the inguinal hernia. Other hernias that are repaired with mesh are, in decreasing order, incisional hernias, large umbilical or paraumbilical hernias, femoral hernias, occasionally large epigastric hernias, and less common hernias like large paraesophageal and lumbar hernias. Each year, 70,000 to 80,000 inguinal hernia operations are performed in the United Kingdom (1). Of these, the majority (80–90%) (2,3) have prosthetic mesh inserted to reinforce the repair. Incisional hernias have also increasingly been repaired with mesh rather than sutures, especially large and recurrent hernias (4). Mesh repairs have overtaken simple suture repairs because they yield better results. For suture repairs, there is a quoted recurrence rate of at least 10%, in some series as high as 40% (5). Inguinal hernia repair with mesh has been shown to reduce recurrence rates to as low as 0.1% (6). The history of the evolution of mesh repair follows that of the American experience. The most common mesh used nowadays is made of nonabsorbable polypropylene (Prolene^™) or polyester (Mersilene^™).