No Mesh Hernia Repairs
The purpose of hernia mesh is to decrease the chance of recurrence, or the hernia coming back. Hernias occur or recur due to tension on a suture closure or from sutures pulling through weak tissue. Mesh acts to relieve tension on repairs and reinforce the surrounding tissue. It does this by creating a foreign body reaction that creates surrounding fibrosis. Hernia mesh has been found to be safe and effective in treating hernias. However, there are some situations in which hernias may not need a mesh repair.
What is an Inguinal Hernia?
Inguinal Hernias may be amenable to suture repair without mesh in select individuals. Not everyone is a candidate for a repair without mesh. Some patients just simply do not have good enough tissue for a repair or would be considered high risk for recurrence.
There are several techniques for inguinal hernia repair which are named for the surgeon that developed them. The Shouldice repair is the most widely accepted and performed. Other tissue repairs include the Bassini, McVay, DeSarda, and Marcy. Certain repairs have advantages over others in certain situations.
Small umbilical hernias less than 2 centimeters in patients without risk factors are good candidates to have the umbilical hernia repaired without mesh. The hernia defect is simply sutured with sutures to close the hernia. Factors that would indicate mesh placement would be a recurrent umbilical hernia, obesity, or diastasis recti.
considerations with pregnancy
Typically, definitive repair with mesh of ventral and umbilical hernias should be deferred until pregnancy is no longer an option. An expanding abdominal wall with mesh can lead to more pain during pregnancy or hernia recurrence. There may be some circumstances that this is not possible.
Abdominal core health quality collaborative
It is often said that no surgeon truly knows his own hernia recurrence rate. How do you know what you are doing is working if you’re not keeping track?
The Americas Hernia Society aims to fix just that with the Abdominal Core Health Quality Collaborative or ACHQC. The quality collaborative is a database created by hernia surgeons that enables them to keep track of their performance, patient outcomes and complications. It also allows us to come together to pool our data to add significance and meaning to the numbers.
It is not research and nothing we do is experimental. It is merely a tool to make good surgeons better.
Participating in the ACHQC is completely optional with no obligation. There is no requirement to participate in order to have your hernia repaired.