H E R N I A
R E P A I R
CHOOSE WISELY Surgeons weigh mesh options based on the patient's condition, hernia location and surgical approach.
more than 98% of hiatal hernias without a mesh and in a tensionfree manner. However, when a mesh is needed for reinforcement, I use an absorbable biosynthetic material composed partly of porcine small intestine submucosa. ePTFE meshes impregnated with antiseptic can be used for diaphragmatic hernias that cannot be approximated primarily.
• Incisional and ventral hernias.
The majority of these hernias can be fixed primarily with bilateral flaps and component release as necessary to establish a tension-free repair. In cases where an underlay mesh technique is required due to a thin abdominal wall (that may also be denervated, devascularized and attenuated), a non-cross-linked bovine pericardium biologic can be used to reinforce the wall while limiting adhesion risks. However, during repair of complex hernias in which the fascial edges cannot be brought together even with bilateral flaps and component release, I'd use that same mesh with running sutures in a tension-free manner to join the flaps. Porcine biosynthetic intestinal, submucosal-derived mesh can sometimes be used for smaller abdominal hernias.
• Inguinal hernias. Almost all can be repaired laparoscopically.
