H E R N I A
R E P A I R
Polyester mesh, which has less foreign-body reaction, less seroma formation and, in my experience, causes less pain to patients, is
preferred.
• Contami-nated hernias. Biomaterial products that are readily colonized by host tissue and that form scaffolding for repair and remodeling of the extracellular matrix should be used in these cases. The problem with these mesh types, however, is that they lose strength with remodeling. Non-cross-linked bovine pericardium biologic mesh seems to hold up best. As a side note, for fixation, it's best to use metallic tacks on inguinal hernias and sutures or a combination in laparoscopic (hiatal or incisional hernia) repairs. For open repairs, polypropylene running sutures are effective.
3. Patient condition
When overweight patients arrive at my clinic with hiatal, abdominal or inguinal hernias, the first thing I'll usually ask them to do is work on weight loss because, for the best outcomes, they must reduce their intraperitoneal pressure before surgery and for several months afterward. Athletic, active patients must know that, after the repair, they must avoid exercising abdominal muscles, which increases intra-peritoneal pressure and increases recurrence risk. Patients must also understand what factors into improved wound healing. Smokers should quit the habit and diabetics must learn how to maintain good blood sugar control leading up to and after surgery. The bottom line: Patients should understand
