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P A I N
M A N A G E M E N T
Dr. Voeller prefers the biosynthetic mesh BIO-A.
With incisional hernias, different situations call for different approaches, as Dr. Ross notes. "If the abdominal wall is thin, or especially if it's denervated, devascularized and attenuated, I use noncrosslinked bovine pericardium biologic mesh to reinforce it," she explains. "This type of mesh lowers the propensity to develop adhesions, while also eliciting a cascade of events leading to new healthy tissue deposition and prosthesis remodeling. Occasionally, I use this same mesh with smaller abdominal wall hernias."
3. Fixation
The question of which of the many fixation devices is best for reducing pain is, to say the least, an open one. "Mesh fixation in laparoscopic inguinal hernias is highly variable by surgeon," sums up Dr. Ross.
Or as another surgeon once put it: "Nations have gone to war with less passion than manufacturers who argue about who makes the best hernia tack."
It may come down to personal preference, but Dr. Ross cites a study showing no difference in pain scores with and without fixation. "Some people worry that fixation has more trauma and can injure the nerves and vasculature in the area," she says. "The study demonstrates that this shouldn't be a concern."
Her favorite approach is suturing and tacking, although she acknowledges that fibrin glue adhesive can also be used effectively.
That's the best choice for inguinal hernias, as far as Dr. Voeller is concerned. "Some clinical studies show that adhesives can cause less pain, while others show no difference," he says. His own experience, however, suggests there is a difference.
"I switched to adhesive fixation in 2003, and anecdotally, it definitely
