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H E R N I A
R E P A I R
The laparoscopic approach results in fewer overall nerve issues
because the anatomical location of the sensory nerves in the
preperitoneal space is predictable. If no dissection is done inferior
to the iliopubic tract, and no mesh affixation is performed with
devices such as tacks or staples below the tract, the operation likely
won't result in significant chronic pain. However, surgeons can still
injure the lateral femoral cutaneous nerve during laparoscopic procedures, leaving patients with pain on the anterior lateral side of the
thigh.
• Mesh. Surgeons are increasingly worried about inflammatory
responses caused by mesh as well as mesh shrinkage. A polypropylene mesh can shrink up to 46%, meaning it pulls away from the tissue
junction and disengages from the body wall, causing pain and hernia
recurrence.
Many surgeons opt for lightweight macroporous mesh instead of
heavyweight microporous mesh because breakage (prevented by
high-tensile strength material) isn't as big a concern as previously
thought. Lightweight macroporous mesh helps prevent chronic postop pain by letting the body more easily grow (incorporate) through
the crosshatches of the material.
To limit risks of inflammation and related chronic pain, synthetic
mesh shouldn't be placed in patients who are allergic to the materials, and mesh shouldn't be used in patients who've been infected by
MRSA. Additionally, prosthetic mesh shouldn't be placed in areas
contaminated by spillage of bowel contents or pus. Biological mesh
can be used in areas of previous (but not gross) infection or contamination.
Surgeons should attach meshes using techniques they're most comfortable with during laparoscopic surgeries. However, absorbable fixation devices are better options than non-absorbable spiral or titanium
