Hernia Mesh Alternatives
Surgery with mesh is not the only way to repair hernias. There are several hernia repair techniques that surgeons can perform without hernia mesh. Some may have lower or comparable complication rates to mesh.
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Types of Alternatives to Hernia Mesh
Most hernias require surgical repair. Hernia mesh is the most common surgical treatment to repair hernias. Nine out of 10 U.S. repairs use surgical mesh, as it provides long-term results with relatively few complications. However, it’s not the only option.
Several alternatives to hernia mesh exist, and many have lower or comparable complication rates. Patients seeking alternatives to hernia mesh have two main approaches.
- Nonsurgical Treatment:
- Nonsurgical interventions, including abdominal binders and medication, can help manage symptoms. Patients may delay surgery or avoid it altogether with nonsurgical interventions.
- Surgical Treatment:
- Surgical alternatives to hernia mesh include variations of pure-tissue repair. These use a patient’s own muscles and connective tissue to repair tears in the abdominal wall. There are three main types of surgical hernia repairs: laparoscopic, open and robotic repairs.
Only 3% to 5% of patients require emergency hernia surgery. However, since hernias tend to get larger over time as the abdominal wall muscles get weaker, most hernias eventually require repair through planned surgery.
Surgical Hernia Mesh Alternatives
Many surgeons consider the Lichtenstein repair the gold standard for hernia repairs. However, new research indicates that many pure-tissue alternatives can be equally effective.
There are two main types of surgical hernia mesh alternatives. Tension repairs firmly reattach tissue from opposing sides of the tear under tension. Nontension repairs use sutures to connect the sides without stretching natural tissue.
Insertion of surgical hernia mesh may not be necessary for most hernias. Several studies indicate that nonmesh alternatives offer comparable effectiveness with fewer complications than hernia mesh.
Surgeons may use one of several different techniques in nonmesh surgical repair. They vary in difficulty, success rates and potential complications. Patients should discuss these options with a health care provider before making a decision.
Bassini Hernia Repair
Introduced in 1887 by Dr. Edoardo Bassini, the Bassini hernia repair is still widely used today. This tension hernia repair involves stitching the muscles above the hernia to the ligaments below.
At the time of its development, the Bassini hernia repair had a 3% recurrent rate. Modifications to the technique and varying skill levels of practicing doctors have resulted in a current recurrence rate between 10% and 15%.
Desarda Hernia Repair
Desarda hernia repair emerged in 2001. This pure-tissue hernia mesh alternative uses live muscle tissue to cover the hernia. This reinforces the inguinal canal’s posterior wall, serving the same purpose as surgical mesh without foreign body complications.
“Desarda patients had a significantly higher quality of life compared with the reference population. Desarda’s procedure is a good option as a pure tissue method for inguinal hernia repair.”
Desarda hernia repair has proven itself a viable alternative to surgical mesh. The recurrence rate after this procedure is around 1%. Patients should discuss these and other hernia repair options with a health care provider.
McVay/Cooper’s Ligament Hernia Repair
Cooper’s ligament hernia repair requires an extensive surgical procedure. It involves carefully attaching muscles from one side of the hernia to the Cooper’s ligament and closing the femoral canal.
“Open primary tissue approximation nonmesh repairs, such as the McVay technique, are valid alternatives to herniorrhaphy, especially if infection is found.” ”
McVay hernia repair has a low morbidity rate and recurrence is between 3% and 15%. Some surgeons consider it an appropriate treatment for large indirect and direct hernias, while others prefer it for all groin hernias.
Moloney’s Darn Repair
As a tensionless technique, Moloney’s darn repair uses two continuous sutures to connect the sides of a hernia. Recurrence is very rare, and it offers a cost-effective alternative to surgical mesh.
“Our results suggest that open darn repair is comparable with open mesh repair for inguinal hernias. Considering that consequences of mesh complications in inguinal hernia repair, albeit rare, can be significant, open darn repair provides an equally credible alternative to open mesh repair for inguinal hernias.”
Darn repair shows promise as an alternative to other procedures. Research indicates patients experience less pain and a quicker recovery compared to Shouldice repair. Several studies support the claim that Moloney’s darn repair represents a good alternative to Lichtenstein mesh repair.
Shouldice Hernia Repair
Canadian Dr. Edward Earle Shouldice developed the Shouldice hernia repair technique during World War II. It’s a complex procedure that requires extensive training to perform correctly.
During a Shouldice hernia repair, a surgeon cuts through three layers of muscle and connective tissue, places the intestines back into the abdomen and then brings opposite sides together. Overlapping layers creates a natural replacement for the torn abdominal wall. The Canadian Journal of Surgery reports that it has very low recurrence rates when an experienced surgeon performs it.
“Most patients could see good results with the Shouldice or other pure-tissue repair.” ”
Shouldice went on to open the Shouldice Hernia Hospital in Toronto in the 1940s. Fewer than 2% of hernia repairs performed at the hospital use surgical mesh.
Are There Nonsurgical Hernia Mesh Alternatives?
Nonsurgical approaches to hernia management are not considered curative but may ease symptoms or delay the need for surgery. They’re also helpful for people who don’t qualify for hernia surgery, including individuals on blood thinners or with health conditions that make surgery too risky.
- Abdominal belt or truss
- Healthy diet under the supervision of a nutritionist
- Hernia brief
- Physiotherapy
In small hernias not requiring surgery, nonsurgical interventions can be effective care options. Patients should only use these treatments under medical supervision. Some, such as prescribed exercise, can help improve circulation and reduce inflammation, while others may worsen symptoms or lead to complications.
Can Watchful Waiting Postpone the Need for Hernia Surgery?
Watchful waiting, the process of carefully monitoring a hernia for developing or worsening symptoms, may allow some patients to delay surgery, but it depends on the individual situation. Doctors generally don’t advise waiting for large hernias and most mild groin hernias.
A surgeon may recommend a watchful waiting approach for patients who aren’t good surgical candidates. Patients should always consult with their doctors about their condition.
Can Medicine Treat a Hernia?
Medicines are typically not effective at treating hernias. However, they may help with symptom management, depending on the type of hernia.
Medications can help address underlying health conditions, such as certain types of kidney disease and acid reflux associated with hiatal hernias. However, most hernias will eventually require surgical repair.
Comparing Hernia Mesh With Nonmesh Repairs
Patients should consider the differences between each procedure when comparing hernia treatment options. Discuss your concerns with your doctor.
| Consideration | Hernia Mesh Repair | Non-Mesh Repair |
|---|---|---|
| Surgery time | 1-2 hours | 45 minutes |
| Hospital stay | Less than one day | Less than one day |
| Early complications | About the same rate for both | About the same rate for both |
| Rate of later complications (including organ damage and infections) | 3% - 6% | 1% or less |
| Revision surgery rate | 10% - 12% | 1.5% - 17% (depending on technique used) |
| Hernia recurrence rate | Less than 3% | 1% - 8% |
| Time to resume light activities | 1 -2 weeks | 5 – 6 weeks |
| Time to resume full activities | 4 – 6 weeks | 15 – 16 weeks |
The type of hernia mesh alternative chosen can impact outcomes significantly. An experienced surgeon can provide insight into which treatment is best suited to specific hernias.
Discussing Hernia Mesh Alternatives With Your Doctor
Patients should choose a hernia repair method carefully alongside their health care provider. Having prepared questions can help patients learn more about each approach.
- Are there benefits to robotic hernia repair?
- Does my hernia require surgical mesh?
- How do you determine which type of hernia repair is best for my condition?
- What are my options for hernia repair?
- What are the potential complications of each type of hernia repair?
Bringing a notebook to appointments provides an excellent place to record the doctor’s answers to questions and concerns. Some patients find it more convenient to record the conversation on a phone to replay later.
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