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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.

About nine in 10 hernia repairs in the U.S. rely on hernia mesh. But the U.S. Food and Drug Administration cautions that mesh repairs for hernias may not be the best option for everyone.

There are several surgical alternatives to hernia mesh. Medicine or monitoring may also put off the need for surgery for some patients.

Surgical Alternatives to Hernia Mesh

Current surgical alternatives to hernia mesh date back to the 1880s. There are at least five surgical techniques to repair hernias without using mesh.

Non-Mesh Hernia Repair Techniques
  • Bassini
  • Desarda
  • Guarnieri
  • McVay/Cooper’s Ligament
  • Shouldice

Doctors may call these techniques “pure-tissue” or “non-mesh” repairs. They involve stitching the patient’s own tissue back together.

Each technique differs in how it tries to prevent hernias from returning. They fall into two categories: tension repairs and tension-free repairs.

Tension repairs place tension on muscle tissue around the hernia. Tension-free repairs place no tension on muscle or other tissue.

“Despite reduced rates of recurrence; there are situations where the use of surgical mesh for hernia repair may not be recommended. Patients should talk to their surgeons about their specific circumstances and their best options and alternatives for hernia repair.”

FDA, Hernia Surgical Mesh Implants, Feb. 4, 2018

Shouldice Hernia Repair

The Shouldice repair is the primary non-mesh hernia repair. Canadian Dr. Edward Earle Shouldice developed the technique during World War II.

Shorter Recovery Times
The Shouldice repair showed improved results and shorter recovery times over previous techniques. It allowed recruits to enlist for military training in World War II.

Shouldice founded a hospital in Toronto, Canada, in the 1940s. It still specializes in the procedure.

Fewer than two percent of Shouldice Hernia Hospital hernia repairs use mesh.

The Shouldice repair is a complex, tension repair technique. That means it places tension on muscle tissue around the hernia. A surgeon cuts through three separate layers of muscle and connective tissue. He then places the intestine and other tissue back inside the abdomen. The surgeon stitches each layer closed so that it overlaps the previous layer. The pattern reinforces the abdominal wall.

Study Found 5 Times Better Results for Shouldice vs. Hernia Mesh Repairs

A 2016 study compared the Shouldice repair with mesh repairs in Toronto. It looked at 315,000 hernia patients. Researchers wanted to know how many hernias recurred – or came back. They found that hospitals that used mesh had recurrence rates between 4.8 and 5.2 percent. The Shouldice Hernia Hospital recurrence rate was 1.15 percent.

Low recurrence rates
The Shouldice repair has very low recurrence rates with an experienced surgeon. But it can take as many as 200 procedures for a surgeon to become proficient at the technique.

“Most patients could see good results with the Shouldice or other pure-tissue repair,” Dr. Robert Bendavid told Drugwatch. “The only problem is that you have to know how to do them. And universities have given up teaching the procedures.”

Bendavid is a hernia surgeon with the University of Toronto and the Shouldice Hernia Hospital.

Bassini Hernia Repair

Italian surgeon Dr. Edoardo Bassini introduced this technique in 1887. By then, Bassini had performed the procedure more than 250 times. He is sometimes called the father of modern inguinal hernia surgery.

The Bassini technique is a tension repair. Bassini stitched the muscle on the upper side of hernias to the ligament below. He reported a 3 percent recurrence rate.

Since then, there have been modifications to the procedure. These changes and doctors’ skill levels have affected the success rate. The recurrence rate is closer to 10 to 15 percent for Bassini repairs performed today.

Fact
Surgeons still perform the Bassini repair today. It is usually performed in countries with limited medical resources.

McVay/Cooper’s Ligament Hernia Repair

American Dr. Chester McVay introduced his technique in 1942. It improved on the Bassini repair and proved suitable for repairing large hernias.

Fact
McVay reported a five percent recurrence rate based on 263 hernia repairs over 22 years.
Source: American Journal of Surgery

A surgeon sutures muscle on one side of the hernia opening to the Cooper’s ligament. The technique closes the femoral canal in the process. This made it a popular repair technique for femoral hernias before mesh.

Desarda Hernia Repair

Indian surgeon Dr. Mohan Desarda presented the technique bearing his name in 2001. The Desarda repair is tension-free. A surgeon sutures a strip of one muscle to another muscle and a ligament in the abdomen.

“The [Desarda] technique has the potential to enlarge the number of tissue-based methods available to treat groin hernias.”

World Journal of Surgery, March 2012.

A 2012 study compared the Desarda repair to the Lichtenstein technique. The Lichtenstein technique is an open surgery using mesh. Researchers looked at three-year follow ups for 208 men. They found that the complication rate for the two procedures was about the same. The results appeared in the World Journal of Surgery.

Guarnieri Hernia Repair

Italian surgeon Dr. Antonio Guarnieri first used this repair in 1988. It is a tension-free technique surgeons can perform with or without mesh. Only about 15 percent of the Guarnieri Hernia Center’s repairs use mesh.

The Guarnieri Hernia Center performed more than 4,800 pure-tissue repairs between 1988 and 2009. It reported a less than 1 percent recurrence rate among pure-tissue repairs.

The Guarnieri hernia repair involves altering the inguinal canal’s physiology. A surgeon overlaps the muscle in a “double-breasted fashion.” This reinforces the repair.

Comparing Hernia Mesh with Non-Mesh Repairs

Patients should consider differences between mesh and non-mesh repair. The following can help them discuss any concerns with their surgeon.

Comparing Hernia Repair Options
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

“Watchful Waiting” Can Put Off Some Hernia Surgeries

Watchful waiting
Watchful waiting does not apply to most large hernias. And doctors may not recommend it for mild groin hernias.

Doctors may recommend a “watchful waiting” approach for some hernias, particularly for patients who have other serious medical conditions that make them poor operative candidates. The doctor and patient monitor the hernia to see if it worsens. This can put off surgery until symptoms show up. But this may not work for all hernias.

Some surgeons suggest surgery as soon as possible for groin hernias. They may do this even if there are no symptoms. Groin hernias can trap loops of the intestine. If this cuts off blood supply, a surgeon may have to remove part of the intestine.

Can Medicine Treat a Hernia?

Surgery is the only way to fix a hernia. Hernias can become medical emergencies in some cases. People should seek medical supervision in treating any hernia.

Straining can worsen groin hernias. A doctor may recommend cough medications to reduce chronic coughing. He may also recommend products that relieve constipation to reduce abdominal pressure. But the hernia could still get worse.

Fact
Medicine can treat symptoms that affect a hernia such as coughing or constipation but cannot “cure” a hernia.

Doctors may also recommend medicine for hiatal hernias. These happen when part of the stomach presses through a hole in the diaphragm.

Hiatal hernia pain generally comes from gastroesophageal reflux (GERD). This can cause burning in the chest.

Doctors may treat this with heartburn medications including proton pump inhibitors. Patients should be aware of these drugs’ potential side effects.

Please seek the advice of a medical professional before making health care decisions.

Terry Turner
Written By Terry Turner Writer

Terry Turner has been writing articles and producing news broadcasts for more than 25 years. He covers FDA policy, proton pump inhibitors, and medical devices such as hernia mesh, IVC filters, and hip and knee implants. An Emmy-winning journalist, he has reported on health and medical policy issues before Congress, the FDA and other federal agencies. Some of his qualifications include:

  • American Medical Writers Association (AMWA) and The Alliance of Professional Health Advocates member
  • Centers for Disease Control and Prevention Health Literacy certificates
  • Original works published or cited in Washington Examiner, MedPage Today and The New York Times
  • Appeared as an expert panelist on hernia mesh lawsuits on the BBC
Medically Reviewed By
Dr. John A. Daller
Dr. John A. Daller American Board of Surgery

29 Cited Research Articles

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