Ubiquitous use of prosthetic mesh in inguinal hernia repair: the dilemma

Summary The omnipresence of prosthetic materials (mesh) used in hernia repairs throughout the world deserves careful review. The propensity to develop operative techniques wherein prosthetic mesh is used routinely, regardless of type hernia, has reached an unacceptable level of practice. Being foreign bodies, postoperative complications occur which directly can be traced to the implanted meshes. Recent interest in mesh complications, i.e., infection, mesh shrinkage, migration and fistula formation, has escalated. Although mesh foreign body tumorigenesis has not been seen in humans following hernia repair, there is sufficient animal data to cause concern. Similarly, neural complications following use of mesh, particularly after the open anterior notension repair methods, are being reported at alarming rates. Many types of inguinal hernias do not need mesh repairs. It is our premise that these hernias must be identified preoperatively. Certainly, type I, II and III C inguinal hernias of our classification, should not receive a prosthetic mesh repair. If prosthetic mesh is to be used, it should be placed to buttress the inguinal wall posteriorly so that advantage of Pascal's law may be assured.