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Archive April 2018 XIX, No. 4

In Search of the Perfect Hernia Mesh

There is no such thing - I know because I went looking for one.

Bruce Ramshaw

Bruce Ramshaw, MD, FACS


MIX AND MESH A mesh that's good for one patient may not be good for another.

What's the perfect hernia mesh? It's the one that works best for you. But there's a good chance the one that's best for you won't be the one that's best for your next-door neighbor. Or your brother-in-law. Or your best friend from college.

I've spent years searching for answers. And to be honest, the one thing above all I've come to learn is how much there still is to learn. We will need to understand and apply a newer scientific paradigm that accommodates our complex biologic world that is constantly changing.

I went searching for the perfect mesh back in the early 2000s as part of a research group with the goal to determine how we could minimize foreign body response while maintaining structural integrity. In short, what would the perfect mesh look like? What would it be made of? How would it be structured?

It was a great goal, but the answer turned out to be elusive for one very good reason. There is no ideal hernia mesh. Case in point. At the time there were a bunch of newer lightweight, wider pore-size meshes on the market. For some people, they worked great. But in other people, the mesh simply wasn't strong enough to hold up. Their bodies reacted in ways that led to holes and mechanical failures.

No size fits all

What we now know is that mesh can have very different levels of interaction in different patients. The only general statement you can make about mesh is that the same mesh and the same technique can produce dramatically different outcomes in different patients. Unfortunately, in some patients, mesh and other factors can contribute to devastating outcomes, the worst of which is severe and disabling chronic pain.

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