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Archive May 2016 XVII, No. 5

In Search of the Perfect Hernia Repair

The latest mesh options and fixation techniques are making surgery safer and more efficient.

Kendal Gapinski

Kendal Gapinski, Contributing Editor

BIO

hernia repair WHICH MESH? Several new mesh options available today address common concerns with hernia repair, including complications and recurrence.

What's the best mesh? "If there were one perfect mesh, we wouldn't be having this conversation," says Kent W. Kercher, MD, FACS, a surgeon with Carolinas Hernia Institute in Charlotte, N.C. "We would be using it." While there's no one-mesh-fits-all solution, the ongoing search for the perfect hernia repair has inspired several new meshes and fixation devices designed to prevent complications and minimize recurrence. Here's a look at 3 trends worth noting.

1. Biologic results at half the price
In most healthy patients, a synthetic polypropylene mesh is suitable, says Hien Tan Nguyen, MD, the director of the Johns Hopkins Comprehensive Hernia Center in Baltimore, Md. However, surgeons often will want to use pricey biologics — made from human or animal tissue — when there's a high risk of infection, since they can encourage growth of healthy tissue and potentially reduce bioburden contamination. But biosynthetic or absorbable synthetic meshes could give your docs the benefits of biologics at a synthetic's price tag. Absorbable synthetic options are around half the cost of true biologic meshes, and the non-absorbable meshes are even less, says Dr. Kercher.

Absorbable synthetic meshes are made from synthetic materials that gradually break down over time. They mimic biologic mesh and usually feature a fully reabsorbable monofilament scaffold design that lets new tissue grow and strengthen the hernia repair. Because they help reinforce the repair without leaving a lasting foreign object in the body, they tend to work best in cases where there is bacterial burden near or within the surgical site, says Dr. Nguyen. "You use absorbable mesh in situations where you're concerned that if the mesh does not break down, it can become a source of infection," he says.

While the mesh may help prevent infection, scientific evidence backing up the claims is limited. There's also a chance of recurrence, since the mesh will eventually disappear. "With an absorbable mesh, we can achieve the goals of hernia repair, which is to put some type of mesh in there to keep the abdominal wall closed," says Dr. Kercher. "The downside is, if you have a mesh that's going to go away over 4 to 18 months, then what you have to rely on is that the patient's body will form scar tissue to minimize the chance of recurrence."

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