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Archive December 2016 XVII, No. 12

Torn Between Two Meshes

Hernia mesh options are no longer just biologics or conventional — you have new options for more complex cases.

Bruce Ramshaw

Bruce Ramshaw, MD, FACS


repairing hernias MESH DECISIONS The challenge when repairing hernias: how to patch abdominal defects without breaking the bank.

How much hernia mesh should you stock? If you have several surgeons performing hernia repair, you'll stock several different types of mesh — some of it quite expensive. Unlike other implants or medical devices, where research clearly supports one product over another, a mesh-implanted patient's outcome depends largely on the patient's characteristics and condition. Though many surgeons rely on conventional, permanent synthetic meshes (polypropylene is the most popular material) in light, mid and heavy weights, in some patients it may contribute to an adverse reaction, and we're still not 100% sure why. Often surgeons find a midweight synthetic is sufficient for their routine cases, but they may use a heavy- or lightweight option depending on the patient and the hernia. Though lightweight options are thought to help reduce chronic pain and inflammation, they may lack the tensile strength for some cases. For example, a lightweight mesh may work fine in inguinal hernia repairs, but it may not always be the best option for ventral hernia repair.

Should you stock conventional, synthetic mesh, or are biologic options better? Are the new bio-synthetic technologies worth the cost? And will your surgeons ever agree to using one type of mesh? Answering these questions is hard. There's no research that supports using one type of mesh over another. With new innovations promising better outcomes — as well as sky-high prices — how can you manage your mesh without breaking the bank?

First things first: You need to understand your mesh options and why your surgeons prefer a particular type of mesh before you can discuss paring down your inventory. There's a lot that's new.

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