Reply To: Non Mesh Repair Questions

Hernia Discussion Forums Hernia Discussion Non Mesh Repair Questions Reply To: Non Mesh Repair Questions


Dear Jnomesh,

Some thoughts about your post:

The outcome from femoral hernia repair is poor for non-mesh tissue repairs. The reason is because, unlike the common inguinal hernias, the femoral hernia is not flanked by muscle. It is flanked by thick taut ligaments. They have “no give.” Tissue repair used to be done, and history has taught us that the ouctomes are poor and chronic pain is a very real problem with it.

It think Dr. Shouldice described the best tissue repair for femoral hernias. I have performed it, and it works well for thin and small build patients (usually women). Simple suture repair does not work in most situations and can result in a lot of pain in the area. Being in such a particular anatomic region, even open mesh repair is no longer considered efficacious enough for femoral hernias. The gold standard is now laparoscopic mesh repair, based on a large study focused on this type of rare hernia.

Though rare for both sexes, femoral hernias are more common in women and can be seen among men. The question is: did you have a true femoral hernia (deep with content) or did you have a wide femoral space notable only on exploration?

With regard to exercise: all studies show that the majority of exercises are protective of hernias, do not increase abdominal pressure, and in some cases can reduce the size and/or symptoms of hernias. Since femoral hernias are not lined by muscle, exercise does not affect its progression or symptomatology.

Lastly, you asked about the mesh left on your vessels. It is common practice to do so, for safety reasons. If your mesh was removed because you had a true mesh reaction, then I do not leave any mesh at all, because even the slight amount may cause pain. Symptoms down your leg may be due to a) femoral hernia, b) nerve pain, and/or c) retained mesh. Your surgeon is very qualified to assess the pain for you and help you figure out why you have the pain down your leg.

You may notice that this forum will have contradicting information. Do not be afraid of this. It is something we are very used to in medicine, as it is not a black and white field and information is always in flux. Also, with surgery, outcome and experience can be different from surgeon to surgeon.

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