If you had to get mesh, which technique and type of mesh would you prefer?

[SN]

If you had to get mesh, which technique, type of mesh, type of fixation (sutures/tacks or without) would you prefer? For instance,

Technique:
Open / Lichtenstein
Laparoscopic
Laparoscopic Robotic
TEP or TAPP

Mesh Type:
ProGrip / Self-Fixating
Ovitex
Biologic
Or maybe any of these meshes but cut into a smaller piece so there is less used

Glues
Tacks
Absorbable Sutures
Permanent Sutures (like stainless steel)
Self-fixating (like ProGrip)

While I know most would prefer a tissue-based repair, I am genuinely curious which the majority choose if they had to go with a mesh-based repair. I wasn’t sure if people would choose Open most of the time since it seems like that would be easiest to remove if mesh was the source of chronic pain.

[Alephy]

I would go for tep with an absorbable mesh, because I am not so worried about the possibility of a recurrence. The hope is also that an absorbable mesh might pose a lesser risk in the long term, and in case of problems it will be absorbed eventually, reducing the need for a complex mesh removal surgery…

[Good intentions]

I think that the type of hernia and the results hoped for would play a big part in a decision.

I also think that the quality of the data available for a broad evaluation like that is poor. Most of what has been published over the decades has been inconclusive. For example, a few years ago Ovitex was in the news, with many surgeons promoting it. The company “went public”, meaning that they entered the stock market where investors could buy shares, and now the fanfare has died down. The stock price has dropped and the company is branching out in to other areas. There is no data other than the initial 31 patient inguinal hernia repair study by a single surgeon that suggests that Ovitex is a good idea for inguinal hernia repair.

The new biologic being promoted is Strattice. Similar to the way in which TelaBio created a white paper showing the weaknesses of synthetic mesh, now the Strattice people have produced a paper showing the weaknesses of Ovitex. Most of these “scientific” papers have a corporate purpose behind them.

https://link.springer.com/article/10.1007/s10029-023-02769-0

Here is a recent short paper (supplement) describing a study comparing synthetic mesh and biologic mesh. In the same person! I don’t know how they convinced these patients to be experimental subjects, but there it is. So far, at 6 months, they see no difference. 6 months is a very short time frame of course.

https://academic.oup.com/bjs/article/110/Supplement_2/znad080.012/7155931

OC-005 COMPARISON OF POSTOPERATIVE PAIN: BIOLOGICAL VERSUS SYNTHETIC MESH SIX MONTHS AFTER LAPAROENDOSCOPIC HERNIA REPAIR – RESULTS OF THE RANDOMIZED, MULTICENTER, SELF-CONTROLLED BIOLAP TRIAL
C S Seefeldt, J Knievel, J Meyer-Zillekens, J Lange, R Lefering, M Heiss
British Journal of Surgery, Volume 110, Issue Supplement_2, May 2023

“… To test the hypothesis that the use of biological meshes results in significantly less pain postoperatively than the use of synthetic meshes, without an increased recurrence rate, patients with bilateral primary inguinal hernias were included. Patients received biological mesh on one side and synthetic mesh on the other. …”

[Good intentions]

Sorry to fill your thread with more research papers SN. If I were considering a repair I would focus more on the qualities of the surgeon. Not so much their skill level, but who they are as people. The surgeon that implanted the mesh in me was skilled but was more of a businessman than a true doctor.

Here is the initial paper about the study I referenced above. It has a good writeup of the lack of knowledge about biologic materials, despite the fact that they were already prevalent in the market.

https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-3122-5

[Good intentions]

SN, here is a video that you should watch that might add to the discussion. It is Dr. David Chen’s explanation of why he chooses open Lichtenstein. He describes possible reasons that people have problems after the procedure.

[pinto]

@SN, you ask a great question and Good intentions gives I think the best answer so far. GI, thanks for that.

[pinto]

Just saw @Alephy’s post there, much appreciated advice, thanks.

[MarkT]

It is a great question.

Generally speaking…permanent sutures, and either stainless or Prolene would be fine (maybe very long term resorbable might be ok too)

I too am intrigued by longer term resorbable meshes being developed, but need to learn a lot more about them.

To be quite honest, I don’t know nearly enough about the various options, products, etc. and freely admit that I am very biased in favour of tissue repair by a high-skill/volume specialist.

In addition to my lack of knowledge regarding mesh repairs and products, I also don’t believe we have sufficiently great data (especially long-term data), that would leave me feeling very confident in making a decision for myself at this moment if I had to get a mesh repair.

[Author]

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