• Mesh is still being recommended as the first choice for inguinal hernia repair

  Posted by Good intentions on August 2, 2023 at 3:20 pm

  Here are two fairly new articles, or revisions of older articles, by authors from Harvard Medical School and the Cleveland Clinic. I had not heard of this resource, the “UpToDate” web page. Apparently the goal is to continuously edit the documents as the editors see fit, or on a regular schedule. Basically, they consider it to be the “state-of-the-art”. For some reason one is pay-per-view and the other is open access.

  The first one states flatly that mesh is recommended for inguinal hernia repairs but the references only cover incisional and ventral hernias. The authors either left out a reference or subconsciously inserted inguinal in to the paragraph. It is the very first statement in the article though, about the use of mesh, so you can see how strong the urge to support the use of mesh is. It’s hard to understand. Where is the objectivity, the acceptance of the possibility that the Guidelines might need revising? Why would they make that statement now, when the Guidelines have ten chapters being updated and are three years past due on the promised update? A very firm statement based on questionable research.

  The second statement is very true though. Laparoscopy requires mesh. As laparoscopy and robotic surgery get promoted mesh goes along for the ride.

  https://www.uptodate.com/contents/hernia-mesh#H3917182230

  Hernia mesh

  AUTHORS:David C Brooks, MDClayton C Petro, MDSECTION EDITORS:Michael Rosen, MDKrishnan Raghavendran, MD, FACSDEPUTY EDITOR:Wenliang Chen, MD, PhD
  Literature review current through: Jul 2023.
  This topic last updated: Apr 24, 2023.

  “INTRODUCTION

  For all groin hernias and all ventral hernias with a defect >1 cm in a clean field, a mesh repair is preferred over a nonmesh repair [1,2]. Mesh is a required element of all laparoscopic or robotic groin or ventral hernia repairs and has been shown to decrease recurrences after open repair of various types of ventral hernias [3-14].
  …”
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  The second seems more objective overall, but still has simple errors like using the 2009 Guidelines as a reference instead of the 2018 Guidelines. Maybe that is a sign of how old the original document is. It’s not “Up to date”.

  https://www.uptodate.com/contents/overview-of-treatment-for-inguinal-and-femoral-hernia-in-adults?topicRef=140572&source=see_link

  Overview of treatment for inguinal and femoral hernia in adults

  AUTHOR:David C Brooks, MDSECTION EDITOR:Michael Rosen, MDDEPUTY EDITOR:Wenliang Chen, MD, PhD
  Contributor Disclosures

  “INTRODUCTION
  The definitive treatment for all hernias, regardless of origin or type, is surgical repair [1]. Groin hernia repair is one of the most commonly performed operations. Over 20 million inguinal or femoral hernias are repaired every year worldwide [2], including over 700,000 in the United States [3].
  …”

  Good intentions replied 1 year, 1 month ago 1 Member · 0 Replies
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