SURGICAL HERNIA REPAIR OPTIONS: WITH OR WITHOUT MESH

Hernia repair is a common procedure in abdominal wall and digestive surgery. Several treatment techniques are currently available, either with or without the use of a surgical mesh (prosthesis). The choice of technique depends on the type of hernia, the patient’s profile, and current medical recommendations. This article provides a clear and accessible explanation of the different hernia repair options, the types of surgical meshes available, and their impact on the risk of recurrence.

What Is a Hernia?

A hernia occurs when an organ or tissue protrudes through a weakened area of the abdominal wall. The most common types are inguinal, umbilical, linea alba hernias, and incisional hernias. Surgical treatment is recommended when a hernia becomes painful, causes discomfort, or carries a risk of complications.

Surgical Repair Options

There are two main approaches to hernia repair: repair without mesh and repair with mesh (prosthesis).

Hernia Repair Without Mesh

Mesh-free repair consists of closing the hernia defect using only the patient’s own tissues. This technique may be appropriate in carefully selected cases, particularly for small hernias or young patients. It avoids implanting a foreign material, but depending on the situation, it may be associated with a higher risk of recurrence.

Hernia Repair With Mesh (Prosthesis)

Repair using a surgical mesh allows the abdominal wall to be reinforced in a durable way. This technique is widely used and supported by numerous scientific studies, particularly to reduce the risk of hernia recurrence.

Types of Surgical Meshes Available

Several types of meshes exist, differing in their composition and how they behave over time:

• Non-resorbable synthetic meshes

Most commonly made of polypropylene, and sometimes polyester or polytetrafluoroethylene (PTFE). They provide permanent reinforcement of the abdominal wall. These meshes are the most commonly used in hernia surgery and offer good mechanical strength and good tissue integration.

• Partially resorbable meshes

These combine a permanent synthetic component with a resorbable synthetic component. Part of the material is absorbed over time while a permanent structure remains (for example, polypropylene combined with PLLA—resorbable poly‑L‑lactic acid). The aim is to reduce the amount of foreign material while keeping a durable framework. Partial resorption occurs over several months.

• Fully resorbable synthetic meshes

These provide temporary support and then gradually disappear (made from biodegradable synthetic polymers designed to degrade progressively in the body). Common materials include polylactic acid, polyglycolic acid, P4HB, and PLA–PGA copolymers (100% synthetic, no permanent material, mesh structure providing temporary support). Resorption is gradual and may take from a few months to a few years depending on the polymer. Final strength depends on the patient’s healing.

• Biological meshes

Derived from processed biological tissues and reserved for specific situations. These meshes are made from animal‑derived tissue; the final product is an acellular collagen matrix (without living cells) designed to serve as a scaffold for healing.

The choice of mesh type depends on the hernia location, the surgical technique used, and the patient’s individual factors.

Resorbable vs Non-Resorbable Meshes: Impact on Recurrence Risk

In most studies, non-resorbable meshes are associated with the lowest recurrence rates. They are currently considered the reference standard for many hernias, particularly inguinal hernias and incisional hernias.

Fully resorbable meshes may be associated with a higher long-term recurrence risk, because mechanical reinforcement gradually disappears and thereafter relies solely on the patient’s healing.

Partially resorbable meshes show intermediate outcomes and may be offered in selected indications. Biological meshes are mainly used in specific contexts (infection, fragile tissue environment) and are not the standard solution for recurrence prevention.

Material selection is always individualized, seeking the best balance between durability, safety, and patient-specific suitability.

Benefits of Mesh Repair

Hernia repair with mesh generally reduces recurrence risk, reinforces the abdominal wall, and supports a faster return to daily activities.

Possible Risks and Complications

As with any surgical procedure, hernia repair—whether performed with or without mesh—carries risks. These may include postoperative pain, infection, local complications, or, more rarely, the need for further surgery. Risks vary depending on the technique used and the patient’s profile.

A Personalized Decision

Choosing the hernia repair technique and the type of mesh is based on a discussion between the patient and the surgeon. The decision takes into account the type of hernia, medical history, age, activity level, and current scientific recommendations.

Conclusion

There is no single solution for treating a hernia. The goal is to provide personalized care tailored to each patient, prioritizing safety, effectiveness, and long-term quality of life.

Risk of Hernia Recurrence After Surgery (According to Technique)

The percentages below are provided for informational purposes only. They reflect approximate ranges reported in international scientific literature. Recurrence rates may vary depending on hernia type, surgical technique, surgeon experience, and duration of follow-up.

Estimated Recurrence Rates

Overall, repairs using non-resorbable synthetic mesh are associated with the lowest and most durable recurrence rates. Mesh-free techniques or repairs using resorbable mesh may expose patients to a higher long-term recurrence risk, which is why indications are carefully discussed case by case.

Sources and References (Further Reading)

• HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018.
• European Hernia Society (EHS). Guidelines on the treatment of inguinal and ventral hernias.
• Cochrane Database of Systematic Reviews – Mesh versus non-mesh repair of inguinal hernia.
• Lichtenstein IL et al. Tension-free hernioplasty. Am J Surg. 1989.
• Shouldice EE. The Shouldice repair for groin hernias. Surg Clin North Am.

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♦ To make an appointment with Dr. Bruto Randone, ENGLISH SPEAKING Digestive Visceral and Abdominal Surgeon, at the Clinique Internationale du Parc Monceau, 21 Rue de Chazelles, 75017 Paris, France and at the Clinique Bizet, 22 bis Rue Georges Bizet, 75116 Paris, France, click on Contact.