“Indications for pure tissue repairs” is a timely and relevant chapter in a modern textbook on the art of hernia surgery. While the introduction of synthetic polypropylene meshes seemed a boon at first in the management of the tenacious hernia recurrence, it fell short as a panacea. Mesh in any shape, form, weight, configuration, and combination with resorbable and non-resorbable addenda is still a foreign body with its expected flaws and limitations. Unfortunately, the most germane predicament has been the chronic post-herniorrhaphy pain syndrome which has become a major obstacle to a patient’s well-being.
Hernia as a surgical specialty has become a complex art which needs and calls upon allied disciplines such as pathology, materials experts, and statisticians to enlighten the surgeons who are beginning to feel hounded by a savvy patient population.
While recurrence rates may have come down for the average general surgeon who performs less than 50 operations a year, those rates have not come down for the hernia specialists who have always had good results.
Recent evidence, as we shall see within the chapter, has proven that for primary hernias which make up 90–95% of all hernia surgery, pure tissue repairs, in the proper hands and proper training in the majority of cases, can provide an excellent mainstay of hernia surgery. Let us hope that our present dedication will serve as an apology for the turbulent past and a promise of a bias-free future!
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Jung K, Rosch R, Klinge U, et al. Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis. Hernia. 2006;10:309–15.CrossRefGoogle Scholar
Burger JW, Luidendijk RW, Hop WC, et al. Long term follow-up of a randomized control trial of suture vs mesh repair for incisional hernia. N Engl J Med. 343:392–8.Google Scholar
Iakovlev V, Koch A, Petersen K, et al. A pathology of mesh and time. Dysejaculation, sexual pain, and orchialgia resulting from polypropylene mesh erosion into the spermatic cord. Ann Surg. 2016. https://doi.org/10.1097/SLA.0000000000002134.
Bendavid R. A femoral “umbrella” for femoral hernia repair. Surg Gynecol Obstet. 1987;165:153–6.PubMedGoogle Scholar
Bassini E. Sulla cura radicale dell’ernia inguinale. Arch Soc Ital Chir. 1887;380:4–30.Google Scholar
Probst P, Knebel P, Grummich K, Tenckhoff S, Ulrich A, Buchler MW, Diener MK. Industry bias in randomized controlled trials in general and abdominal surgery: an empirical study. Ann Surg. 2016;264(1):87–92.CrossRefPubMedGoogle Scholar
Amato B, Moja L, Panico S, Persico G, Rispoli C, Rocco N, Moschetti I. Shouldice technique versus other open techniques for inguinal hernia repair. Cochrane Data Base Syst Rev. 2012;(4):CD001543.Google Scholar
Olavarria OA, Holihan JL, Cherla D, Perez CA, Kao LS, Ko TC, Liang MK. Comparison of conflicts of interest among published hernia researchers self reported with the centers for medicare and medicaid services open payment database. J Am Coll Surg. 2017;224(5):800–4.CrossRefPubMedGoogle Scholar
Koch A. The “Tailored approach” to inguinal hernias. The current statistical realities. AHS 18th Annual Repair. Cancun, Mexico. Accessed 8 Mar 2017.Google Scholar
Werner MU, Kehlet H. Management of patients with persistent pain following groin hernia repair. Ugeskr Laeger. 2014; pii:V061130349.Google Scholar
Petersen K. 1st World Conference on Abdominal Wall Hernia Surgery. Milan, Italy, April 25-29, 2015, Program page 46.Google Scholar
Kumar V, Abbas A, Fausto N, Aster J. Robbins and cotran pathological basis of disease, 7th and 8th editions. Elsevier, Imprint: W.B. Saunders; 2004 and 2010.Google Scholar
Hallab NJ, Jacobs JJ. Biologic effects of implant debris. Bull NYU Hosp Jt Dis. 2009;67(2):182–8.PubMedGoogle Scholar
Anderson JM. Exploiting the inflammatory response on biomaterials research and development. J Mater Sci Mater Med. 2015;3:121.CrossRefGoogle Scholar
Klinge U, Klosterhalfen B, Müller M, Schumpelick V. Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg. 1999;165(7):665–73.CrossRefPubMedGoogle Scholar
Klosterhalfen B, Klinge U. Retrieval study at 623 human mesh explants made of polypropylene—impact of mesh class and indication for mesh removal on tissue reaction. J Biomed Mater Res B Appl Biomater. 2013;101(8):1393–9.CrossRefPubMedGoogle Scholar
Klosterhalfen B, Junge K, Hermanns B, Klinge U. Influence of implantation interval on the long-term biocompatibility of surgical mesh. Br J Surg. 2002;89(8):1043–8.CrossRefPubMedGoogle Scholar
Klinge U, Klosterhalfen B, Birkenhauer V, Junge K, Conze J, Schumpelick V. Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res. 2002;103:208–14.CrossRefPubMedGoogle Scholar
Klosterhalfen B, Junge K, Klinge U. The lightweight and large porous mesh concept for hernia repair. Expert Rev Med Devices. 2005;2(1):103–17.CrossRefPubMedGoogle Scholar
Klinge U, Klosterhalfen B, Müller M, Ottinger AP, Schumpelick V. Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg. 1998;164(12):965–9.CrossRefPubMedGoogle Scholar
Zogbi L, Trindade EN, Trindade MR. Comparative study of shrinkage, inflammatory response and fibroplasia in heavyweight and lightweight meshes. Hernia. 2013;17(6):765–72.CrossRefPubMedGoogle Scholar
Tunn R, Picot A, Marschke J, Gauruder-Burmester A. Sonomorphological evaluation of polypropylene mesh implants after vaginal mesh repair in women with cystocele or rectocele. Ultrasound Obstet Gynecol. 2007;29(4):449–52.CrossRefGoogle Scholar
Svabík K, Martan A, Masata J, El-Haddad R, Hubka P, Pavlikova M. Ultrasound appearances after mesh implantation—evidence of mesh contraction or folding? Int Urogynecol J. 2011;22(5):529–33.CrossRefPubMedGoogle Scholar
Jerabek J, Novotny T, Vesely K, Cagas J, Jedlicka V, Vlcek P, Capov I. Evaluation of three purely polypropylene meshes of different pore sizes in an onlay position in a New Zealand white rabbit model. Hernia. 2014;18(6):855–64.CrossRefPubMedGoogle Scholar
Weyhe D, Cobb W, Lecuivre J, Alves A, Ladet S, Lomanto D, Bayon Y. Large pore size and controlled mesh elongation are relevant predictors for mesh integration quality and low shrinkage—systematic analysis of key parameters of meshes in a novel mini pig hernia model. Int J Surg. 2015;22:46–53.CrossRefPubMedGoogle Scholar
Bendavid R, Lou W, Koch A, Iakovlev V. Mesh-related SIN syndrome. A surreptitious irreversible neuralgia and its morphologic background in the aetiology of post-herniorrhaphy pain. Int J Clin Med. 2014;5:799–810.CrossRefGoogle Scholar
Bendavid R, Lou W, Grischkan D, Koch A, Petersen K, Morrison J, Iakovlev V. A mechanism of mesh-related post-herniorrhaphy neuralgia. Hernia. 2016;20(3):357–65.CrossRefPubMedGoogle Scholar
Massaron S, Bona S, Fumagalli U, Battafarano F, Elmore U, Rosati R. Analysis of post-surgical pain after inguinal hernia repair: a prospective study of 1,440 operations. Hernia. 2007;11(6):517–25.CrossRefPubMedGoogle Scholar
Huerta S, Patel PM, Mokdad AA, Chang J. Predictors of inguinodynia, recurrence, and metachronous hernias after inguinal herniorrhaphy in veteran patients. Am J Surg. 2016;212(3):391–8.CrossRefPubMedGoogle Scholar
Hallén M, Sevonius D, Westerdahl J, Gunnarsson U, Sandblom G. Risk factors for reoperation due to chronic groin postherniorrhaphy pain. Hernia. 2015;19(6):863–9.CrossRefPubMedGoogle Scholar
Hamouda A, Kennedy J, Grant N, Nigam A, Karanjia N. Mesh erosion into the urinary bladder following laparoscopic inguinal hernia repair; is this the tip of the iceberg? Hernia. 2010;14(3):317–9.CrossRefPubMedGoogle Scholar
Agrawal A, Avill R. Mesh migration following repair of inguinal hernia: a case report and review of literature. Hernia. 2006;10(1):79–82.CrossRefPubMedGoogle Scholar
Nikhil K, Rishi N, Rajeev S. Bladder erosion and stone as rare late complication of laparoscopic hernia meshplasty: is endoscopic management an option? Indian J Surg. 2013;75(3):232–4.CrossRefPubMedPubMedCentralGoogle Scholar
Riaz AA, Ismail M, Barsam A, Bunce CJ. Mesh erosion into the bladder: a late complication of incisional hernia repair. A case report and review of the literature. Hernia. 2004;8(2):158–9.CrossRefPubMedGoogle Scholar
Liebert TC, Chartoff RP, Cosgrove SL, McCuskey RS. Subcutaneous implants of polypropylene filaments. J Biomed Mater Res A. 1976;10:939–51.CrossRefGoogle Scholar
Iakovlev VV, Guelcher SA, Bendavid R. Degradation of polypropylene in vivo: a microscopic analysis of meshes explanted from patients. J Biomed Mater Res B Appl Biomater. 2017;105(2):237–48.CrossRefPubMedGoogle Scholar
Mary C, Marois Y, King MW, Laroche G, Douville Y, Martin L, Guidoin R. Comparison of the in vivo behavior of polyvinylidene fluoride and polypropylene sutures used in vascular surgery. ASAIO J. 1998;44(3):199–206.CrossRefPubMedGoogle Scholar
Miklos JR, Chinthakanan O, Moore RD, Mitchell GK, Favors S, Karp DR, Northington GM, Nogueiras GM, Davila GW. The IUGA/ICS classification of synthetic mesh complications in female pelvic floor reconstructive surgery: a multicenter study. Int Urogynecol J. 2016;27(6):933–8.CrossRefPubMedGoogle Scholar
Kaza AK, Pigula FA. Are bioprosthetic valves appropriate for aortic valve replacement in young patients? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2016;19(1):63–7.CrossRefPubMedGoogle Scholar
Wantz G. Hernia III. In: Nyhus L, Condon R, editors. Philadelphia: JB Lippincott; 1989. p. 245.Google Scholar
Shouldice Hospital in Bendavid R. The Shouldice method of inguinal herniorrhaphy. In Nyhus L, Baker RJ, editors. Mastery of surgery, 2nd ed. Boston: Little Brown; 1992.Google Scholar
Moran MR, Bliek M, Collura M. Double layer of transversalis fascia for repair of inguinal hernia. Surgery. 1968;63:424–9.Google Scholar
Berliner S, Burson L, Kate P. An anterior transversalis fascia repair for adult inguinal hernias. Am J Surg. 1978;135:633–6.CrossRefPubMedGoogle Scholar
Simons MP, Aufenacker T, Bay-Nielsen M, et al. European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403.CrossRefPubMedPubMedCentralGoogle Scholar