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Comparing No Mesh and Tension-Free Hernia Repairs

With the advent of surgical mesh to cover a hernia defect, the tension-free method of repairing a hernia has become the gold standard. However, a small proportion of patients do not wish to have a mesh repair. These patients elect to have their hernia fixed without a mesh.  For that reason, it is important to quickly discuss the pros and cons of the two options available to patients when repairing a hernia.

The Tension-Free Method

The most commonly performed hernia repair technique is known as the tension-free repair. This can be performed an open or laparoscopic manner and employs a surgical mesh to cover the defect or hole in the fascia of the abdomen. The mesh is placed over the defect, essentially creating a barrier – the defect is not closed.

Bottom line benefit: The main benefit of this technique is that the synthetic mesh creates a very strong wall over the hernia defect. As the body’s inflammatory response kicks in, tissue begins to grow in and around the mesh, creating an extremely strong barrier. Mesh repairs have a very low recurrence rate as a result.

Bottom line risk: Having a foreign body implanted can have different consequences in different people. Some patients will experience chronic pain, possibly as a result of the mesh, but more likely due to the hernia being repaired in the open method. Other potential issues such as inappropriate mesh size or quality as well as the way that the mesh is affixed have been overcome with modern surgical mesh technology.

The No-Mesh Repair

The traditional tension repair involves suturing the edges of defect closed. It is called a tension repair because the sutures pull on the edges of the hernia defect to close it.  All hernias were fixed in this matter when hernias started to be repaired in the early part of the 19th century.  Due to the high recurrence rates, mesh repairs were adopted and now become the standard of care.

Bottom line benefit: Tension repairs do not employ surgical mesh and therefore do not have any of the risks associated with the implantation or fixation of a foreign body in the abdomen.

Bottom line risk: Because of the very nature of the technique, the risk of recurrence of the hernia is relatively high. Of course, a recurrence requires an additional surgical procedure. To further complicate the problem, a recurrence of the hernia will require a second more difficult repair to fix the hernia.

What’s the Better Method?

There are various techniques that have been developed over the history of hernia repair to address the most common pitfalls of each of type of surgical repair. Hernia mesh has come a long way since it was first developed, with more options combined with improved surgical techniques. Others have sought to reduce the risk recurrence and complications in tension/no mesh repairs.

Ultimately, the most important factor in the success of a hernia procedure lies in the surgeon’s experience.  That is why employing a hernia specialist for your procedure is critical for the success of your hernia repair.  Dr. Lublin believes that a tension-free hernia repair using mesh is the ideal method for repair because: the risks of significant and long-term chronic pain are very low in the hands of an experienced surgeon, modern meshes and fixation techniques have significantly reduced the chance of chronic pain, and the recurrence rate is extremely low. Thus, the need for a more complicated revisional hernia procedure is quite minimal.

Of course, no two patients are the same and the technique ultimately employed depends on the patient’s particular circumstance, their general health, and their preference. We encourage our patients to arrive at their preliminary consultation with plenty of questions to ensure that they understand and feel comfortable with the procedure that they will undergo.

Posted in: Hernia Surgery

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