Hernia Repair with Mesh Implants

What is a mesh implant?

A mesh implant is a special medical material used to reinforce a weakened area of the abdominal wall.

Unlike repair using only the patient's own tissues, a mesh creates an additional framework in the area of the hernia defect.

After placement, the implant gradually integrates into the surrounding tissues and becomes part of the reconstructed abdominal wall.

For which hernias are mesh implants used?

Mesh repair may be used for:

• inguinal hernias
• femoral hernias
• umbilical hernias
• epigastric hernias
• hernias of the linea alba
• ventral hernias
• incisional ventral hernias
• recurrent hernias
• large and giant ventral hernias
• parastomal hernias
• complex and combined hernias

The technique and type of implant are chosen depending on the specific clinical situation.

How is the operation performed?

The operation may be performed with an open, laparoscopic, or robotic approach, depending on the type of hernia and the required extent of reconstruction.

During the operation, the following are performed:

• exposure of the hernia defect
• reduction of the hernia contents
• preparation of the tissues
• closure of the hernia defect when indicated
• creation of the required anatomical plane
• placement of the mesh implant
• ensuring sufficient overlap of the defect
• fixation of the implant if necessary
• verification that the reconstruction is secure

Mesh placement planes

Depending on the type of hernia, the mesh implant may be placed in different anatomical planes.

These may include:

• preperitoneal placement
• retromuscular placement
• properitoneal placement
• other reconstructive planes depending on the type of defect

When choosing the plane, the patient's anatomy, the size of the defect, previous operations, and the type of implant are taken into account.

Mesh repair of inguinal and femoral hernias

For inguinal and femoral hernias, a mesh implant reinforces the entire myopectineal orifice and covers potential hernia sites.

Mesh repair can be performed:

• with an open approach
• laparoscopically using the TAPP technique
• laparoscopically using the TEP technique
• robotically in suitable cases

Mesh repair of ventral hernias

For ventral and incisional hernias, a mesh can be used to reinforce the front abdominal wall.

For large defects, it may be part of a comprehensive reconstruction with:

• closure of the hernia defect
• restoration of the midline
• correction of diastasis
• retromuscular reconstruction
• TAR
• other reconstructive techniques

Mesh repair of recurrent hernias

For a recurrent hernia, the previous operation and the position of the old implant must be taken into account.

The previous mesh does not always need to be removed.

Depending on the situation, the following may be done:

• preserving the previous implant
• placing a new implant in a different anatomical plane
• partial or complete removal of the old mesh when indicated
• comprehensive reconstruction of the front abdominal wall

The strategy is determined after assessing the condition of the tissues and the previous reconstruction.

Choosing a mesh implant

Different types of mesh implants are used.

When choosing one, the following are taken into account:

• the location of the hernia
• the size of the defect
• the anatomical placement plane
• whether the mesh will be in contact with the peritoneum or internal organs
• the condition of the tissues
• the presence of infection
• previous operations

For different anatomical situations, polypropylene, composite, and other specialized implants may be used.

Advantages of mesh implants

• Reliable reinforcement of the abdominal wall
• The load is distributed over a larger area of tissue
• Less tension during reconstruction
• Lower risk of recurrence for many types of hernia
• Large hernia defects can be treated
• Complex and recurrent hernias can be reconstructed
• Can be combined with laparoscopic and robotic techniques

When may a mesh not be appropriate?

Not every hernia requires a mesh implant.

For small defects and a favorable anatomical situation, repair with the patient's own tissues may be used in certain cases.

The choice of technique may also change in the case of:

• infection
• contamination of the surgical field
• acute incarceration
• the need for bowel resection
• significant tissue deficiency or damage

The final strategy is determined by the surgeon after assessing the specific clinical situation.

Recovery after surgery

Postoperative recovery depends on the type of hernia, the method of mesh placement, and the extent of the reconstruction.

After surgery, the following are recommended:

• early mobilization
• pain control
• a gradual return to eating
• wound care
• a gradual increase in physical activity

After major reconstructive operations, the recovery period may be longer.

Patient care follows the principles of *ERAS (Enhanced Recovery After Surgery)*.

Frequently Asked Questions