From the Guidelines
Mesh Weight Selection in Hernia Repair The choice of mesh weight in hernia repair depends on the individual patient's needs and the surgeon's professional judgment, with heavy meshes (density > 80 g/m², pore size < 1 mm) recommended for high-tension repairs, such as in large hernias or in patients with high intra-abdominal pressure 1.
Key Considerations
- Medium-weight meshes (density 50-80 g/m², pore size 1-2 mm) are suitable for most standard hernia repairs, offering a balance between strength and flexibility 1.
- Lightweight meshes (density < 50 g/m², pore size > 2 mm) are preferred for low-tension repairs, such as in small hernias or in patients with compromised tissue quality, as they promote better tissue integration and minimize foreign body reaction 1.
Indications for Each Mesh Type
- Heavy meshes: large hernias, high intra-abdominal pressure, or high-tension repairs 1.
- Medium-weight meshes: standard hernia repairs, balancing strength and flexibility 1.
- Lightweight meshes: small hernias, low-tension repairs, or patients with compromised tissue quality, promoting tissue integration and minimizing foreign body reaction 1.
Biological Meshes
- Cross-linked biological meshes have the lowest failure rate in contaminated and infected fields, but may not be suitable for all patients 1.
- Non-cross-linked biological meshes can be used in contaminated hernias without mesh infection and subsequent need for mesh explantation, but may have higher recurrence rates 1.
From the Research
Indications for Heavy vs Medium vs Lightweight Mesh in Hernia Repair
The choice of mesh weight in hernia repair depends on various factors, including the type of hernia, patient characteristics, and surgical technique. The following points summarize the indications for heavy, medium, and lightweight mesh in hernia repair:
- Heavyweight mesh is often used for larger defects, as it provides additional strength and support [ 2 ]. However, it may be associated with a higher rate of foreign body perception [ 3 ].
- Medium-weight mesh is less commonly used, but it may offer a balance between strength and flexibility. One study found that medium-weight mesh had fewer superficial surgical site infections and shorter length of stay compared to heavyweight mesh [ 2 ].
- Lightweight mesh is often preferred for its potential to reduce chronic pain and improve tissue growth. Studies have shown that lightweight mesh is associated with less chronic pain and similar recurrence rates compared to standard mesh [ 4 ]. However, the long-term outcomes of lightweight mesh need to be further evaluated [ 3 ].
Mesh Characteristics
The characteristics of mesh, including weight and pore size, can influence the outcome of hernia repair. The following points summarize the mesh characteristics:
- Mesh weight is defined as lightweight (<60 g/m2), medium-weight (around 55 g/m2), and heavyweight (>70 g/m2) [ 5 ].
- Pore size is also an important factor, with smaller pores potentially reducing the risk of recurrence. However, one study found no significant association between pore size and recurrence rate, pain on exertion, or chronic pain requiring treatment [ 6 ].