From the Guidelines
For inguinal hernia repair, a lightweight mesh with a monofilament suture is recommended to minimize the risk of incisional hernia and postoperative complications. When selecting a mesh and suture for inguinal hernia repair, it is crucial to consider the type of material that will provide the best outcomes in terms of morbidity, mortality, and quality of life. The choice of suture material is critical, with monofilament sutures being associated with a significantly lower risk of incisional hernia than multifilament sutures 1. Some key points to consider when choosing a mesh and suture for inguinal hernia repair include:
- The use of lightweight mesh to reduce foreign body reaction and postoperative pain
- The selection of monofilament non-absorbable sutures, such as polypropylene, for mesh fixation due to their durability and reduced risk of infection
- The use of absorbable sutures, such as polyglactin, for subcutaneous tissue and skin closure to minimize the risk of complications. Given the strong recommendation for the use of monofilament sutures in emergency settings 1, it is reasonable to extend this recommendation to inguinal hernia repair, where minimizing the risk of incisional hernia and postoperative complications is paramount. The specific characteristics of the mesh, such as its weight and size, should be carefully considered to ensure adequate overlap of the defect and minimize the risk of recurrence. Ultimately, the goal of inguinal hernia repair is to achieve the optimal balance between preventing hernia recurrence and minimizing postoperative complications, and the choice of mesh and suture material plays a critical role in achieving this goal.
From the Research
Mesh Type
- Bilayer polypropylene mesh is a recommended type for inguinal hernia repair, as it provides both onlay and underlay mesh layers, resulting in low complication and recurrence rates 2.
- Monofilament PTFE mesh is also a viable option, as it seems to be a practicable alternative to commonly used polypropylene meshes in open inguinal hernia repair, with reduced postoperative pain and improved quality of life 3.
- Resterilized polypropylene mesh can be used, as it has been shown to be feasible without considerable changes in infection and recurrence rates, and it decreases the overall cost of operation 4.
Suture Type
- Skin staples can be used to secure the mesh, as they are as effective as conventional sutures, with the added advantage of significant reduction in operating time and complications 5.
- Fibrin-sealant mesh fixation is also an option, as it effectively reduces acute and chronic postoperative pain, and trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay 3.
- Polypropylene sutures are commonly used, but may have a higher complication rate compared to skin staples 5.
- Suture fixation using a layered suture (Shouldice) or prosthetic (Lichtenstein) repair is also a recommended technique, according to the Royal College of Surgeons of England guidelines, as mentioned in a study on the mesh plug technique 6.