What is the reoccurring rate of suture-only primary hernia (hernia repair using only sutures, no mesh) repair?

Suture-Only Primary Hernia Repair Has Significantly Higher Recurrence Rates Than Mesh Repair

Suture-only primary hernia repair has an unacceptably high recurrence rate of 43-63% at 3-10 years compared to 24-32% with mesh repair, and should be abandoned in favor of mesh-based techniques. 1

Recurrence Rates by Repair Type and Time Period

Suture-Only Repair Recurrence Rates:

• 4.0% at 6 months 2
• 32.6% at 1 year 2
• 52.4% at 2 years 2
• 61.4% at 3 years 2
• 43% at 3 years for primary hernias 3
• 58% at 3 years for first recurrence hernias 3
• 63% at 10 years (long-term follow-up) 1
• 67% for small incisional hernias at long-term follow-up 1
• 73.7% at 5 years 2

Mesh Repair Recurrence Rates:

• 2.8% at 6 months 2
• 8.0% at 1 year 2
• 19.7% at 2 years 2
• 29.3% at 3 years 2
• 24% at 3 years for primary hernias 3
• 20% at 3 years for first recurrence hernias 3
• 32% at 10 years (long-term follow-up) 1
• 17% for small incisional hernias at long-term follow-up 1
• 44.9% at 5 years 2

Risk Factors for Hernia Recurrence

Several factors contribute to hernia recurrence after suture-only repair:

• Use of absorbable sutures for primary repair 4
• Suture tension 4
• Increased intra-abdominal pressure due to prolonged ileus 4
• Poor chest toileting 4
• Intra-abdominal sepsis causing tissue and suture disruption 4
• Infection (independent risk factor) 1
• Prostatism in men 3
• Previous surgery for abdominal aortic aneurysm 3
• Higher BMI 2
• Immunosuppressant use 2
• Incisional and parastomal hernias 2

Why Mesh Is Superior to Suture-Only Repair

1. Underlying pathophysiology: Patients with incisional hernias often have systemic disturbances in collagen metabolism, leading to insufficient wound healing mechanisms 5

2. Tension reduction: Mesh repair eliminates excessive tension that occurs with suture-only repairs 6

3. Lower recurrence rates: Mesh repair consistently shows significantly lower recurrence rates across multiple studies 3, 1, 2

4. Reduced abdominal pain: Long-term follow-up shows less abdominal pain with mesh repair compared to suture repair 1

5. Comparable complication rates: Despite concerns, mesh repair does not result in significantly more complications than suture repair (17% vs 8%, P=0.17) 1

Optimal Mesh Placement Techniques

For best outcomes with mesh repair:

• Preperitoneal mesh placement with adequate overlap (3 cm) of the defect 6
• Mesh underlay with at least 3 cm overlap of the defect 6
• For larger defects (>8 cm or area >20 cm²), mesh should overlap the defect edge by 1.5-2.5 cm 6
• Retromuscular placement of mesh prosthesis is considered the gold standard for open repair 5
• Laparoscopic approach shows excellent results with recurrence rates as low as 3.4% in some series 7

Clinical Implications and Recommendations

1. Abandon suture-only repair: Based on long-term evidence, suture repair of incisional hernias should be abandoned 1

2. Mesh repair for all sizes: Mesh repair is superior regardless of hernia size 3, 1

3. Consider laparoscopic approach: Laparoscopic repair shows excellent outcomes with short hospital stays, minimal blood loss, and low recurrence rates 7

4. Long-term follow-up: Given that recurrence rates increase over time, close long-term follow-up is essential 2

5. Risk factor modification: Address modifiable risk factors such as infection prevention, weight management, and smoking cessation 6

Common Pitfalls to Avoid

• Using suture-only repair for "small" hernias (recurrence rates remain high) 1
• Inadequate mesh overlap of the defect 4
• Improper fixation of prosthetic material 4
• Underestimating the importance of fascial closure when possible 2
• Insufficient follow-up (recurrences continue to develop over many years) 2

Mesh repair represents the standard of care for hernia repair, with significantly lower recurrence rates than suture-only techniques across all time periods and hernia types.