What is the success rate of mesh stent placement for inguinal hernia repair?

Success Rates of Mesh Stent for Inguinal Hernia Repair

Mesh repair for inguinal hernia demonstrates significantly higher success rates with approximately 50-75% reduction in recurrence compared to non-mesh techniques, making it the recommended standard approach. 1

Effectiveness of Mesh Repair

• Mesh repair is strongly recommended as the standard approach for all non-complicated inguinal hernias according to current guidelines, with high success rates and lower recurrence rates compared to tissue repair 2
• Prosthetic repair with synthetic mesh is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection (clean surgical field) 3
• The recurrence rate with mesh repair is significantly lower (0.1-2.8%) compared to non-mesh repair techniques, with some studies reporting recurrence rates as low as 0.1% over long-term follow-up 4, 5
• A Cochrane systematic review found that mesh repair reduces the risk of hernia recurrence by 54-63% compared to non-mesh repair (RR 0.46,95% CI 0.26 to 0.80) 1

Complication Rates

• Wound infection rates are generally low with mesh repair, with studies showing rates of 4.3% in emergency settings 3
• Seroma formation occurs more frequently with mesh repair than with non-mesh repair (RR 1.63,95% CI 1.03 to 2.59), but this is generally a minor complication 1
• Neurovascular and visceral injuries are less common in mesh repair groups compared to non-mesh repair (RR 0.61,95% CI 0.49 to 0.76) 1
• Postoperative urinary retention is reduced with mesh repair compared to non-mesh techniques (RR 0.53,95% CI 0.38 to 0.73) 1

Special Considerations for Complicated Hernias

• Even in cases of strangulated hernias requiring bowel resection, mesh repair has been shown to be safe with no significant increase in complications compared to non-mesh repair 3
• For clean-contaminated surgical fields (CDC wound class II), emergent prosthetic repair with synthetic mesh can be performed without increased 30-day wound-related morbidity 3
• In contaminated or dirty surgical fields (CDC wound classes III and IV), biological mesh may be used when direct suture is not feasible for defects larger than 3 cm 3

Laparoscopic vs. Open Mesh Repair

• Laparoscopic repair shows a significantly lower wound infection rate compared to open repair (P < 0.018) without a higher recurrence rate (P < 0.815) 3
• Laparoscopic approaches (TAPP or TEP) offer the advantage of identifying and repairing occult contralateral hernias, which are present in 11.2-50% of cases 2
• Hernioscopy (a mixed laparoscopic-open technique) is effective in evaluating the viability of herniated bowel, potentially avoiding unnecessary laparotomy 3

Long-term Outcomes

• Patients undergoing mesh repairs may return to normal activities of daily living approximately 2.87 days sooner than those with non-mesh repair 1
• Hospital stays may be shorter with mesh repair by approximately 0.6 days compared to non-mesh techniques 1
• Recent studies comparing absorbable biosynthetic mesh with permanent polypropylene mesh show similar 1-year outcomes with no significant differences in recurrence rates or complications 6

Common Pitfalls to Avoid

• Inadequate mesh size or improper fixation can lead to recurrence, particularly at the pubic tubercle 4
• Overlooking contralateral hernias is a common issue that can be addressed by using laparoscopic approaches 2
• Delaying repair of strangulated hernias can lead to bowel necrosis and increased morbidity/mortality 2

Algorithm for Mesh Selection

1. For clean surgical fields (CDC wound class I): Use synthetic mesh (Grade 1A recommendation) 3
2. For clean-contaminated fields (CDC wound class II): Synthetic mesh can still be safely used 3
3. For contaminated/dirty fields (CDC wound classes III/IV):
   • Small defects (<3 cm): Primary repair 3
   • Larger defects: Consider biological mesh 3
   • If biological mesh unavailable: Consider polyglactin mesh or delayed repair 3