When was the first mesh-based repair for hernia (Hernia Repair) performed?

From the Guidelines

The first mesh-based repair was performed in 1958 by Dr. Francis Usher, who used polypropylene mesh (Marlex) to repair hernias. This innovation represented a significant advancement in hernia surgery, moving away from traditional tension repairs that had high recurrence rates. Usher's technique involved placing a synthetic mesh over the hernia defect to provide tension-free reinforcement of the abdominal wall. The mesh created a scaffold for tissue ingrowth, resulting in a stronger repair than was possible with suture-only techniques. This approach dramatically reduced recurrence rates from approximately 30% with traditional repairs to less than 10% with mesh repairs.

Key Points

• The introduction of mesh-based repair revolutionized hernia surgery and established the foundation for modern hernia repair techniques that are still used today, though with significant advancements in mesh materials and surgical approaches.
• The basic principle of using a prosthetic material to strengthen the repair rather than relying solely on the patient's own tissue remains a cornerstone of contemporary hernia surgery.
• According to the study by 1, mesh infection is a challenging complication of abdominal wall defect repairs, and the use of biological meshes can confer protective factors such as resistance to infection and high biocompatibility when implanted.
• The study by 1 suggests that biological meshes may be a viable option for repair in contaminated fields, with a lower risk of infection and recurrence compared to synthetic meshes.

Considerations

• The choice of mesh material and surgical approach depends on various factors, including the size and location of the hernia, the patient's overall health, and the presence of any underlying medical conditions.
• The use of mesh in hernia repair has been shown to reduce recurrence rates and improve patient outcomes, but it is not without risks and complications, such as mesh infection and adhesion formation.
• Further research is needed to fully understand the benefits and risks of mesh-based repair and to develop new and improved mesh materials and surgical techniques.

From the Research

History of Mesh-Based Repair

• The use of surgical meshes for hernia repair dates back to 1891, as mentioned in the study 2.
• The first tensionless technique using a prosthetic material was described by Lichtenstein, who used Marlex mesh to strengthen the posterior wall of the inguinal canal, as reported in the study 3.
• The introduction of synthetic polymers by Carothers in 1935 marked a significant turning point in hernia surgery, leading to the development of various mesh-based repair techniques, as discussed in the study 3.
• The first mesh-based repair using a synthetic plug was performed by Lichtenstein in 1968, who used a Marlex mesh plug in the treatment of inguinal and femoral hernias, as mentioned in the study 3.

Evolution of Mesh-Based Repair

• Over the years, various advancements have been made in mesh products and fixation devices, as discussed in the study 4.
• The introduction of lightweight meshes has improved the outcomes of hernia repair, reducing chronic mesh-related discomfort and improving the overall quality of life of patients, as reported in the study 5.
• Newer mesh products, such as polyester and expanded polytetrafluoroethylene (ePTFE) meshes, have been developed to improve pliability and reduce adhesiogenic potential, as mentioned in the study 5.
• The use of biologic meshes and combination meshes has also become more prevalent, offering improved outcomes and reduced complications, as discussed in the study 6.