This review assessed the difference in outcomes between surgical hernia repair with and without mesh.
Hernias are out-pouchings of an organ through the body wall that normally contains it; in this review, we refer to the bowel or its surrounding fatty tissues protruding through the abdominal wall in the groin region. This is a very common medical problem, affecting 27 out of every 100 men. These hernias can cause significant discomfort, and can occasionally become so tightly stuck that the blood supply can be cut off (strangulation), requiring emergency surgery. The curative treatment of hernias is surgical repair, which can be closed with sutured techniques (non-mesh repair) or with a fine mesh to promote tissue growth to strengthen the previously weak area (mesh repair). Mesh repair is becoming increasingly popular in many countries, particularly in conjunction with laparoscopic (key-hole) surgery.
We searched a number of databases for studies; this search was last updated on 9 May 2018.
In this update of a review originally published in 2001, we included a total of 25 studies (with a total of 6293 people) undertaken in a number of different countries. A variety of outcomes were assessed, including return of the hernia after initial repair (hernia recurrence), a variety of complications including pain, duration of surgery, hospital stay and time before going back to normal activities.
One hernia recurrence is prevented for every 46 mesh repairs performed rather than non-mesh repairs. Compared to non-mesh repairs, mesh repairs are more likely to develop collections of fluid next to the surgical wound, but are less likely to result in difficulty urinating following the operation, or injury to nerves, blood vessels or other organs. Postoperative pain could not be clearly compared between studies due to differences in measurement methods and time frames, but overall the studies appeared to indicate that participants who had mesh repairs had less pain. The length of the surgical operation was slightly shorter for mesh repairs. Participants who had a mesh repair were more likely to have a shorter hospital stay and had a shorter average recovery time before returning to their normal activities.
Quality of the evidence
The studies included in this review used good-quality methods, considered potential factors which could affect the results, and addressed their proposed outcomes clearly. In our assessment of the quality of evidence, we marked down some outcomes to ‘moderate’ quality, particularly due to variability within results.
Overall, hernia repairs with and without mesh both proved effective in the treatment of hernias, although mesh repairs demonstrated fewer hernia recurrences, a shorter operation time and faster return to normal activities. Non-mesh repairs are still widely used, often due to the cost and poor availability of the mesh product itself.