Surgical mesh better than stiches in fending off hernia recurrence

Using surgical mesh rather than stitches fends off the recurrence of abdominal hernias, a new study suggests.

"When repairing primary abdominal hernias, mesh reinforcement has the best long-term outcomes in most situations," said the study's lead researcher, Dr. Mike Liang, an assistant professor of surgery at the University of Texas Health Sciences Center at Houston, in a press release.

An abdominal hernia is when the intestines protrude through a weak part of the abdominal wall, and surgeons repair it using a loosely woven sheet of flexible mesh instead of stitches alone. But the mesh is advantageous in comparison because it spreads out the tension across the abdominal wall, giving patients full range of movement afterwards, remarked general surgeon Dr. Steven Hodgett.

Liang and colleagues looked at data from nine studies conducted from 1980 to 2012, comparing the effectiveness of mesh and stitches for hernia repair. After 637 mesh and 1,145 suture repairs, the results showed that when both mesh and stitches were used, hernias recurred only 2.7 percent of the time, compared to 8.2 percent with just stitches.

Mesh is not without it's drawbacks, however. The material increased the odds of seromas from 3.8 percent to 7.7 percent, and incision infections were more common at 7.3 percent versus 6.6 percent when compared to just stitches.

Despite these complications, Hodgett still believes mesh is the way to go.

"Hernia repair is a complex patient decision, but there are great options. It appears our ability to fix hernias is evolving as we try to bring our recurrence and complication rates down to zero," he said.

More than 350,000 abdominal hernia repair surgeries occur annually in the United States, and of these 75 percent are primary ventral hernias, where the weakening of the abdominal wall is at the navel.

One expert notes, though, that every procedure is different because each situation is different.

"As with any treatment - medical or surgical - there is nuance and patient-specific factors that should be considered when deciding on a treatment," said Dr. Robert Andrews, director of acute care surgery at Lenox Hill Hospital in New York City.