Do all hernia repairs need a mesh? Do we ever do hernia repair without a mesh? What are the alternatives for hernia mesh? Let us answer this question today.

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Why is Mesh used in Hernia Surgery?

Before answering this question, first let us understand what causes a hernia. A hernia happens because there is a weakness in the muscle wall. The weakness in the muscle wall leads to a gap and through the gap, intestines start protruding out. That is called a Hernia.

So, when you want to repair a hernia, what do you do? You close the gap with stitches. what if the muscle is not strong enough to hold the stitches? Then we need to use another buttress or another support like a mesh. The mesh is kept in places where the muscle strength is not reliable. Suppose you stitch the hole with stitches, after a period of three months or six months, because the muscle is innately weak, the muscle becomes thinned out and the stitches will open out and these are times where you would need to reinforce your repair, with prosthesis like a mesh.

Cases Where You Don’t Need a Hernia Mesh

So does it mean that we put a mesh for all hernias and we do a repair of hernia without a mesh? No. There are certain scenarios where you do not need a mesh to repair a hernia. So what are these conditions? Let us see them one by one.

Scenario 1: Congenital Hernias
The first scenario which doesn’t need a mesh is congenital hernia. This is usually seen in children or new born babies where there is absolutely no defect in the muscle. There is a natural window in the groin which are usually open for the testicles to pass out. Usually they close after the birth. If they fail to close the hole will remain open and the intestines will start protruding out and this is called a congenital hernia. In these hernias, all that we need to do is put back the intestine that has come back, and close the hole with a stitch because these is no weakness of muscle involved, you do not need a mesh to repair these hernias.

Scenario 2: Traumatic hernias
Second is traumatic hernia.  If somebody gets an injury, especially a stab injury in the abdomen, it can pierce through the abdominal wall and that can also cause a hole through which the intestine can come out. This is usually an emergency situation. And in these conditions, there is absolutely no weakness of the muscle wall. It is basically a injury or a trauma or a cut which has caused the muscle to give way and in these conditions, the intestine is just put back and the hernia is repaired using stitches alone in most of the cases.

Scenario 3: Small Umbilical Hernias
The third one is very small hernia, especially belly button hernia. See belly button is a region which usually does not have a muscle. It is a natural weak spot that is a point through which the umbilical cord enters the body and after the baby is born, that is usually sealed with a scar tissue or a fibrous tissue.   In some people this scar tissue or a thin plugging tissue can become weak and give raise to small defect through which the intestines can bulge out. This is called umbilical hernia. If the person has good tummy tone or abdominal wall muscle tone, and if the belly button hernia is very small, it can easily be repaired with stitches alone without the use of a mesh.

Hernia Surgery without mesh – Conclusion

There are times where very young people with good muscle tone where even groin hernias can be repaired without mesh. But these are scenarios which are quite less common than the usual hernia scenarios we see. So majority of patients we would require to use a mesh but not all hernias require a mesh. Like I told you, these are the scenarios where we need not use a mesh to repair a hernia and we a simple repair of the muscle with simple stitches would suffice.

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