Can Hernia Surgery Be Done Without Mesh? Candidate Selection & Outcomes
Dr. Todd Harris discusses the possibility of performing inguinal and umbilical hernia repairs without mesh, focusing on long-term outcomes and candidate criteria.
Specialist Overview
No-mesh hernia repair, also known as primary tissue repair, utilizes the patient’s own healthy tissue and specialized suture techniques to close a defect, completely avoiding the use of prosthetic or synthetic mesh. This approach is highly effective for patients who prefer a “natural” repair or have concerns regarding foreign-body reactions, chronic inflammation, or mesh-related complications.
- The Shouldice Technique: Recognized as the gold standard of tissue repair, this method involves a meticulous, four-layer imbrication of the abdominal wall to reinforce the inguinal floor.
- Anatomic Restoration: We focus on the Shouldice techniques to restore the natural integrity of the inguinal canal without altering the body’s native biomechanics.
- Patient Selection: Success in no-mesh repair is highly dependent on patient factors such as BMI and hernia size. We provide a comprehensive evaluation to ensure a durable, low-recurrence outcome.
Innovation Through Natural Repair
Dr. Todd Harris is one of a select group of surgeons nationwide with high-volume expertise in traditional tissue-to-tissue repairs. As an 11-year OCMA Physician of Excellence (2015–2025) and ACHQC Verified Surgeon of Quality, he combines “old-world” surgical mastery with modern recovery data. Our no-mesh protocols are anchored by our national leadership in the NOPIOIDS trial (NCT05929937) and our published research on evidence-based pain management (PMID: 39724506).
Is a No-Mesh Repair Right for You?
While modern mesh is a cornerstone of durable hernia repair, many patients are interested in a ’tissue-only’ alternative. In this video, Dr. Todd Harris explains our approach to non-mesh hernia surgery. We focus on identifying the ideal candidates—typically those with smaller defects and a healthy BMI—where primary suture repair offers the best balance between avoiding foreign materials and preventing recurrence. Our goal is to provide a specialized, personalized surgical plan that respects your preferences while ensuring a permanent result.
Overview of No Mesh Hernia Repairs
A no mesh natural tissue hernia repair is just that: the use of a patient’s own tissues to close and/or reinforce a hernia repair. A hernia develops at a point of weakness in the abdominal wall muscles. Over time, this weakness eventually becomes an actual hole, through which fat or internal organs protrude through. Obviously repairing a hernia of any type involves closing or patching that hole in the muscle. Using only a patient’s own natural tissues to repair a hernia can be problematic since it’s a weakness of the patient’s own tissues which is what caused the hernia in the first place.
When repairing a hernia without mesh, the hole in the muscle is closed, sewing together a patient’s own natural surrounding tissues. This contrasts with mesh hernia repairs in that an artificial mesh is placed over or under the hernia repair after it is closed to provide additional reinforcement and strength to the repair. Obviously without this added strength, no mesh repairs come with an increase in recurrence rates, or the chances that a patient’s hernia will return in the future.
It’s very important to point out that hernia mesh is utilized in about 99% of hernia repairs performed in our country every year. When used by an experienced hernia surgeon, the use of mesh is extremely safe and very well tolerated by patients.
Since patients undergoing a no mesh repair do not have the added strength of a mesh, this surgery is only offered to appropriate candidates:
- Patients who are thin and healthy
- Patients who have relatively small sized hernias
- Patients who wish to avoid the use of mesh in their hernia repair
Other patients who can benefit from a no mesh natural tissue repair may include:
- Patients who suffer from autoimmune diseases
- Patients who are extremely sensitive to foreign bodies in their system
There is no definitive cut off for the criteria above. Instead, making the decision to use mesh or not should be made on a case by case basis with a qualified surgeon. This includes balancing a patient’s personal priorities against their hernia characteristics. In the end, a patient’s desires and expectations should guide the overall approach. A patient who prioritizes avoiding a mesh at all costs, may be a better candidate for no mesh compared with a patient who prioritizes minimizing his/her chances that the hernia will recur in the future.
No Mesh Hernia Repair – Inguinal
A Canadian Surgeon Dr. E.E. Shouldice developed a revolutionary no mesh technique for inguinal hernia repairs in 1945. Since that time, the Shouldice technique has been performed worldwide to offer patients a no mesh inguinal hernia repairs with excellent outcomes. The Shouldice technique is the approach that our center utilizes when performing a no mesh natural tissue inguinal hernia repair.
While it has not been proven through medical studies, some hernia experts believe that in young, thin, active, athletic patients with small inguinal hernias, the use of mesh may contribute to chronic pain after surgery. Keep in mind that while this may be true, medical studies have repeatedly demonstrated that in expert hands, chronic pain occurs in under 1% of patients and that the use of mesh reduces the chances of a recurrent hernia in the future.
Outcomes & Expectations: Non-Mesh vs. Mesh Repair
Patients often ask about the trade-offs of choosing a tissue-only repair. In this video, Dr. Todd Harris provides a transparent look at the data. While mesh repairs generally offer a recurrence rate of 1-2%, modern non-mesh techniques in appropriate candidates still achieve a 92-96% success rate. Dr. Harris also addresses the misconception that mesh is the primary driver of chronic pain, explaining how high-volume surgical expertise is the true factor in preventing nerve entrapment.
No Mesh Hernia Repair – Umbilical and Ventral
It’s important to balance the desire to avoid the use of a mesh with the chances that a patient’s hernia may recur in the future after it is repaired. Patients who have larger hernias with more damage to the surrounding tissues and muscles may have an unreasonably high chance of a recurrent hernia. Also, having a larger body habitus and higher body mass index (BMI) puts significantly more stress and strain on a hernia repair also increasing a patient’s chances of having a recurrent hernia. Therefore, these patients may not be good candidates for a non mesh repair.
Conversely, in select patients who have relatively small umbilical or ventral hernias and are lean with a low BMI, a primary no mesh natural tissue repair can be offered without the fear of having an unreasonably high chance of a recurrence. While there are no specific cut offs for these criteria, most surgeons feel that a 1-2cm hernia can be a candidate for a no mesh natural tissue umbilical or ventral hernia repair. Patients who have a BMI of 25 or less are usually good candidates for a no mesh repair.
The approach for a no mesh natural tissue repair for an umbilical or ventral hernia is by sewing the muscles closed with sutures. Ensuring that healthy tissues are brought together with strong sutures will help provide a robust repair. Patients themselves are important parts of a successful outcome by allowing the freshly repaired muscles to heal and maximize the strength of the repair. The most important aspect of having a successful outcome after surgery is participating in an open discussion of the risks and benefits of no mesh surgery with a qualified surgeon.
Tension Vs. Tension-Free Hernia Repair
The term ‘tension’ or ‘tension-free’ is commonly used when describing a particular hernia surgery. Hernias are caused by a weakening of the abdominal muscles which over time develops into a true hole. For patients who desire a no mesh repair, the muscles surrounding the hernia defect are sewn back together to close the hernia. This pulling together of the muscles creates tension which his why primary (no mesh) repairs are considered ‘tension repairs’.
In many patients, whether due to the size of the hernia or the patient, it’s not advisable for a surgeon to simply pull the muscles back together. In those cases, most hernia specialists today utilize a mesh to help strengthen the muscles and the hernia repair. When using a mesh, the muscles themselves are often not sewn together limiting the tension on the tissues providing a ‘tension free’ repair. Instead, a mesh is placed over or under the hole in the muscle to prevent anything from pushing through the abdominal wall.
Choosing a Non-Mesh Repair: Patient Autonomy and Safety
While modern surgical mesh is statistically the most durable option, Dr. Todd Harris understands that for patients with autoimmune diseases or foreign body sensitivities, a tissue-only repair may be the preferred choice. By weighing personal health priorities against recurrence rates, we help you decide on a specialized plan that minimizes inflammatory risk. Dr. Todd Harris discusses the clinical benefits of tissue-only (non-mesh) hernia repair for patients with autoimmune concerns or foreign body sensitivities.
Dr. Harris continues to advance open surgery outcomes as the Principal Investigator for the NOPIOIDS trial (NCT05929937), focusing on narcotic-free recovery for both open and laparoscopic repairs.
Patients can read more on our ‘Truths About Hernia Mesh‘ page.
Mesh Safety: Separating Fact from Fear
We understand that headlines about hernia mesh can be alarming. In this video, Dr. Todd Harris explains why the data supports the use of modern, lightweight mesh for the majority of patients. By using the ‘tension-free’ repair method—think of patching a hole in old jeans rather than pulling the fabric tight—we can drastically reduce the risk of recurrence. Our practice uses only the most advanced, biocompatible materials to ensure your repair is strong, flexible, and permanent.
Our Approach
Our office specializes in the surgical repair for all hernia types. We provide patients with the full spectrum of treatment options from open no mesh hernia repairs to advanced minimally invasive laparoscopic techniques. Dr. Harris and our team perform over 500 hernia repairs each year making us the busiest center on the West Coast, and one of the top 3 in the country.
For over 10 years we have partnered with the Abdominal Core Health Quality Collaborative (ACHQC) to track the outcome of every surgery we perform. Year over year, our nationally leading outcome data shows a lower chance of hernia recurrence and a lower risk of developing chronic pain – data which we actively publish on our website. Our commitment to cutting edge hernia care, the full spectrum of surgical options, as well as research and transparency in our data, helps ensure you will have the best outcome after your hernia surgery.
Dr. Harris, Thank you for saving Justin’s life. You saw how much he suffered. When no pediatric surg/gi would touch him, you saved him!
