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.

Regardless, having an open discussion with a surgeon to outline expectations and possible outcomes is the best way to make an informed decision on whether a no mesh hernia repair could be the right decision. Some patients may feel like a slight increase in the chances of a recurrent hernia – from 1-2% to upwards of 10% – outweigh the risks of having a mesh placed at the time of surgery. While other patients may prioritize only having a hernia repaired one time and understand the very small chances of having lingering pain after their recovery.

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.

Mesh Versus No Mesh Hernia Repairs

While a no mesh hernia repair is an option for some patients, many others will strongly benefit from the use of a mesh. Some patients have heard or read negative information about mesh surgery. However, the unbiased government agency The National Institutes of Health performed a study of whether mesh should or should not be used for hernia surgery and found that in the vast majority of patients, a mesh is the recommended approach to repairing a hernia. They also found that in the right hands, the use of a mesh causes little if any additional risks to the patient. Read the article by clicking on the logo below:

Patients can read more on our ‘Truths About Hernia Mesh‘ page.

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.