Mesh for Hernia Repair Reduces Recurrence: Study
But the open surgery technique increases odds of complications, researchers find
Dr. Michael Castellano, director of the hernia program at Staten Island University Hospital in New York City, said most surgeons have long believed that using mesh generally reduces recurrence. The study confirms this belief, he said.
"The infection rate in both groups is essentially similar, but the seroma [pockets of clear fluid that develop after surgery] is higher with mesh," Castellano added. "Fortunately, seromas usually resolve on their own, and rarely need drainage or significant intervention. As techniques improve, I'm sure seroma rates will fall also."
For the study, published Feb. 19 in the online edition of JAMA Surgery, Liang's team analyzed the data in nine studies done between 1980 and 2012, comparing the use of mesh versus stitches alone. In total, 637 mesh repairs and 1,145 suture repairs were included.
When mesh was used with stitches, the recurrence rate was just 2.7 percent, compared with 8.2 percent with stitches alone, the results showed.
However, mesh use increased the odds of seromas -- 7.7 percent versus 3.8 percent, the researchers found. And incision infections were slightly more common with mesh, 7.3 percent versus 6.6 percent.
The authors suggest that further studies are needed to determine if one surgical technique has clear advantages over the other.
"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.
Obesity, the mesh material used, tobacco use, technical factors related to the operation, and certain medications may affect the results, Andrews pointed out.
"I believe a safe message for patients is unchanged: Consult with an experienced surgeon and discuss your particular case," Andrews said.