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Open Mesh Vs Laparoscopic Mesh Repair

Mesh is a significant part of hernia repair surgeries, either open or laparoscopic. This content piece is intended to guide you on how open and laparoscopic hernia mesh work for inguinal hernia repair. To know more about hernia mesh repair surgery, you may consult expert general surgeons at Pristyn Care.

Mesh is a significant part of hernia repair surgeries, either open or laparoscopic. ... Read More

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    Dr. Dhamodhara Kumar C.B (0lY84YRITy)

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What Is a Hernia Mesh?

A hernia mesh is a flexible medical apparatus used during surgery to bolster damaged tissue surrounding a hernia. Typically made from synthetic materials like polypropylene, polyester, or Gore-Tex (EPTFE), it is employed by surgeons to offer lasting reinforcement to the repaired region. The mesh, with its woven or perforated design, acquires a mesh-like appearance. As patients heal post-surgery, their tissue grows over the mesh, yielding a lasting repair.

Hernia meshes can be broadly categorised into:

  • Absorbable mesh: A temporary reinforcement, this type degrades with time as new tissue grows.
  • Non-absorbable mesh: Offers lifelong strength and support; this type remains permanent.
  • Animal-derived mesh: Created from natural materials like pig or cow skin, this provides an absorbable, natural choice.

Open mesh inguinal and laparoscopic mesh repair are the two most common procedures among numerous hernia repair procedures.

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What Happens in Open Mesh Inguinal Hernia Repair?

For the open mesh inguinal hernia repair procedure, the Lichtenstein tension-free mesh repair is the most preferred method. This approach comprises several key steps:

  • First, the external oblique aponeurosis (a fibrous sheet of tissue) is opened to expose the inguinal canal and hernia sac.
  • The hernia sac is then mobilised and isolated. It may be inverted, divided, or ligated as required.
  • A piece of polypropylene mesh, typically of size 7.5 x 15 cm, is placed over the defect in the posterior inguinal wall.
  • The mesh gets sutured to the edges of the defect and the inguinal ligament, thus creating a new internal ring.
  • Finally, the external oblique aponeurosis is closed over this mesh.

This mesh reinforcement lends permanent strength to a weakened inguinal floor, thus reducing hernia recurrence risk compared to non-mesh repairs. Research indicates that Lichtenstein open mesh repairs demonstrate lower recurrence rates than laparoscopic inguinal hernia repairs.

What Happens in Laparoscopic Mesh Repair?

Laparoscopic mesh repair is a surgical method to treat hernias in the abdominal wall. With the help of small incisions, specialised instruments, and a mesh, the procedure of laparoscopic mesh repair is executed efficiently. 

Its key steps involve:

  • To start with, the patient is administered general anaesthesia.
  • Minor cuts are made on the abdomen to facilitate the insertion of surgical instruments and a laparoscope.
  • The abdomen is then filled with carbon dioxide gas, which helps provide a clear visualisation of the hernia.
  • A polypropylene mesh is used to cover and close the hernia defect. This is firmly held in place using staples.
  • Post-surgery, absorbable stitches are used that dissolve over time and do not require removal.

After the surgery, the patients are discharged after a few hours with the necessary post-operative instructions for a faster recovery. Laparoscopic mesh repair has revolutionised hernia surgeries due to its minimal invasiveness, quicker recovery times, and fewer complications than traditional hernia operations. 

Advantages of Open Hernia Mesh Repair

Open hernia mesh repair offers several benefits over other techniques, particularly for complex cases. These include:

  • Double reinforcement: The ability to insert two mesh pieces provides added strength, unlike laparoscopic repair, which uses only one.
  • Ideal for complex cases: Larger or more complicated hernias can be better addressed through this technique, as it provides improved access and visualisation.
  • Diverse anaesthesia options: Open hernia repair can be performed under varying types of anaesthesia, including local, spinal, or general, based on the patient’s needs and health status. 
  • Economical: It is generally more cost-effective due to simpler surgical requirements.
  • Restoring abdominal wall anatomy: Open mesh repair restores normal abdominal wall anatomy in certain hernia types through techniques like component separation.

Hence, the advantages of open hernia mesh repair make it a strong option for many patients, depending on their specific hernia characteristics and the surgeon’s expertise.

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Advantages of Laparoscopic Hernia Mesh Repair

Laparoscopic hernia mesh repair boasts several notable benefits, making it a preferred choice for both patients and doctors:

  • Lower chances of infection and haematoma due to smaller surgical incisions.
  • Reduced pain and discomfort as it involves less tissue disruption.
  • Shorter duration of hospital stays as the recovery period is quicker. 
  • Quicker return to daily routines and work.
  • Deep repair of inguinal hernias, addressing the issue at its origin.
  • Ability to address co-existing diseases such as cholelithiasis during the same procedure.
  • Preferred for recurring cases after anterior approach due to easier dissection.

These benefits make laparoscopic hernia mesh repair an appealing choice for many.

Recovery After Open Hernia Mesh Repair

The healing journey after open hernia mesh repair is often longer than a laparoscopic procedure. Let’s understand what you can anticipate during the recovery period:

  • Initial recovery: Post-surgery, patients may remain in the hospital for a day or two. It’s common to endure discomfort, pain, and swelling at the operative site. A hard lump, known as a healing ridge, might be felt at the operation site, which diminishes gradually.
  • First week: Avoid lifting heavy weights or engaging in strenuous activities. The second and third days post-surgery might increase discomfort due to anaesthesia wearing off.
  • Full recovery: This generally occurs three to four weeks post-surgery, when patients can return to their routine, including work.

Factors like overall health condition, age, type of hernia, and pre-existing conditions like diabetes or hypertension can affect recovery time. For a speedy recovery, adhere to your doctor’s guidance closely, avoid smoking, and maintain a healthy lifestyle. Even though hernia recurrence is rare, do not hesitate to seek medical help if anything unusual surfaces during your recovery period.

Recovery After Laparoscopic Hernia Mesh Repair

When you’ve had a laparoscopic hernia mesh repair, your recovery period is typically around 1-2 weeks. Here’s what to expect:

  • Hospital stay: You may leave the same day, but some patients may need an overnight stay.
  • Initial recovery: Expect some discomfort and swelling at the operation site. Refrain from heavy lifting and vigorous activities for the first week.
  • Return to work and activities: Within a few days, you can resume normal activities, including driving. However, avoid strenuous exercise for two weeks after surgery.
  • Pain management: You’ll likely be given pain medication. Always follow your doctor’s instructions for managing discomfort.

Consequently, the recovery after laparoscopic hernia mesh repair is faster but requires patience and adherence to your doctor’s advice for speedy and safe healing.

Open Mesh Repair vs Laparoscopic Mesh Repair : Which Is Best for You?

Choosing between open and laparoscopic mesh repair for hernia can depend on several aspects, like the kind of hernia, patient-related factors, and your doctor’s expertise. Here are some key points to consider:

Open mesh repair

  • Benefits include lesser recurrence rates, making it preferable for treating primary hernias.
  • It is often chosen for larger or more complex hernias.
  • It is generally cost-effective as compared to laparoscopic repair.

However, it also has certain downsides:

  • The recovery period for the procedure is longer.
  • Patients can experience more pain and discomfort during and after the operation.

Laparoscopic mesh repair

  • This method causes less pain and discomfort for the patient.
  • Recovery times are quicker, allowing patients to resume normal activities faster.
  • There is less blood loss during the procedure.

But it also has some disadvantages:

  • Recurrence rates are higher than with open mesh repair.
  • There’s a higher rate of complications, such as adhesions and mesh migration.

In conclusion, both methods have their strengths and weaknesses. Your choice between open mesh repair and laparoscopic mesh repair should be based on individual factors and your doctor’s expertise. Always consult your doctor to decide on the most ideal treatment for you.

Comparison Table Between Open and Laparoscopic Hernia Mesh Repair

Let’s explore a comparison table between open and laparoscopic hernia mesh repair:

Aspects Open Mesh Repair Laparoscopic Mesh Repair
Procedure It involves an open surgery with a larger incision. It is minimally invasive, with several small incisions.
Recovery Time 3-4 weeks 1-2 weeks
Pain and Discomfort More pain and discomfort during and after surgery Due to its minimally invasive nature, there’s less pain and discomfort.
Recurrence Rates Lower recurrence rates Noticeable recurrence rate
Complications Fewer complications Fewer complications
Cost Less expensive More expensive

 

Notably, in both repairs, the mesh is fixed using sutures and tacks, and tissue grows into the mesh over time. However, choosing between open and laparoscopic hernia mesh repairs depends on surgeon expertise, patient preference, and overall health condition.

Frequently Asked Questions

Who is suitable for these hernia mesh surgeries?

Those with certain types of hernias, like groin, incisional, umbilical, or hiatal, could be ideal candidates. However, patients with conditions like diabetes, obesity, or a smoking history might face more complications.

What are the associated risks of hernia mesh repairs?

Risks could include recurrence, infection, bleeding, and mesh migration. Poor health or medical conditions may increase complications.

Does insurance cover the cost of hernia mesh repair?

Insurance coverage can vary based on the type of hernia and individual patient conditions. We recommend discussing this with your insurance provider and surgeon.

Are there dietary or lifestyle restrictions post-surgery?

Patients might need to adhere to specific dietary and lifestyle guidelines to ensure proper healing and reduce complications.

How do doctors choose the right mesh type?

Doctors analyse individual patient cases and make decisions based on factors like the type of hernia, patient characteristics, and their expertise.

Can the mesh type be changed during surgery?

Yes, in certain scenarios, mesh type can be altered during surgery if doctors deem it necessary.

Are different mesh types linked to specific risks or complications?

Each type of mesh has its own set of potential risks, such as infection, rejection, or migration.

Is a mesh always needed in hernia repairs?

Although commonly used in hernia repairs, not all cases require a mesh. Pure tissue repair is an alternative option for certain types of hernias.

How would I know if my hernia requires surgical repair?

Pain, discomfort, or bulging at the site could suggest that your hernia needs surgical attention. Consult a surgeon for an accurate diagnosis.

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Medically Reviewed By
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Dr. Dhamodhara Kumar C.B
26 Years Experience Overall
Last Updated : April 11, 2025

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