Hernia Mesh: Types, Complications & Mesh-Free Repair
Understand what surgical mesh is, the different types of mesh, possible complications and how mesh-based repair compares with mesh-free hernia repair.
What is Mesh in Hernia Repair?
A mesh is a medical material used during hernia surgery to strengthen the weak area in the abdominal wall. A hernia happens when an internal organ or tissue pushes through a weak spot in the muscles. During mesh repair, the surgeon places a mesh over or around this weak area to give additional support.
Mesh is available in different materials, sizes, shapes and designs. Depending on the type and location of the hernia, the surgeon decides where and how the mesh should be placed. It can be used in both open hernia surgery and laparoscopic or minimally invasive surgery.
Mesh repair is commonly used for many types of hernias because it provides additional strength to the repaired area. However, mesh may not be required for every patient or every type of hernia. The decision depends on factors such as the size and location of the hernia, whether it is a recurrent hernia, the condition of the surrounding tissues and the patient’s overall health.
It is important for patients to understand that mesh is not the only approach to hernia repair. Different techniques may be considered depending on the individual case.
Key Points
- Mesh is used to strengthen a weak abdominal wall.
- It is available in different types and materials.
- Mesh can be used in open and laparoscopic hernia surgery.
- The choice of mesh depends on the type and location of the hernia.
- Mesh may not be required in every hernia surgery.
- Other mesh-free hernia repair techniques are also available in selected cases.
- The most suitable technique should be decided after proper evaluation by a hernia surgeon.
Types of Mesh
Modern biomaterial science offers diverse categories of meshes tailored to specific anatomical planes, contamination risks, and patient tissue characteristics. Below is an exhaustive breakdown of the six primary categories utilized by Dr. Adarsh M Patil.
Polypropylene Mesh (Lightweight vs. Heavyweight)
Polypropylene is the undisputed workhorse of hernia surgery. It is a non-absorbable, knitted synthetic polymer with exceptional tensile strength.
- Material: Polypropylene monofilament or multifilament.
- Pore Size: Macroporous (>1mm in modern lightweight variants) allowing rapid fibroblastic ingrowth.
- Infection Risk: Low-to-moderate; monofilament fibers resist bacterial harboring better than multifilament.
- Integration: Excellent tissue incorporation and collagen deposition.
- Shrinkage: Moderate (10% to 30% depending on weight).
- Best Use Case: Primary inguinal, umbilical, and clean ventral hernia repairs. Lightweight variants are strongly preferred to reduce stiffness and chronic pain.
- India Availability: Widely available, ranging from economical domestic brands to premium German/US implants (e.g., Bard, Atrium, Johnson & Johnson, Meril).
Polyester Mesh
Polyester (Polyethylene Terephthalate) is another prominent synthetic mesh known for its remarkable elasticity and soft handling characteristics.
- Material: Polyethylene terephthalate fibers.
- Pore Size: Macroporous, facilitating excellent tissue integration.
- Infection Risk: Moderate; multifilament structure requires careful sterile technique.
- Integration: Superior three-dimensional compliance matching abdominal wall dynamics.
- Shrinkage: Low to moderate.
- Best Use Case: Open retromuscular ventral hernia repairs and complex abdominal wall reconstructions where tissue compliance is paramount.
- India Availability: Readily available through major multinational surgical distributors in Bangalore.
ePTFE (Expanded Polytetrafluoroethylene)
ePTFE is a synthetic biomaterial characterized by a smooth, microporous structure designed specifically to minimize visceral adhesion formation when placed in direct contact with bowel.
- Material: Expanded polytetrafluoroethylene (Gore-Tex type).
- Pore Size: Microporous (<10 microns), preventing tissue ingrowth on the visceral side.
- Infection Risk: Higher than macroporous meshes; once infected, ePTFE is notoriously difficult to salvage without complete removal.
- Integration: Minimal tissue ingrowth on visceral face; encapsulated by fibrous tissue.
- Shrinkage: Minimal.
- Best Use Case: Intraperitoneal Onlay Mesh (IPOM) repair where the mesh touches the intestines (though largely superseded by modern composite meshes).
- India Availability: Available in premier corporate hospitals in Bangalore.
Biological / Biologic Mesh
Derived from acellular dermal matrix of human, porcine, or bovine origin, biological meshes act as scaffolds that the body gradually remodels into native host tissue.
- Material: Porcine dermis, bovine pericardium, or human cadaveric dermis.
- Pore Size: Natural collagen matrix pore architecture.
- Infection Risk: Low; highly resistant to bacterial colonization and capable of clearing established infections.
- Integration: Replaced by host cellular infiltration and neo-vascularization over 6–12 months.
- Shrinkage: Variable during remodeling phase.
- Best Use Case: Contaminated, infected, or septic surgical fields (e.g., strangulated hernias with bowel perforation, salvage operations).
- India Availability: Available on specialized order in top-tier Bangalore medical centers due to high cost.
Composite / Dual-Layer Mesh
Composite meshes combine two distinct sides: a macroporous synthetic side for robust abdominal wall integration, and an anti-adhesive barrier side (collagen, Omega-3 fatty acids, or hydrophilic film) facing the intra-abdominal organs.
- Material: Polypropylene/Polyester combined with resorbable barrier (e.g., Seprafilm, PLLA, Hydrogel).
- Pore Size: Macroporous on parietal side, non-porous barrier on visceral side.
- Infection Risk: Low-to-moderate.
- Integration: Strong parietal ingrowth with zero visceral adhesion formation.
- Shrinkage: Low.
- Best Use Case: Laparoscopic and robotic intraperitoneal ventral/incisional hernia repairs (IPOM).
- India Availability: Standard availability in advanced surgical centers across Bangalore.
Absorbable / Bioresorbable Mesh
Engineered to provide temporary mechanical reinforcement while the body heals, these meshes completely hydrolyze and disappear over several months, leaving zero permanent foreign body behind.
- Material: Polyglycolic acid (PGA), polylactic acid (PLA), or copolymer blends.
- Pore Size: Macroporous during active support phase.
- Infection Risk: Low.
- Integration: Temporary scaffolding replaced entirely by native scar collagen.
- Shrinkage: Absorbed within 6 to 36 months.
- Best Use Case: Paediatric hernia reinforcement, temporary abdominal closure in trauma/damage control surgery, or combined with biologics.
- India Availability: Specialized availability in tertiary care hospitals.
Complications of Hernia Mesh
Surgical mesh is used in many types of hernia repair to strengthen the abdominal wall.
While mesh repair is an established surgical option, like any medical implant, it can
have potential complications. These complications do not happen in every patient, and
their likelihood can depend on the type of hernia, the mesh used, its position, the
surgical technique and individual patient factors.
Understanding these possible problems can help patients make an informed
decision about their hernia treatment.
Chronic Pain After Hernia Mesh Surgery
Pain is one of the concerns some patients may experience after hernia repair. Mild pain and discomfort are common during the initial healing period, but in some patients, pain can continue for months or longer.
Chronic pain after hernia mesh surgery may have several possible causes. It can sometimes be related to irritation or involvement of nearby nerves, scar tissue, mesh fixation devices such as tackers or sutures, or the body’s response to the implanted mesh.
Pain may be felt around the surgical site or, particularly after inguinal hernia surgery, may extend towards the groin or upper thigh.
The severity and duration of pain can vary from one patient to another. Persistent pain may sometimes require medicines, further evaluation or additional treatment.
Infection
Infection is a possible complication after any surgical procedure, including mesh-based hernia repair. A mesh infection can be particularly important because the mesh is a foreign material placed inside the body.
Signs that may suggest infection include:
- Persistent redness or swelling
- Increasing pain
- Warmth around the surgical area
- Fever
- Discharge from the wound
- Delayed wound healing
Treatment depends on the severity and timing of the infection. Some infections may respond to antibiotics and wound care, while deeper or persistent infections involving the mesh may require additional surgical treatment.
The risk of infection can vary depending on the type of hernia, surgical approach, patient’s health and the type and position of the mesh.
Adhesions
Adhesions are bands of scar tissue that can develop between tissues or organs inside the abdomen. They can form after abdominal surgery and, in certain situations, may occur around a surgical mesh.
The possibility of adhesions depends partly on where the mesh is placed. Some meshes have special coatings or barriers designed to reduce direct contact between the mesh and abdominal organs when used in positions where such contact is possible.
Most adhesions may not cause noticeable symptoms. However, in some cases, they can contribute to abdominal discomfort or, rarely, complications such as bowel obstruction.
This is one reason why the position and type of mesh are important considerations during hernia surgery.
Mesh Migration
Mesh migration means that the mesh moves from its original position after hernia surgery. This is an uncommon but recognized complication.
A mesh is placed carefully during surgery, but healing, tissue changes, contraction of the mesh or other factors can sometimes affect its position.
In rare cases, migrated mesh can come into contact with nearby tissues or organs and may cause symptoms or other complications.
Treatment depends on the location of the mesh and the problems it is causing. Some patients may require observation and evaluation, while significant complications may require further surgery.
Proper surgical planning, appropriate mesh selection and correct placement are important factors in reducing the possibility of mesh-related problems.
Mesh Shrinkage or Contraction
After mesh is implanted, the body naturally responds to it by forming scar tissue and incorporating the mesh into the surrounding tissues. During this healing process, some meshes can contract or change in size and shape.
This is sometimes referred to as mesh shrinkage or mesh contraction.
In some patients, this may not cause any noticeable problem. In others, contraction can contribute to tightness, discomfort, pain or changes around the repaired area.
The extent of tissue response can depend on the type of mesh, its material, weight, structure and where it has been placed.
This is one of the reasons surgeons consider several factors when selecting a mesh rather than using the same mesh for every type of hernia.
Hernia Recurrence
The main purpose of hernia surgery is to repair the weakness and prevent the hernia from coming back. However, hernia recurrence can occur even after a technically successful repair.
A recurrence means that a hernia develops again at or near the previous repair site.
Several factors can contribute to recurrence, including:
- Size and type of the original hernia
- Weakness of the abdominal wall
- Previous hernia surgery
- Surgical technique
- Wound complications or infection
- Patient-related factors
- Healing of the repaired tissues
Mesh can reduce the risk of recurrence in many types of hernia repairs, but mesh does not completely eliminate the possibility of recurrence.
A recurrent hernia may require another evaluation and, depending on the situation, another surgical procedure.
Mesh Erosion and Fistula Formation
In rare cases, a surgical mesh can gradually erode into nearby organs, particularly when it is placed close to or in contact with the intestine.
When mesh comes into prolonged contact with the intestine, it can sometimes cause inflammation, scarring and gradual erosion of the intestinal wall. In severe cases, the mesh may eventually enter or perforate the intestine.
This can lead to the formation of an abnormal connection between the intestine and another organ or the skin, known as a fistula.
Patients may experience symptoms such as persistent abdominal pain, recurrent infection, discharge or other gastrointestinal symptoms, depending on the location and severity of the problem.
Mesh erosion into the intestine is an uncommon but potentially serious complication and may require complex surgical treatment, including removal of the mesh and repair of the affected intestine.
The risk depends on several factors, including the type of mesh, its location, surgical technique and the relationship between the mesh and surrounding organs.
Cost of Hernia Mesh
The cost of hernia surgery can vary depending on the type of hernia, surgical technique, hospital, surgeon and other medical requirements.
When mesh is used, the cost of the mesh itself becomes an additional component of the overall treatment cost. Different meshes have different prices depending on their material, design, coating, absorbability and manufacturer. Some advanced or specialised meshes can be considerably more expensive than standard meshes.
Therefore, the total cost of mesh-based hernia repair can vary significantly from patient to patient.
It is important for patients to understand that the decision regarding hernia repair should not be based on cost alone. The type of hernia, expected outcome, potential risks, recovery and available treatment options should all be considered.
For selected patients with suitable primary inguinal hernias, a mesh-free repair may be an alternative. Since this approach does not require a synthetic mesh implant, the cost associated specifically with purchasing the mesh is avoided.
Are Mesh Complications Common?
Not every patient who undergoes mesh-based hernia repair develops complications. Millions of mesh repairs have been performed worldwide, and mesh continues to be an important option for many types of hernia.
At the same time, patients should understand that mesh is a foreign material and can have potential risks.
The decision to use mesh should therefore consider the patient’s individual hernia, the benefits and possible risks of the procedure, and whether other repair options may be appropriate.
Can Hernia Be Repaired Without Mesh?
For selected patients with certain primary inguinal hernias, a mesh-free approach may be considered.
The Desarda Technique is a tissue-based technique for inguinal hernia repair that does not use synthetic mesh. Instead, the patient’s own tissue is used to reinforce the weakened area.
The suitability of a mesh-free repair depends on the type and characteristics of the hernia and the individual patient. It is not a replacement for mesh in every type of hernia.
Mesh vs Mesh-Free Hernia Repair
When it comes to hernia repair, patients often have one important question: Is mesh necessary for my hernia?
Mesh repair is a well-established option for many types of hernia. However, depending on the type and location of the hernia, the size of the defect, previous surgeries and the patient’s individual condition, a mesh-free hernia repair may also be considered in selected cases.
What is Mesh-Based Hernia Repair?
In a mesh repair, a synthetic or other medical mesh is placed over or around the weak area of the abdominal wall. The mesh provides additional reinforcement and becomes incorporated into the surrounding tissues during healing.
Mesh-based repair is commonly used for several types of hernia, including inguinal, incisional, umbilical and ventral hernias. The type and position of the mesh depend on the individual case and the surgical technique being used.
What is Mesh-Free Hernia Repair?
As the name suggests, mesh-free hernia repair does not involve placing a synthetic mesh inside the body.
Instead, the surgeon uses the patient’s own tissues to repair and reinforce the weakened area. One of the recognised tissue-based approaches for primary inguinal hernia is the Desarda Technique.
The Desarda Technique was developed by Dr. Mohan Desarda and uses a strip of the patient’s own abdominal wall tissue to reinforce the inguinal region without using a synthetic mesh.
Mesh vs Mesh-Free: What is the Difference?
| Mesh Repair | Mesh-Free Repair |
|---|---|
| Uses a surgical mesh | Does not use synthetic mesh |
| Provides additional reinforcement | Uses the patient’s own tissue |
| Used for many types of hernia | Mainly considered for selected inguinal hernias |
| Can be performed using different surgical approaches | Desarda Technique is a tissue-based repair |
| Mesh-related complications are possible | Avoids complications specifically related to an implanted mesh |
Is Mesh-Free Hernia Repair Suitable for Everyone?
Mesh-free repair is not suitable for every type of hernia or every patient. The decision depends on the type, size and location of the hernia, previous operations, tissue condition and other individual factors.
Similarly, mesh remains an important and effective option for many hernias, particularly where stronger reinforcement is required.
What is Mesh-Based Hernia Repair?
In a mesh repair, a synthetic or other medical mesh is placed over or around the weak area of the abdominal wall. The mesh provides additional reinforcement and becomes incorporated into the surrounding tissues during healing. Mesh-based repair is commonly used for several types of hernia, including inguinal, incisional, umbilical and ventral hernias. The type and position of the mesh depend on the individual case and the surgical technique being used.What is Mesh-Free Hernia Repair?
As the name suggests, mesh-free hernia repair does not involve placing a synthetic mesh inside the body. Instead, the surgeon uses the patient’s own tissues to repair and reinforce the weakened area. One of the recognised tissue-based approaches for primary inguinal hernia is the Desarda Technique. The Desarda Technique was developed by Dr. Mohan Desarda and uses a strip of the patient’s own abdominal wall tissue to reinforce the inguinal region without using a synthetic mesh.Mesh vs Mesh-Free: What is the Difference?
| Mesh Repair | Mesh-Free Repair |
|---|---|
| Uses a surgical mesh | Does not use synthetic mesh |
| Provides additional reinforcement | Uses the patient’s own tissue |
| Used for many types of hernia | Mainly considered for selected inguinal hernias |
| Can be performed using different surgical approaches | Desarda Technique is a tissue-based repair |
| Mesh-related complications are possible | Avoids complications specifically related to an implanted mesh |
Is Mesh-Free Hernia Repair Suitable for Everyone?
Dr. Sushil Deshmukh and Mesh-Free Hernia Repair
Dr. Sushil Deshmukh, a Desarda Specialist Surgeon, has a dedicated focus on the Desarda Technique and mesh-free inguinal hernia repair. His work is closely associated with the teaching and surgical practice of Dr. Mohan Desarda, the surgeon who developed the technique.
Along with mesh-free repair, Dr. Sushil Deshmukh also treats different types of hernias, selecting the surgical approach according to the patient’s individual condition.
“The important question is not simply:”
The important question is not simply:
“Mesh or no mesh?”
It is:
“Which type of hernia repair is appropriate for my condition?”
A proper clinical evaluation helps determine whether a mesh-based repair, mesh-free repair or another surgical approach is most suitable.