The rational use of mesh in hernias. A perspective.

The decision to use mesh in abdominal wall hernia repairs is not always based on rationale. Some surgeons use mesh on nearly all cases, encouraged by the impression that they never get recurrences. Other surgeons rarely use mesh, citing the fact that there is always enough tissue on site and that foreign bodies can have their complications. A third group of surgeons will respond to the particular need of that herniorrhaphy. Because few surgeons have a large personal experience, it becomes difficult to scan the spectrum of hernias seen in the surgical population. Yet, when numbers are available, a pattern may be discerned which reveals four classes of hernias. These four classes are those which require mesh--"rarely" (less than 1%), "sometimes" (less than 5%), "frequently" (38% and 63.3%) and "always" (91.0% and 100%). These statistics should provide surgeons with some insight as to when mesh may be used.