The reason mesh became so popular in the UK was in response to high rates of hernia recurrence after surgery. However, with experience, it is possible to repair hernia without mesh and with low rates of recurrence. Please feel free to discuss this at your consultation.

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When the mesh is inserted into the abdominal cavity, for example for the repair of an incisional hernia, the mesh is coated on one side to prevent the bowel from sticking to it, (Dynamesh IPOM, coated with anti-adhesive polymers, Proceed or Parietene Composite)

There is a huge range of meshes available, supplied by a range of companies. In principle, however, there are two main types. Heavyweight small porous, and lightweight large porous meshes.
The heavyweight meshes are designed to guarantee mechanical stability. They create a dense scar plate.

In contrast, lightweight meshes are designed to mimic the physiological movement of the abdominal wall. Meshes in this group have large pres and high flexibility. There is a significant reduction in scar tissue formation with these meshes.

Studies have shown that mesh complications are rare. However, some of the reported risks of mesh are serious and can be severe. Early results suggest that complications are less common with lightweight large pore mesh.

Complications of mesh repair

• Seroma
• Infection
• Chronic pain
• Recurrence
• Fistula
• Degradation

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• Hernia Recurrence
• Nerve injury
• Wound Infection
• Mesh Infection
• Pain
• Testicular injury
• Seroma

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Driving is not permitted for 48 hours after a general anaesthetic and you should be confident to perform an emergency stop. I generally advise patients to wait for approximately 5 days before driving.

The decision about when to return to work is more variable and depends really upon the requirements of the individual’s job. For someone who is mainly office based, then a return to work at 7-10 days is normal. For those whose job is more physical then it may be possible to return to work light duties before returning to hard physical work by 4 weeks.

In general, you are advised is to avoid any activities that cause pain.

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The principal advantages of this technique over open surgery are:

• less post-operative pain,
• a quicker recovery a
• a quicker return to full physical activities.
• There is no significant difference in the recovery after TEP or TAPP repair.

What complications can occur?

• Pain
• Bleeding
• Wound infection
• Mesh infection
• Scar
• Difficulty passing urine
• Atrophy of the testicle (Shrinkage)
• Hernia recurrence
• Deep Vein Thrombosis, Pulmonary embolus
• Bowel injury
• Seroma

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The principal advantages of this technique over open surgery are:

• Less post-operative pain
• A quicker recovery
• Faster return to full physical activity

The TEP repair differs from the TAP in that the abdominal cavity is not entered with the laparoscope.  All the surgery is performed in the layers outside the peritoneum.  The risk of bowel injury is therefore less with this technique.

The TEP repair is particularly recommended for the repair of bilateral inguinal hernias and recurrent inguinal hernias.  The procedure is performed under general anaesthesia (Asleep).  Three small incisions are made in the midline between the umbilicus and the pubic bone.

Complications that can occur

• Pain
• Bleeding
• Wound infection
• Mesh infection
• Scar
• Difficulty passing urine
• Atrophy of the testicle
• Hernia recurrence

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The mesh repair is the technique most commonly used to repair inguinal hernias. An incision is made in the groin, to expose the weakness in the abdominal wall. If there is a sac associated with the hernia, it is called an indirect hernia. In this case, the sac is excised. Where there is no sac, the hernia is a direct hernia. In this case, the weakened layers of the posterior inguinal canal are repaired. In either case, for both direct and indirect hernias, a synthetic mesh is placed between the layers of the oblique muscles. The mesh is secured in place with sutures. The purpose of the mesh is to cover the area of weakness and produce a strong repair.

What does the operation involve?

The operation is usually performed under local anaesthetic with you awake. The groin area is temporarily numbed. Occasionally general anaesthetic is advised for especially large hernias. The operation takes approximately 30 minutes. You can usually go home on the same day as the operation. The repair is uncomfortable for 5-10 days after surgery. During this time you should rest and avoid lifting.

As the discomfort improves you can gradually increase your daily exercise, in particular walking, to strengthen the abdominal muscles.

What complications can occur?

• Pain
• Bleeding
• Wound infection
• Mesh infection
• Scar
• Difficulty passing urine
• Numbness around the scar
• Atrophy of the testicle (Shrinkage)
• Hernia recurrence

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