Hernia Mesh Alternatives

Most hernias require surgical repair. Hernia mesh is the most common surgical treatment to repair hernias. Nine out of 10 U.S. repairs use surgical mesh, as it provides long-term results with relatively few complications. However, it’s not the only option.

“For small umbilical, epigastric or ventral hernias, a primary repair using sutures to close the hernia defect without the use of mesh can be successful more than 90% of the time,” Dr. Mazen Al-Mansour, a hernia specialist and assistant professor at the University of Florida College of Medicine’s department of surgery, told Drugwatch.

Several alternatives to hernia mesh exist, and many have lower or comparable complication rates. Patients seeking alternatives to hernia mesh have two main approaches.

Only 3% to 5% of patients require emergency hernia surgery. However, since hernias tend to get larger over time as the abdominal wall muscles get weaker, most hernias eventually require repair through planned surgery.

Many surgeons consider the Lichtenstein repair the gold standard for hernia repairs. However, new research indicates that many pure-tissue alternatives can be equally effective.

There are two main types of surgical hernia mesh alternatives. Tension repairs firmly reattach tissue from opposing sides of the tear under tension. Nontension repairs use sutures to connect the sides without stretching natural tissue.

Insertion of surgical hernia mesh may not be necessary for many hernias. Several studies indicate that nonmesh alternatives offer comparable effectiveness with fewer complications than hernia mesh for certain types of hernias.

Surgeons may use one of several different techniques in nonmesh surgical repair. They vary in difficulty, success rates and potential complications. Patients should discuss these options with a health care provider before making a decision.

Bassini Hernia Repair

Introduced in 1887 by Dr. Edoardo Bassini, the Bassini hernia repair is still widely used today. This tension hernia repair involves stitching the muscles above the hernia to the ligaments below.

At the time of its development, the Bassini hernia repair had a 3% recurrent rate. Modifications to the technique and varying skill levels of practicing doctors have resulted in a current recurrence rate between 10% and 15%.

Desarda Hernia Repair

Desarda hernia repair emerged in 2001 and is used for inguinal hernias. This pure-tissue hernia mesh alternative uses existing muscle tissue to cover the hernia. This reinforces the inguinal canal’s posterior wall, serving the same purpose as surgical mesh without foreign body complications.

Desarda hernia repair has proven itself a viable alternative to surgical mesh. The recurrence rate after this procedure is around 1%. Patients should discuss these and other hernia repair options with a health care provider.

McVay/Cooper’s Ligament Hernia Repair

Cooper’s ligament hernia repair requires an extensive surgical procedure. It involves carefully attaching muscles from one side of the hernia to the pectineal (Cooper’s) ligament and closing the femoral canal.

McVay hernia repair has a low morbidity rate and recurrence is between 3% and 15%. Some surgeons consider it an appropriate treatment for large indirect and direct hernias, while others prefer it for all groin hernias.

Moloney’s Darn Repair

As a tension-free open technique, Moloney’s darn repair uses two continuous sutures to connect the sides of a hernia. Recurrence is very rare, and it offers a cost-effective alternative to surgical mesh.

Darn repair shows promise as an alternative to other procedures. Research indicates patients experience less pain and a quicker recovery compared to Shouldice repair. Several studies support the claim that Moloney’s darn repair represents a good alternative to Lichtenstein mesh repair.

Shouldice Hernia Repair

Canadian Dr. Edward Earle Shouldice developed the Shouldice hernia repair technique during World War II. It’s a complex procedure that requires extensive training to perform correctly. 

During a Shouldice hernia repair, a surgeon cuts through three layers of muscle and connective tissue, places the intestines back into the abdomen and then brings opposite sides together. Overlapping layers creates a natural replacement for the torn abdominal wall. The Canadian Journal of Surgery reports that it has very low recurrence rates when an experienced surgeon performs it.

Shouldice went on to open the Shouldice Hernia Hospital in Toronto in the 1940s. Fewer than 2% of hernia repairs performed at the hospital use surgical mesh.

Nonsurgical approaches to hernia management are not considered curative but may ease symptoms or delay the need for surgery. They’re also helpful for people who don’t qualify for hernia surgery, including individuals on blood thinners or with health conditions that make surgery too risky.

In small hernias not requiring surgery, nonsurgical interventions can be effective care options. Patients should only use these treatments under medical supervision. Some, such as prescribed exercise, can help improve circulation and reduce inflammation, while others may worsen symptoms or lead to complications.

Can Watchful Waiting Postpone the Need for Hernia Surgery?

Watchful waiting, the process of carefully monitoring a hernia for developing or worsening symptoms, may allow some patients to delay surgery. However this depends on individual circumstances. Doctors generally don’t advise waiting for large hernias and most mild groin hernias.

“If the hernia is minimally symptomatic one should consider watchful waiting — no surgery at all — unless the hernia is deemed to carry high risk of incarceration or strangulation,” Al-Mansour said.

A surgeon may recommend a watchful waiting approach for patients who aren’t good surgical candidates. Patients should always consult with their doctors about their condition.

Can Medicine Treat a Hernia?

Medicines are typically not effective at treating hernias. However, they may help with symptom management, depending on the type of hernia.

Medications can help address underlying health conditions, such as acid reflux associated with hiatal hernias. However, most hernias will eventually require surgical repair.

Patients should consider the differences between each procedure when comparing hernia treatment options. Discuss your concerns with your doctor.

The type of hernia mesh alternative chosen can impact outcomes significantly. An experienced surgeon can provide insight into which treatment is best suited to specific hernias.

Work alongside your health care provider to choose a hernia repair method.

A 2024 analysis published in the medical journal Cureus suggested that surgeons should weigh the benefits and drawbacks of tissue-only repairs versus repairs made with mesh when deciding on the best surgical approach for inguinal hernia repair. While tissue-only repairs offer simplicity, repairs with mesh may reduce recurrence rates and complications. 

Having questions prepared for your doctor can help you learn more about each approach.

Bringing a notebook to appointments provides an excellent place to record the doctor’s answers to questions and concerns. Some patients find it more convenient to record the conversation on a phone to replay later.