Aim Inguinal hernias (IH) can be repaired via open, laparoscopic, and robotic approaches, with or without mesh. We aim to understand the changing trends in IH repair that may serve as a guideline toward a tailored approach for hernia repair. Materials & Methods All patients undergoing primary IH repair from 2009–2021 by a single surgeon at a specialty hernia center were included. Temporal differences were evaluated using Chi-squared, Fisher's exact test, and logistic linear regression. Results Over 12 years, 533 patients underwent primary IH repair. Most were males (59.1%), average age 51.7 years, and average BMI 26.6 kg/m2. IHs were repaired via open (28.3%) or minimally invasive (MIS) approaches (71.7%), either with (93.4%) or without mesh (6.6%). Trends showed a significant increase in females undergoing IH repair (p<0.001) and increase in MIS approach (p<0.001). There was a significant decrease in open approach (p<0.001) and an overall trend away from mesh-based repairs and toward tissue-based repairs (p<0.001). Conclusions We present our hernia specialty center's best practices for IH repair, which is a result of a tailored approach. Our 12-year study shows a significant trend toward the use of MIS approach for IH repair. This is aligned with international consensus guidelines, especially for females. While mesh use remains the standard of care in the US, we show a progressive and significant trend away from the overuse of mesh in IH, especially for females.

In our practice, we have noticed an increased number of patients requiring mesh removal due to a systemic reaction to their implant. We present our experience in diagnosing and treating a subpopulation of patients who require mesh removal due to a possible mesh implant illness (MII). All patients who underwent mesh removal for indication of mesh reaction were captured from a hernia database. Data extraction focused on the patients’ predisposing medical conditions, presenting symptoms suggestive of mesh implant illness, types of implants to which reaction occurred, and postoperative outcome after mesh removal. Over almost 7 years, 165 patients had mesh removed. Indication for mesh removal was probable MII in 28 (17%). Most were in females (60%), average age was 46 years, with average pre-operative pain score 5.4/10. All patients underwent complete mesh removal. Sixteen (57%) required tissue repair of their hernia; 4 (14%) had hybrid mesh implanted. Nineteen (68%) had improvement and/or resolution of their MII symptoms within the first month after removal. We present insight into a unique but rising incidence of patients who suffer from systemic reaction following mesh implantation. Predisposing factors include female sex, history of autoimmune disorder, and multiple medical and environmental allergies and sensitivities. Presenting symptoms included spontaneous rashes, erythema and edema over the area of implant, arthralgia, headaches, and chronic fatigue. Long-term follow up after mesh removal confirmed resolution of symptoms after mesh removal. We hope this provides greater attention to patients who present with vague, non-specific but debilitating symptoms after mesh implantation.

Aim Synthetic non-absorbable mesh repair is considered standard of care for most hernias in the United States (US). The introduction of biologic absorbable mesh in the 2000’s has changed this practice and now novel synthetic absorbable and hybrid meshes are available. We aim to describe US trends of mesh use. Material and Methods We surveyed the Abdominal Core Health Quality Collaborative database for all repairs using mesh from 2012 to 2021. Mesh types and indications were analysed. Results Among 47,555 patients who underwent hernia repair with mesh, the majority were with synthetic non-absorbable meshes (96%). Absorbable mesh was placed in 2,039 (4%) patients and included biologic absorbable (893, 44%), synthetic absorbable (1,070, 52%), and hybrid (76, 4%) meshes. Synthetic non-absorbable mesh use was significantly predominant in all wound classes, including dirty/contaminated wounds (P < 0.01) [Figure 1]. Over time, we noted a trend toward lower incidence of absorbable and hybrid mesh use, from 18% to 2% (P < 0.01). Interestingly, we noted a relative increase in annual incidence of absorbable and hybrid mesh use in clean wounds, from 20% to 63% (P < 0.01) [Figure 2]. Figure 1Mesh type used in each wound classFigure 2Absorbable mesh use in clean vs. not clean wounds. Conclusions In the United States, synthetic non-absorbable meshes are commonly used during hernia repairs in dirty and contaminated fields. At the same time, there is a significant increase in the use of absorbable and hybrid meshes in the repair of hernias with clean wound classification. The costs and long-term outcomes of such surgeon choices have yet to be validated.