Mesh choice in inguinal hernia repair: key evidence and practical considerations

Eduardo León-Madrigal; Jeffrey Barragán-Ortega; Diego Ruiz-Ruiz; Emilio Godínez-Lazarini; Manuel E. Tamayo-Gómez; Alfonso Sandoval-Polito; Miguel  De Hoyos-Riebeling; Dalia A. De Luna-Vega; Andrea Navalón-Calzada; Juan H. Marquez-Moreno; Aline Gonzalez-Martinez; Camila Robles-Rojas; Stephanie J. Chon-Pineda; José Emiliano González Flores

doi:10.18203/2349-2902.isj20261197

Authors

Eduardo León-Madrigal Escuela Superior De Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
Jeffrey Barragán-Ortega National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
Diego Ruiz-Ruiz National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
Emilio Godínez-Lazarini PEMEX Central North Hospital, Mexico
Manuel E. Tamayo-Gómez Dr. Javier Buenfil Osorio" General Hospital of Specialties, Campeche, Mexico
Alfonso Sandoval-Polito School of Medicine and Health Sciences, Tecnológico De Monterrey, Mexico City, Mexico
Miguel De Hoyos-Riebeling National Medical Center “20 de Noviembre”, Mexico City, Mexico
Dalia A. De Luna-Vega National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
Andrea Navalón-Calzada Spanish Hospital, Mexico City, Mexico
Juan H. Marquez-Moreno Autonomous University of Guadalajara, Jalisco, Mexico
Aline Gonzalez-Martinez National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
Camila Robles-Rojas School of Medicine, Westhill University, Mexico City Campus, Mexico City, Mexico
Stephanie J. Chon-Pineda School of Medicine and Health Sciences, Tecnológico De Monterrey, Mexico City, Mexico
José Emiliano González Flores School of Medicine and Health Sciences, Tecnológico De Monterrey, Mexico City, Mexico

DOI:

https://doi.org/10.18203/2349-2902.isj20261197

Keywords:

Inguinal hernia repair, Prosthetic mesh, Mesh selection, Lightweight mesh, Chronic postoperative pain, Laparoscopic hernia repair

Abstract

Inguinal hernia repair is one of the most commonly performed procedures in general surgery, with prosthetic mesh reinforcement widely recognized as the standard of care due to its ability to significantly reduce recurrence rates. However, the increasing diversity of available mesh products has introduced important considerations regarding optimal prosthetic selection. Beyond structural reinforcement, mesh characteristics have been shown to influence postoperative pain, foreign body sensation, functional recovery, and overall patient quality of life. This focused review summarizes key evidence surrounding mesh selection in contemporary inguinal hernia repair, emphasizing practical considerations relevant to daily surgical practice. Core variables analyzed include mesh weight, pore size, density, anatomical placement, and fixation strategies. Lightweight meshes have demonstrated favorable outcomes in terms of reduced chronic postoperative pain and improved abdominal wall flexibility, while maintaining acceptable recurrence rates in most primary repairs. Similarly, large-pore and low-density meshes appear to enhance tissue integration and reduce fibrotic response compared with microporous prostheses. Mesh positioning within anterior or posterior planes, as well as the choice between penetrating and atraumatic fixation methods, further influences postoperative outcomes. Techniques such as glue fixation or non-fixation in selected laparoscopic repairs may reduce pain without compromising stability. Ultimately, no single mesh type is universally superior. Prosthetic selection should be individualized based on patient characteristics, hernia complexity, surgical approach, and surgeon expertise. Continued innovation in biomaterials and fixation technologies, alongside standardized outcome reporting, will be essential to refine evidence-based mesh selection and optimize long-term results in inguinal hernia surgery.

References

Fitzgibbons RJ, Forse RA. Clinical practice. Groin hernias in adults. N Engl J Med. 2015;372(8):756-63.

Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343-403.

Hernia Surge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.

Poobalan AS, Bruce J, Smith WC, King PM, Chambers WA, Krukowski ZH. A review of chronic pain after inguinal hernia repair. Clin J Pain. 2003;19(1):48-54.

Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618-25.

Klinge U, Klosterhalfen B. Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall. Eur J Surg. 1999;165(7):665-73.

Bringman S, Wollert S, Osterberg J, Smedberg S, Granlund H, Heikkinen T. Three-year results of a randomized clinical trial of lightweight or standard polypropylene mesh in Lichtenstein repair. Br J Surg. 2006;93(9):1056-9.

Junge K, Klinge U, Rosch R, Klosterhalfen B, Schumpelick V. Functional and morphologic properties of a modified mesh for inguinal hernia repair. World J Surg. 2002;26(12):1472-80.

Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, et al. Guidelines for laparoscopic treatment of ventral and inguinal hernias. Surg Endosc. 2011;25(9):2773-843.

Cobb WS, Kercher KW, Heniford BT. The argument for lightweight polypropylene mesh in hernia repair. Surg Innov. 2005;12(1):63-9.

Klinge U, Conze J, Krones CJ, Klosterhalfen B, Schumpelick V. Incisional hernia: open techniques. World J Surg. 2005;29(8):1066-72.

Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2005;95(1):69-76.

Sajid MS, Kalra L, Parampalli U, Sains P, Baig MK. A systematic review and meta-analysis evaluating the effectiveness of lightweight mesh against heavyweight mesh in inguinal hernia repair. Am J Surg. 2012;203(1):103-10.

Reinpold W. Risk factors of chronic pain after inguinal hernia repair: a systematic review. Innov Surg Sci. 2017;2(2):61-8.

Weyhe D, Schmitz I, Belyaev O, Grabs R, Müller KM, Bauer KH, et al. Experimental comparison of monofile light and heavy polypropylene meshes. Eur Surg Res. 2007;39(6):373-80.

Klosterhalfen B, Junge K, Klinge U. The lightweight and large porous mesh concept for hernia repair. Expert Rev Med Devices. 2005;2(1):103-17.

Amid PK. Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia. 2004;8(1):1-7.

McCormack K, Scott NW, Go PM, Ross SJ, Grant AM. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;(1):CD001785.

Fortelny RH, Petter-Puchner AH, Glaser KS, Redl H. Use of fibrin sealant in hernia repair. Hernia. 2012;16(4):387-92.

Sanders DL, Waydia S. A systematic review of randomized control trials assessing mesh fixation in laparoscopic inguinal hernia repair. Hernia. 2014;18(2):165-76.

Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15(3):239-49.

Belyansky I, Tsirline VB, Klima DA, Walters AL, Lincourt AE, Heniford BT. Prospective comparative study of postoperative quality of life after TEP vs

Lichtenstein repair. Surg Endosc. 2011;25(2):439-45.

Kukleta JF. Causes of recurrence in laparoscopic inguinal hernia repair. J Minim Access Surg. 2006;2(3):187-91.

Campanelli G, Pascual MH, Hoeferlin A, Rosenberg J, Champault G, Kingsnorth A, et al. Randomized controlled trial of self-gripping mesh versus sutured mesh. Hernia. 2012;16(5):563-70.

Ferzli GS, Frezza EE, Pecoraro AM, Ahern KD. Prospective randomized study of stapled versus unstapled mesh in laparoscopic preperitoneal hernia repair. J Am Coll Surg. 1999;188(5):461-5.

Charles EJ, Mehaffey JH, Hawkins RB, Hallowell PT, Tribble CG, Kron IL, et al. Cost analysis of mesh fixation techniques. Surgery. 2017;161(3):816-23.

Loos MJ, Roumen RM, Scheltinga MR. Classifying post-herniorrhaphy pain syndromes. Hernia. 2007;11(3):181-7.