Hernia Mesh: The Complete Guide
Hernia mesh is the most important advance in hernia surgery of the last century, dramatically reducing recurrence. This guide explains mesh types, how mesh works, and the truth about common concerns.
Contents
What is hernia mesh?
Hernia mesh is a flexible medical implant used to reinforce a weak abdominal wall during hernia repair. The body's own tissue (fibres and blood vessels) grows through its pores, forming a strong integrated layer — the mesh acts as a scaffold.
Why use mesh?
Suture-only repairs pull muscle edges together under tension, with high recurrence. The tension-free mesh principle:
- dramatically reduced inguinal hernia recurrence;
- reduced umbilical hernia recurrence versus suture in randomised trials (HUMP);
- roughly halves recurrence in incisional hernia compared with suture;
- is therefore recommended by international guidelines for most adult hernias.
Materials
| Material | Characteristics |
|---|---|
| Polypropylene | The most widely used worldwide, strong, decades of experience |
| Polyester | Soft and flexible |
| PVDF | Relatively adhesion-resistant and stable |
| ePTFE | Smooth, historically used intraperitoneally |
| Composite (coated) meshes | Anti-adhesion layer for intraperitoneal use |
| Biologic meshes | Processed animal or human tissue for contaminated fields; expensive |
| Biosynthetic absorbable meshes | Absorbed slowly over months; for infection-prone cases |
Weight and pore size
Lightweight, large-pore meshes are more flexible with less inflammation and foreign-body sensation — generally preferred today. Heavyweight meshes are stronger but stiffer. Also available: self-gripping meshes and 3D pre-shaped meshes for laparoscopic groin repair.
Mesh positions
| Position | Description | Notes |
|---|---|---|
| Onlay | Over the muscles, under the fat | Easy, but more seroma and wound problems |
| Inlay | Bridging the defect edges | Not recommended — high recurrence |
| Sublay / retromuscular | Behind the rectus muscle | Among the best: protected, excellent results |
| Preperitoneal | In front of the peritoneum | Excellent for laparoscopic inguinal and umbilical repair |
| Intraperitoneal (IPOM) | Inside the abdomen on the bowel | Requires a special coated mesh |
Fixation
Sutures, permanent or absorbable tacks (used cautiously to limit pain), glue (reduces chronic pain), no fixation in selected laparoscopic groin repairs, or self-gripping meshes.
Is hernia mesh safe?
Generally yes — hernia meshes are among the most widely used implants in the world, with millions placed successfully every year.
What about the scary headlines? Many lawsuits and warnings concern transvaginal gynaecological mesh for incontinence and prolapse — a completely different use. A few specific hernia mesh products have been recalled in the past. What matters is quality approved meshes, the right position and size, and surgical expertise.
Possible (rare) complications
Mesh infection (more with diabetes, obesity, smoking), chronic pain or foreign-body sensation, mesh shrinkage or folding, adhesions or — very rarely — erosion into bowel, and recurrence at the mesh edge if too small. See hernia complications.
When is mesh not used?
Children (sac ligation only — see hernia in children), very small defects (<1 cm), contaminated fields (biologic/biosynthetic mesh or staged repair), and patients who decline mesh — for whom the Shouldice repair is a good inguinal option.
Will I feel the mesh?
Most patients do not feel the mesh after recovery. It does not interfere with MRI or airport scanners and does not prevent future pregnancy.
Frequently asked questions
Does the body reject hernia mesh?
Does mesh stay for life?
Can I get pregnant after mesh hernia repair?
What is the best hernia mesh?
Scientific references
- HerniaSurge Group. International guidelines for groin hernia management. Hernia 2018
- Kaufmann R et al. Mesh versus suture repair of umbilical hernia (HUMP). Lancet 2018
- Burger JW et al. Suture versus mesh repair of incisional hernia, long-term follow-up. Ann Surg 2004
- U.S. FDA – Hernia Surgical Mesh Implants
⚠ This website is for health education and does not replace a medical examination. If you develop sudden severe pain at a hernia, vomiting, or the bulge changes colour, go to the emergency department immediately.