Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
Once a patient accepts that mesh is being used, the next question is usually which one, and whether the costlier option is better.
The short answer is that the mesh is chosen for the hernia and for the layer it will sit in. Those two things decide almost everything.
A mesh is a flat sheet with open pores. It is not a plug that blocks the gap. It is a scaffold that your own tissue grows into, so that the weak area ends up backed by a sheet of strong scar tissue.
That is why the pores matter. Large pores let tissue grow through. Very dense mesh leaves a stiffer patch with less ingrowth.
Will the mesh touch bowel? If the answer is no, and it is no in most repairs, a plain polypropylene mesh is used. It is the most studied material in surgery.
If the answer is yes, because the mesh has to be placed inside the abdominal cavity, then one face needs a coating so that bowel does not stick to it. That is what a composite mesh is for, and it is the main reason some meshes cost much more.
Types of mesh and where each is used
| Type of mesh | Where it is used | Why |
|---|---|---|
| Plain polypropylene, large pore | Groin repairs, most ventral repairs | Strong, well studied, tissue grows through the pores |
| Composite or coated mesh | Where the mesh must touch bowel | One face resists sticking to the bowel |
| Lightweight mesh | Groin repairs in thin or active people | Less stiffness, so the wall feels more natural |
| Pre-shaped or three-dimensional mesh | Some groin repairs | Sits in the space without needing to be shaped |
| Biological mesh | Contaminated or infected fields | Used where a permanent synthetic mesh is unwise |
Want to know which mesh your repair would use, and why? Ask at the planning visit.
A mesh shrinks a little as scar tissue forms around it. If it only just covered the defect to start with, an edge can pull clear, and the hernia returns at that corner.
So the mesh is cut to overlap the defect generously in every direction. In a large incisional repair that overlap is several centimetres on each side. This is where a repair is won or lost, far more than in the choice of product.
Whichever is used, the lasting hold is your own tissue growing in over about six weeks. The fixation is only there to keep the mesh still until that happens.
Not on its own. Price usually reflects a coating or a pre-formed shape, and those help only in the positions they were designed for. A plain mesh, correctly sized and correctly placed, does better than a costly mesh in the wrong layer.
Where cost does matter is in the bill, and in insurance. Ask which mesh is planned and what it adds to the estimate, so there is no surprise afterwards.
It does not set off airport scanners. It does not need replacing. It does not stop a MRI scan. A thin person may feel a firm patch at the site for a few months while the tissue matures, and that usually fades.
Mesh can become infected, which is rare and is a separate subject. If a wound over the repair keeps discharging, even months later, it should be looked at.
No. The mesh is chosen for the hernia and for where it will sit. A groin repair and a large incisional repair need different materials and different sizes.
Not by itself. Price usually reflects the coating or the shape, which matter only in certain positions. A plain mesh used correctly beats a costly one used in the wrong place.
By tacks, sutures, glue, or in some repairs by the pressure of the abdomen itself. Your own tissue grows into it over about six weeks and that is the lasting hold.
It cannot be felt in most repairs, and it does not set off airport scanners. A thin person may feel a firm patch at the site for the first few months.
A plain large-pore mesh or a biological mesh, depending on how contaminated the field is. A coated mesh is generally avoided in that setting.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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