Non-mesh Hernia repair

Non-mesh Hernia repair – What you need to know 

A hernia is a common medical condition that affects 10% to 12% of the adult population annually. A hernia is caused when internal tissue, protrudes through the weak spot in the abdominal wall resulting in a bulge. Sometimes this can be internal, and we don’t see a bulge.

Occasionally, when a hernia grows in size and the intestinal parts get trapped, and starts to compromise  immediate surgery is required, otherwise surgery is elective and you can chose a surgical approach at your convenience that approximate the two types of hernia repair.  Surgery is performed with and without mesh. If you’d rather go without a piece of plastic stapled into your groin what are the options?


How is non-mesh hernia repair performed?

A non-mesh hernia is performed by suturing nearby abdominal wall tissues to itself rather than the usage of a plastic mesh to reinforce the wall. This significantly reduces the risks associated with mesh usage such as triggered reaction by the body’s nervous and immune system to reject the implant (mesh).

Non-mesh hernia repair is usually performed by highly trained and experienced  surgeons The method is time tested as the gold-standard over 80 years.  A technique hanging around that long, does so because it has been shown to be effective whether one looks at the quality  of the repair, without recurrence or the lack of pain or other complication.   The hernia opening during the surgery is closed by the patient’s replacing one’s  own nearby tissues. Hence, it is called as pure tissue repair. Detractors often bemoan this repair is fashioned under tension, because of the tension placed on tissues during suturing.

This is patently untrue with respect to the Shouldice hernia repair,   surgeons who are skilled in this technique, know how to mobilize tissue and place it into a new position without undue tension. It's only with inexperienced and unskilled surgeons or the method itself results a lot of tension placed on tissues pulled into a new position.


Different procedures in non-mesh hernia repair

There are different methods used for the non-mesh hernia repair. These methods broadly fall under two categories: Tension-free repair and Tension repair.

1.  Shouldice Hernia Repair

Shouldice hernia repair technique is the gold standard for the treatment of prosthesis (mesh) free repair performed by doctors over many decades. This pure-tissue method was devised by a Canadian surgeon Dr. Edward Earle Shouldice during the 2nd world war to help soldiers return to active duty. With the final adjustments to the technique completed between 1948 -1952, the technique has remained the world—wide gold standard ever since, with the lowest recurrence rate ever.

This is a complex four-layer repair procedure. Firstly we use the nearby tissues in a unique way of incorporating the inguinal ligament to create a cuff or valve mechanism, to create a cuff or valve mechanism, thus extending the muscular ring to prevent the in indirect recurrence.  The transversalis fascia from the  abdominal wall is incised laterally to the tubercle to create the upper and lower flaps which are then overlapped with 2 layers of sutures. Muscles are gently placed in a distributive, flexible, vital and reinforced framework to each other and to the inguinal ligament at its base reinforcing the floor of canal. We use a running, continuous suture spreading the distracting forces in the wound across the entire length of the wound. This accomplishes a strong floor of the inguinal canal preventing the direct recurrence. The transversalis fascia to the inguinal ligament with interrupted non-absorbable monofilament suture. This procedure is carried out by imbrication. The reoccurrence rate for this procedure varies from 10 to 15 percent and has largely fallen from favour.

3. McVay/Cooper’s ligament repair

This technique was introduced in the year 1942 by Dr.Chester Mcvay. This procedure is an improvised version of Bassini repair and is suitable in the treatment of large hernias.

In this technique, the doctor places interrupted sutures pulling, under tension, the conjoined tendon (internal oblique and transversus abdominis) to the Cooper ligament with non-absorbable interrupted sutures. Coopers ligament is very strong, and many times when using this technique, patients walk hunched over at the hips to relieve the tension on the repair.  This procedure has been performed in the past  for patients inguinal herniorrhaphy and femoral hernia. The recurrence rate however after this repair is high, du to the tension.

4. Desarda repair

This method was presented by Indian surgeon Dr. Mohan Desarda in 2001. This is a tension-free procedure. It is predominantly used in the treatment of groin hernias.

In this method, a small strip will be separated from the upper part of the aponeurosis which will be sutured with the ligament below. Then, the new layer is sutured behind the spermatic cord to form a new layer that reinforces the deep narrowing of the abdominal wall.

5. Guarneiri repair

This repairing technique was first proposed and performed by Dr. Antonio Guarnieri in 1988. It falls under the tension-free technique. This pure tissue method has a low recurrence rate of less than 1%.

In this procedure, the outer aponeurotic flap is sutured to the rectus sheath, which narrows down the inguinal canal and that of an inguinal triangle. The lateral flap is covered adequately with the medial flap that reduces the tension of the oblique aponeurosis from moving.


Advantages of Non-mesh hernia repair

Following are the advantages of non-mesh hernia repair:

  1. Low cost
  2. Reduced post-surgery complications
  3. Low recurrence rate
  4. Short non-complex surgery procedure


Consult our medical experts today

Hernia doctors at Ansa healthcare are certified and highly trained medical professionals who are committed to helping the patients with tailor-made comprehensive repair surgery. Our surgeons have a proven record of success rate in performing mesh and non-mesh hernia repair over two decades.

The Shouldice hernia method needs exclusively trained hernia surgeons because the technique requires the utmost attentive need. At ANSA healthcare, quick treatment is initiated when there is severe abdominal pain, intense abdominal cramping, unusual high fever (Above 100°F), or no proper bowel movements for more than two days by a comprehensive team, equipped with the state-of-art technologies.

Also, ANSA healthcare provides timely consultation, pre & post operative care, therapeutic lifestyle corrections till your surgery wounds heal. If you or your loved ones face any of these symptoms persistently, then please make use of the ANSA online health opinion to receive proper health guidance.  You can consult one of our reputed medical practitioners by filling the form.

Also, at ANSA healthcare we have the best hernia surgeons. Ontario hernia clinic is headed by Dr. Ash Maharaj, BSc MB BCh FACS, a fellow of the American College of Surgeons.

His expertise includes treating outpatients with Gastrointestinal Medicines, Natural Tissue Hernia Repairs (Shouldice hernia method) and Clinical Lead Minimally Invasive Hemorrhoid Therapies ProctoCAN

Dr. Ash is a Fellow of the American College of Surgeon/ a. Member of the  Canadian Association of General Surgeons. He is recommended as he has a low recurrence rate and higher recovery rate.


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