International Group of Hernia Mesh Experts Warn Against Mesh Plug-and-Patch Repair

A group of international hernia mesh experts and surgeons recently published guidelines for groin hernia management and through their research, the group concluded surgeons should not use mesh plug-and-patch repair techniques.

The group formed because more than 20 million patients undergo groin hernia repair annually and the many different approaches, treatment, and techniques for groin hernia repair “warrant guidelines to standardized care, minimize complications and improve results.”

The HerniaSurge Group is an expert group of international surgeons and one anesthesiologist pain expert. Members are from all continents who have specific experience in hernia-related research. Care was taken to include surgeons who perform different types of hernia repair, including groin hernia surgery.

The group held five, two-day meetings in which evidence-based medicine (EBM) training occurred and 166 key questions were developed. EBM rules were followed in the research process and all articles prior to inclusion were scored by teams of two or three. The group formulated 136 statements and 88 recommendations. An external review was then performed by three international experts, who recommended the guidelines with high scores.

The 165-page document encompasses hours of research, discussions, and evidence-based material and recommendations for hernia mesh surgeons by the HerniaSurge Group.
Notably, the plug-and-patch repair method is not recommended by the panel of experts.

“The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh … is currently not recommended,” page two of the guidelines reads.

Furthermore, the information suggests because of human anatomy and physiology, mesh must conform to a certain structure and stability profile.

BBGA partner Jim Matthews

Requirements for mesh construction include: “sufficient strength to reinforce the repair, the ability to stretch … the ability to integrate into tissues without forming blocking scars, a low risk of precipitating chronic inflammation, and a low risk of bacterial adherence. … the risk of complications may be increased by the use of a poorly designed mesh.” (pg. 35)

“This confirms that Bard’s Perfix Plug and 3D Max hernia meshes should never have been put on the market,” BBGA partner Jim Matthews said.