Can incisional hernias be repaired without mesh.


Yes. Very large incisional hernias and incisional hernias in the epigastrium however have very high recurrence rates if mesh is not used. I am mostly successfully avoiding mesh but when I do use mesh it is for these types of hernias. One thing that I do differently than many other doctors when I do use the mesh is that I do not put it under the abdominal wall near the intestines. The worst problems created by mesh are when it is in contact with the intestines. I believe mesh is better placed on top of the fascia and muscle where it is insulated from the intestines. Also it is much easier to securely ancor the mesh to the external oblique fascia than to the peritoneum and transversalis fascia.



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