The problem with surgical dogma is that it discourages critical thinking at a cost to some patients. Take the notion that hernia mesh is the standard of care. This is dogma. The authorities have judged the risks and benefits of using mesh out weigh not using it and are saying that it should be used in all cases and that if you do not you are not practicing the standard of care. Feverent defence of an idea is the halmark of dogma and those who question it are heretics, But in holding mesh hernia surgery as the standard of care someone is deciding for the rest of us that the benefits outway the risks. But this is a judgement call that a reasonable and capable surgeon can disagree with. There are surgeons who can do pure tissue repairs with low recurrence rates that hold up to mesh repairs. And who should decide that chronic pain at 20% and crippling pain at 5% is an acceptable outcome campared to the so called benefits of mesh? Having taken care of many patients with horrible mesh pain I do not believe this is acceptable. In many cases not repairing the hernia would be better. Another dogma - all hernias must be repaired.