Why Don’t we do Non-Mesh Repair of Inguinal Hernias?

Abstract Repair of inguinal hernias without the use of a mesh has been in vogue for many years. Advocates of the non-mesh techniques cite the various risks involved with the mesh as a cause for major concern. The most stated risks are mesh infection, chronic groin pain, testicular atrophy and male fertility issues. However, non-mesh repairs, even after proving their efficacy and safety, are not the first choice procedure for managing an uncomplicated inguinal hernia in many parts of the world. With the advent of minimally invasive surgery, there have been significant advances in the management of inguinal hernia repair in the last two decades. This article reviews current literature to critically assess the validity of mesh related complications in the light of these technical advances. In addition, it also attempts to elucidate the drawbacks of non-mesh repairs and examines the reasons as to why non-mesh repairs remain less commonly practiced worldwide today. It was found that mesh related complications are often overstated, while non-mesh repairs face challenges in their reproducibility and training. In the light of these findings, non-mesh repairs cannot be the first choice in managing an uncomplicated inguinal hernia in the present day.