Principles of hernia repair

Over the years a number of different type of hernia repair have been developed and tested. One fact that has become clear over time is that in order for a hernia repair to be effective and long lasting it must be “tension free”. This means that there is no point in the surgeon using strong stitches and pulling hard to bring together the edges of a hernial defect (the hole through which the hernia comes) since these stitches will simply cut through the tissue leading to the recurrence of the hernia within a short period of time (sometimes before the patient has got back to the ward). The key to overcoming this problem and of providing a tension free repair is not to struggle to bring the edges of the hernial defect together but rather to bridge the gap between the edges with some strong material. The most commonly used materials are plastic meshes. They are strong, flexible, easy to cut to the right size and to stitch in place, permanent and do not cause, as far as we can tell, any adverse reaction when left in the body. They can be used in all types of hernias either as a sheet of material stitched over the hole or less commonly, rolled into a plug which is then inserted into the hernial defect and held in place with a few stitches. Either way, to key to success is for a hernia repair to be tension free.