Hernia Repair Guidelines
Introduction to Hernia Repair
- The choice of hernia repair method should be stratified primarily by wound contamination status and hernia complexity, with synthetic mesh repair being the gold standard for clean fields, while biological meshes or tissue repair are reserved for contaminated/infected cases 1
Repair Selection Based on Wound Classification
- Synthetic mesh repair is strongly recommended as it provides significantly lower recurrence rates compared to tissue repair without increasing wound infection risk 1
- For clean-contaminated fields, synthetic mesh can still be safely used in patients with intestinal strangulation requiring bowel resection without gross spillage 1
- For stable patients with small defects, primary tissue repair is recommended 1
- For larger defects when direct suture is not feasible, biological mesh may be used 1
Mesh Selection Considerations
- When biological meshes are indicated, Permacol (cross-linked porcine) has a 13.8-29% infection rate, 5.8-18.3% recurrence at 12-24 months 3, 4, 5
- Strattice (non-cross-linked porcine) has a 4.9-29.9% infection rate, 0-43% recurrence 3, 4, 5
- Surgisis (non-cross-linked porcine) has a 41% infection rate, 61% recurrence at median 47 months 4, 6
- Tutomesh (non-cross-linked bovine) has a 3% infection rate, 0% recurrence at 12 months 5, 7
Emergency Hernia Repair
- Patients should undergo emergency repair immediately when intestinal strangulation is suspected 1
- SIRS, contrast-enhanced CT findings, lactate, CPK, and D-dimer levels are predictive of bowel strangulation 1