Mesh-Based Hernia Repair: Advances, Complications, and Future Perspectives

Abstract

Background and Objective: More than six decades have passed since the first open hernia repair, and the hernia meshes are still fundamental in abdominal wall surgery. The open, laparoscopic, and robotic approaches all have unique advantages. The objective of this review is to discuss the current hernia repair procedures, surgical mesh selection, associated complications, and future trends in hernia mesh development.

Methods: This review assesses surgical approaches and hernia mesh materials, focusing on mesh design and selection, tissue integration, foreign body reaction, and chronic functionality, which are directly impacted by material composition, porosity, textile architecture, and mechanics. Biological, absorbable, synthetic, and innovative mesh technologies were also considered.

Results: Although surgical meshes significantly reduce recurrence rates as compared to traditional suture repair, important clinical complications, including infection, adhesion, seroma formation, chronic pain, and mesh migration, still exist. A mesh design and selection are key factors affecting the surgical outcome. Synthetic meshes are still popular due to their durability, ease of handling, and cost-effectiveness, while biological and absorbable options are suitable in contaminated environments and in high-risk patients. While these meshes have progressed, none have yet shown optimal performance across all clinical indications.

Conclusion: Research in the future is directed towards development of biocompatible mesh, reduction of complications and enhancement of patient quality of life. Innovative approaches, such as nanofiber scaffolds, bioactive coatings and hybrid materials, have the potential to contribute to the realization of the “ideal” hernia mesh. Until then, a tailored surgical routine and ongoing advancements in mesh technology remain essential for achieving optimal hernial repair.