Elective surgery using mesh to repair primary or incisional hernias in adults: SHTG recommendation for Scotland (9 December 2021)

Summary

Below is the recommendation for NHS Scotland made by the Scottish Health Technologies Group (SHTG).

SHTG was asked by the Scottish Government to explore a series of questions relating to the use of surgical mesh in the elective repair of abdominal and groin hernias in all adults.

Content

The evidence supports the continued availability of surgical mesh as an option for elective repair of primary ventral hernias, incisional hernias, and primary inguinal hernias, in adults in Scotland.

Patient preference may be for a non-mesh (suture) hernia repair and access to alternative hernia management options should be available to accommodate this.

All elective hernia repairs should be preceded by a detailed discussion between the patient and the surgeon as part of an informed consent process. Points for discussion include:

• the benefits and risks of surgical and non-surgical approaches to hernia management, including the fact that neither mesh nor non-mesh repair are risk-free procedures
• the risk of developing chronic pain following hernia repair, especially for patients with pain as their main presenting symptom, and
• the uncertainty around long-term outcomes from hernia surgery, using mesh or non-mesh repair, given the few studies that followed up with patients beyond 1 year.

Patients should be provided with detailed information on hernia repair in a variety of accessible formats, including verbal and written.

The decision to use laparoscopic or open mesh repair should be based on the patient’s medical history, the characteristics of their hernia, and surgical expertise. The decision on which mesh fixation technique to use in elective hernia repair should be based on surgical expertise, the type and size of hernia, laparoscopic or open repair, and the type of mesh used.

It is important that data on long-term outcomes from hernia repair in Scotland are recorded at a national level to inform future decision-making. This should be aligned with the UK Medical Device Information System and include collection of patient reported outcomes.