Evolution of Technology

Hernia Mesh

Mesh was first introduced in the late 19th century when Witzel first used silver mesh in a groin hernia surgery.  Many other materials were tested but none surfaced as the standard of care until the development of polypropylene mesh in 1954.

The advantages of mesh for hernia surgery included decreased postoperative pain and decreased hernia recurrence. While this has generally been accepted as the gold standard for abdominal wall hernias, rare complications such as mesh infections and foreign body irritation/mesh discomfort have led to the development of new forms of mesh—such as lightweight mesh, antibiotic coated mesh, absorbable mesh, and biocompatible mesh—in an attempt to improve outcomes and patient satisfaction.

In modern day hernia surgery, mesh can be divided into synthetic and biologic mesh types. Synthetic meshes such as polypropylene are permanent and nonabsorbable while biocompatible meshes (derived from human or animal materials) are integrated into the body. 

Evolution of Procedure

Umbilical / Ventral / Incisional Hernia Repair

Surgical repair of Umbilical/Ventral/Incisional Hernias involves reducing the abdominal contents back into the abdomen and repair or the wall defect either primarily with suture or with a covered material placed over the defect, such as mesh.

Hernia surgery has been around for quite sometime, being identified as early as 1500 BC in Egyptian records and soon thereafter in Greek history. More recently in the 19th century advances in groin hernia surgery were made such as proper primary suture repair, the use of local anesthesia (Lidocaine), and the use of mesh.

With the advent of laparoscopic surgery in the 20th century and robotic surgery in the 21st, multiple approaches now exist to fix an abdominal wall hernia in addition to the standard open approach.

Depending on the severity of the hernia, hernia surgery is usually an outpatient procedure performed with general anesthesia with discharge the same day, however for more complex ventral hernias, observation in the hospital may be warranted. Most postoperative instructions include no heavy lifting or strenuous exercise for four to six weeks. 

Evolution of Diagnosis

Umbilical / Ventral / Incisional Hernia

A hernia is the condition in which an organ is displaced through the wall of a cavity containing it, thus an abdominal hernia is projection of any intra-abdominal structure through the abdominal wall. This can be caused from a congenital defect, weakness of the abdominal muscles, and at surgery sites that violate the abdominal wall.

The most common places for hernias to occur are at prior surgical scars (incisional), at natural orifices (umbilical), or on a patient’s midline (ventral). Anything that increases the intra-abdominal pressure (coughing, straining with heavy lifting, ascites, obesity, etc.) contributes to the development of a hernia, especially in those with developmental abnormalities, pregnant patients, or patients who have had surgery before.

Hernias usually present as a reducible bulge, which can be bothersome cosmetically and occasionally cause symptoms such as nausea, vomiting, constipation, and pain at the hernia site. In some individuals no obvious bulge is appreciated—but symptoms are present—and imaging such as a computed tomography (CT) scan is used to make the diagnosis. When herniated contents become entrapped and cannot be pushed back into the abdomen, this is called incarceration. This can cause a compromise of the hernia contents and is a surgical emergency.