🔷 In Which Hernias Is Mesh Required?

(कौन-कौन से हर्निया में मेश लगाना ज़रूरी होता है?)**

Hernia repair is of two types:

  1. Tissue repair (no mesh)

  2. Mesh repair – the standard modern treatment

Most hernias require mesh because it reduces the risk of recurrence and provides strong reinforcement to the abdominal wall.

🔶 Hernias That Usually Require Mesh (Standard of Care)

1️⃣ Inguinal Hernia (Indirect / Direct)

  • Most common hernia

  • Mesh is recommended in almost all adult patients

  • Methods:
    ✔ Lichtenstein mesh repair
    ✔ TEP / TAPP laparoscopic mesh repair

Why?
High recurrence if repaired without mesh.

2️⃣ Ventral Hernia

Includes:

  • Umbilical hernia

  • Epigastric hernia

  • Paraumbilical hernia
    These require mesh when the defect > 1–2 cm.

Reason:
Small stitches alone cannot hold the abdominal muscle under pressure.

3️⃣ Incisional Hernia

Occurs at previous surgery site.
Mesh is mandatory in almost all cases.

Why?
Abdominal wall is already weak at the incision line, so mesh gives necessary strength.

4️⃣ Femoral Hernia

Rare but dangerous because of high strangulation risk.
Mesh repair is recommended after reducing the hernia.

5️⃣ Spigelian Hernia

Located at the outer border of the rectus muscle.
Almost always repaired with mesh due to high tension on muscles.

6️⃣ Lumbar Hernia

Complex hernia requiring mesh reinforcement for stability.

🔶 Hernias Where Mesh May or May Not Be Used

1️⃣ Small Umbilical Hernia in Children

  • Usually repaired without mesh

  • Most close naturally by age 3–5

2️⃣ Very Small Adult Umbilical Hernia (<1 cm)

Sometimes can be closed with sutures, depending on surgeon’s judgement.

3️⃣ Infected / Contaminated Surgical Field

Mesh may be avoided or a special biological mesh may be used.

🔶 Hernias Where Mesh Is Not Used

1️⃣ Hiatal Hernia (Stomach going into chest)

  • Treated by laparoscopic antireflux surgery

  • Mesh use is selective and not routine

2️⃣ Diaphragmatic Hernia in Newborns

Repaired without mesh unless defect is large.

🔷 Why Dr. Karan R. Rawat Prefers Mesh Repair

Dr. Karan R. Rawat, one of Agra’s leading General Surgeon & Hernia Specialist, uses mesh repair for hernias because:

  • ✔ Lower recurrence (less than 1–2%)

  • ✔ Strong abdominal wall repair

  • ✔ Faster recovery

  • ✔ Less pain in modern mesh techniques

  • ✔ Laparoscopic methods allow small cuts & early discharge

He works with all advanced mesh options:

  • Lightweight mesh

  • Composite mesh

  • 3D anatomical mesh

  • Self-fixating mesh

  • Biological mesh (in infected fields)

🔷 Hindi Summary (हिंदी सारांश)

कौन-कौन से हर्निया में मेश लगती है?

  • Inguinal hernia

  • Ventral / Umbilical / Epigastric hernia

  • Incisional hernia

  • Femoral hernia

  • Spigelian hernia

  • Lumbar hernia

कब मेश नहीं लगती?

  • छोटे बच्चों में नाभि हर्निया

  • बहुत छोटा वयस्क नाभि हर्निया

  • Hiatal hernia में सामान्यत: नहीं

  • संक्रमित घाव में synthetic mesh नहीं