Dear Colleagues,

Hernia surgery plays an important role in our surgical routine. The use of mesh is recommended for almost every kind of hernia: For groin hernias, for example, mesh repair is recommended as the first choice either with an open procedure or a laparo-endoscopic repair technique (HerniaSurge Group, Hernia 2018). The use of mesh is also routine for incisional hernia repair and has been shown to significantly reduce the recurrence rate independent from the surgical procedure. The choice of mesh depends on the technique used and the layer where it is placed.

In laparoroscopic IPOM, repair meshes coated with an antiadhesive layer are used, and this intraperitoneal placement address another challenge. Even for umbilical and epigatsric hernias, the use of mesh is recommended by the latest guidelines in cases of hernia defects of more than 1cm (Henriksen et al., BJS 2020).

Quite naturally, the extensive use of meshes has led to an ongoing debate about the ideal mesh. One major concern about the use of mesh is the risk of infection especially in complex hernias and infected fields. A postoperative wound infection may lead to a mesh infection. The worst-case scenario is the need for the removal of an infected mesh prothesis because of bacterial biofilm. There have been several publications about the different strategies to reduce this complication. Various biological scaffolds are on the market which support the idea that in case of an infection, these protheses do not have to be removed. The flip side, however, is that some of these biological scaffolds show severe degradation and subsequent failure in the infectious environment and may be less mechanically durable in the face of infection (Cole et al., Hernia 2014).

Lately, long-term resorbable biosynthetic meshes have been introduced. With these new products, the risk for mesh infection with subsequent mesh removal has been averted, even in high-risk patients. The newest “kid on the block” is a polypropylene mesh coated with silver to achieve antibacterial properties and keep the stability of permanent systemic meshes. The fear of mesh infection following hernia repairs is also still apparent, although there are several new strategies available to reduce that risk.

Another concern about the use of meshes is the potential of causing chronic discomfort. Postoperative chronic pain is a major concern in groin hernia repair. The role of the mesh in this is still under debate.

This Special Issue of JCM focuses on the various aspects of using different kinds of permanent or resorbable implants for hernia repair. Our hope is for highly valued publications which will help all of us hernia surgeons to deal with the everyday struggle of providing the best treatment for our patients and to avoid severe complications and achieve the best results.

Dr. Guido Woeste
Guest Editor

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• Hernia
• Hernia repair
• Mesh
• Infection