Recommendation for NHSScotland

Surgical mesh should be used for elective repair of primary inguinal hernia in adult males in Scotland. Mesh repair of inguinal hernia provides lower rates of hernia recurrence, lower rates of serious adverse events and similar or reduced risk of chronic pain, compared with non-mesh procedures. Mesh repair of inguinal hernias is a cost-effective treatment option.

All elective inguinal hernia repairs should be preceded by a detailed discussion with patients to help manage post-surgery expectations. These conversations should cover the potential consequences of not repairing an inguinal hernia, the relative risks of mesh inguinal hernia repair compared with nonmesh repair, and the risk of chronic post-operative pain for some patients.

Appropriate systems should be in place to routinely collect and use data from all inguinal hernia repairs in Scotland to inform clinical practice and the assessment of new types of mesh as they become more widely used.

NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.

What were we asked to look at?

We were asked to assess the evidence on the use of surgical mesh for elective repair of primary inguinal hernia in male patients compared with repairs without surgical mesh (nonmesh/suture repair). In particular, we were asked to consider safety and patient aspects relating to surgical mesh repair of inguinal hernias.

Why is this important?

Surgical mesh has become an important topic in the last few years following women’s experiences of severe, chronic pain after surgical mesh was used to treat pelvic organ prolapse. In Scotland, inguinal hernia repair using surgical mesh is a common procedure accounting for around 5,000 surgeries per year. Following the media and political spotlight on surgical mesh for prolapse in women, there is an awareness that similar issues need to be considered in relation to using surgical mesh to repair inguinal hernias.

Referred by

Scottish Government