Mesh is made of chemical fiber woven into various shapes.

From the late 1980s, it was first used for inguinal hernia surgery.

And today it is the most widely performed inguinal hernia repair worldwide.

It is used to cover the inside or outside of a weak area of the inguinal region either through open surgery or by laparoscopic surgery.

Before mesh operations, a tissue repair method called posterior wall repair was widely performed for inguinal hernia surgery.

Surgery is undertaken to reinforce the inguinal canal by pulling and sewing the muscles and ligaments, which are found at the outer layer of the hernia hole, together.

This is the barrier which acts to block herniation.

But the recurrence rate was very high: 10 to 30%.

Doctors postulated that the high recurrence rate was due to tension at the newly formed barrier.

Pulling muscles together to sew creates a repellent force in the direction of the muscles original position.

This force is called tension.
Eventually, when the force exceeds the limit, the muscle is ripped apart and released.

Then, the hernia recurs.
In order to avoid tension, they covered it with a tough mesh cloth instead of pulling and stitching,

And they thought that by doing this, recurrences could be prevented.

Recurrence rates of tissue repair, which were 10-30%, were reduced to as low as 2-5% after the use of mesh.

Some of the expected objectives were achieved.

But it's a bit disappointing that there wasn’t a perfect result.

As the recurrence rate of 2-5% is still not small.

In addition, some studies have suggested that the recurrence rate for mesh hernia repairs is still higher than 10%.

(Niebuhr H and Köckerling F. Surgical risk factors for recurrence in inguinal hernia repair – a review of the literature. Innov Surg Scl 2017;2(2):53-59.)

If the sequela is severe, you should undergo surgery to remove the mesh.

This operation is very difficult and can damage nearby nerves, blood vessels, and muscles.

But it's a bit disappointing that there wasn’t a perfect result.

Moreover, if the mesh was inserted laparoscopically, it is much more difficult to remove it.

Therefore, mesh repair gives some reduction in recurrence at the cost of increased complications.

If you have a recurrence, you need to get another operation. But when mesh complications occur, you will go through a much more painful situation.

In conclusion, mesh hernia repair delivers more setbacks than solutions.

What is the best way to prevent mesh complications?

It is obviously to stop using mesh.

Then, should we go back to the old tissue repair method?

The high rate of recurrences effectively rules out going back to that method. For this reason,
it is crucial to find a hernia repair method which resolves mesh complications and minimizes recurrences.

There should be a new and innovative operation that can be performed without using mesh.

The resolution to the aforementioned mesh problem is the direct suture closure of the hernia hole.

As you can see above, even the use of a tough mesh still still leads to recurrences despite there being no ‘tension’. Why?

It is because of the repair method which covers either the inside or outside of the hernia hole with mesh, leaving the open hernia hole untouched.

There is always a possibility of the organs protruding again because the hernia hole itself is not directly closed.

As a result, they could not fully prevent more recurrences even though they used a tough mesh.

Leaving the hernia hole open also accounts for the high rate of recurrences for old-fashioned tissue repairs, which used to be around 10-30%.

Tension is of course an issue, but the major reason for high recurrences is from lack of directly closing hernia holes.

A hernia is a disease that allows the intestine to escape through a hole in the abdominal wall muscles.

So, if you block the hole firmly, it can be completely cured.

That is common sense.

It is curious however that past hernia tissue repair methods ignored this common sense approach.

And the same is also true of recent mesh hernia repair methods.

Finally, after returning to our common senses, it’s clear to see that you need to find the hernia hole and close it directly.

Then you can catch both rabbits, the recurrence issue and mesh complications.

Thankfully, such a surgery was developed in 2012 at our Gipum Hospital.

‘Kang repair’ is the name of that operation.

This is a new concept of hernia surgery and is the only one to perform direct closure of the hernia hole.

Direct closure of the hernia hole is not that easy because of the complicated anatomy around hernia holes.

So, elaborate surgery is needed.

A hernia hole is a gap between tissues that were originally attached to each other. So, even if you suture them together, there will be no tension, as they have been restored to their natural state.

Therefore, by directly suturing the hernia holes, we can achieve the goal of using non-mesh and leaving no tension. It's similar to the two birds and one stone analogy.

However, we don’t agree that high recurrence rates are significantly related to tension.

Kang repair significantly reduces the relapse and sequelae after a hernia operation.
So far, more than 6,000 Kang repairs have been performed, with a recurrence rate of less than 0.5%.
Mild and intermittent chronic pain have been the subject of complaints in less than 1% of cases.

All over the world, the side effects of mesh hernia repair are widely known to the public.

Nevertheless, hernia surgeons continue to perform mesh hernia surgery as ‘the gold standard’ for the inguinal hernia repair.
There are a lot of patients who are really frustrated by this situation.

Whilst trying to find out if there were any other repair options so as to avoid mesh complications and high rates of recurrences, they came across Kang repair and came to Gipum Hospital from all over the world.

They have discovered that the only way to solve the dilemma of inguinal hernias in this day and age is to undergo Kang repair surgery.