Related Experiment Video
Updated: Mar 23, 2026
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
The routine use of prosthetic mesh in austere environments: dogma vs data
John P Kuckelman1, Morgan R Barron1, Kelly Blair1
1Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, 9040-A Fitzsimmons Avenue, Tacoma, Washington 98431, USA.
Background:
Mesh repair has become the standard in adult hernia repairs. Mesh infection is an uncommon but potentially devastating complication. Currently, there is widespread dogma against the use of prosthetic mesh (PM) in deployed or austere environments but little available data to support or refute this bias.
Methods:
Retrospective review of all hernia repairs over 1 year in a forward deployed surgical unit in Afghanistan. Demographics, hernia type, repair performed, and mesh type were evaluated. Follow-up was completed up to 6 weeks and then as needed for up to a year, and complications to include infection were recorded.
Results:
Sixty-six patients were identified, mean age was 38 (range 3 to 80) and 98% were male. Single-dose perioperative antibiotics and standard sterile technique were used in all cases. The majority (70%) had PM placed. The mean operative time was 54 min, and mean estimated blood loss was less than 25 cm(3). The vast majority of our hernias were inguinal (95%) with 1 ventral and 2 umbilical hernias. In the PM group, there were no surgical site infections, no mesh infections, and no mesh explantation or reoperation. There were no recurrences in either group identified at up to 1-year postoperation. There was no statistically significant difference in any outcome measure between the PM and no-PM groups.
Conclusions:
The use of PM for hernia repairs in the austere or forward environment appears safe and did not increase the risk of wound infection, mesh infections, or recurrence.
