"It comes down to the experience of the surgeon and their under-
standing of meshes to tailor what mesh they use for what patient and
for what procedure," says Dr. Blatnik. "I commonly use four different
styles of meshes, and subsequent sizes within those styles. I have a
playbook in my mind for different patients and what meshes we're
going to use for their problems, and then tailor the size to the individ-
ual patient and the issue they have."
Dr. Mazer typically uses a lightweight polypropylene mesh for
most hernias unless there's a reason not to. "I use it in part because
of the amount of evidence and the amount of stability it has, how
long it's been around and my comfort level with it," she explains.
Patient characteristics — comorbidities, obesity, smoking, future
surgical needs, plans to have children — also come into play. "The
key is evaluating each hernia and each patient individually, and
hopefully having a large toolbox of repair options and mesh options
so you can pick the right repair for the right patient," says Dr. Mazer.
"Most hernias are best treated with standard repairs, but not all.
Especially as we start seeing the bigger hernias, hernia recurrences
or patients who had reactions to mesh. Having a broader toolbox to
offer those patients can be really powerful."
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