Introduction

The concept of using a reinforcing material in the repair of hernias is ancient, as Dr Northington and Dr Asfaw point out in this issue. The practice has, at various times and points in recent history, fallen in and out of favor as new uses, and new complications, have arrived. It is evident from most data that the use of mesh in the repair of large ventral and inguinal hernias has clear benefit in reduction of recurrence rates over primary repair alone. Clearly, this comes at the price of mesh-related complications, as Drs Resnick and Bleier point out. The main problem using mesh in these circumstances seems to be determining which mesh to use. So little data exist favoring one type of mesh over another that empiricism seems to be the rule at times. Even so, detailed retrospective reviews of the use of mesh in the repair of ventral hernias, parastomal hernias, rectoceles, and cystoceles can give guidance regarding mesh use. Prospective randomized studies comparing mesh vs none are just beginning to be done in cases where retrospective data do not exist, as Dr Hull points out in her discussion of its use in repair of parastomal hernia defects. Hopefully, a current ongoing study will yield useful data on prevention of this vexing problem.

The use of mesh for hernia repair has expanded well outside the boundaries of the fields of colorectal and general surgery and extends also to the related field of urogynecology where its use is well established. Support of the vaginal apex in vaginal vault prolapse repairs, as well as its use in the support of the urethra and both anterior and posterior vaginal wall defects, is well established. Again, however, convincing prospective data comparing mesh types are lacking and it is often the preference of the surgeon, cost, and availability that dictates choices rather than scientific evidence.

This issue deals directly with using mesh in the repair of ventral, parastomal, and perineal hernias, as well as its urogynecologic applications. It explores in detail the biology of wound healing and how the use of both biological and manufactured mesh material alters, and is altered by, surrounding tissue. It aims to provide data on the ways in which mesh is used in repair, as Dr Friel et al do in their discussion of laparoscopic ventral hernias, and it serves to discuss the complications that may ensue. Hopefully, it will help to shed a bit more light on new directions in the use of mesh for the repair of hernias of all types and expose the limitations of the materials and techniques in an effort to stimulate improvement.