1. AHRQ Publication No. 12-EHC091-EF August 2012

2. Risk of Infection Suture
Symptomatic
Inguinal Hernia
Elective Surgery
Recurrence
Mesh
Primary unilateral
Primary bilateral
Incarcerated
Risk of Infection Suture
Flowchart at Page 5 of the Guidelines !

4. With or without mesh?
*Amato B, Moja L, Panico S, Persico G, Rispoli C, Rocco N, Moschetti I.
Cochrane Database Syst Rev Apr 18;4:CD
Shouldice technique versus other open techniques for inguinal hernia repair.
Sixteen trials contributed to this review. A total of 2566 hernias
Shouldice herniorrhaphy is the best non-mesh technique in terms of recurrence, though it is more time consuming and needs a slightly longer post-operative hospital stay.
The use of mesh is associated with a lower rate of recurrence. The quality of included studies, assessed with jaded scale, were low.
Patients have similar characteristic in the treatment and control group but seems more healthy than in general population, this features may affect the dimension of effect in particularly recurrence rate could be higher in general population.
The length of follow-up vary broadly among the studies from 1 year to 13.7 year.

5. Volume 206, Issue 4 , Pages 619-623, October 2013Fi
Fischer JE:
Hernia repair: why do we continue to perform
mesh repair in the face of the human toll of
inguinodynia?

6. Great Debate:
Is there a successful repair for inguinal hernia possible without mesh?
before: 20% yes
after: 50% yes
William Hope: „... Than you have to come to the US to teach us in pure tissue repairs...“

7. Mc Gilliguddy 1998 Invited Commentary by L.M. Nyhus
Arch Surg Sep;133(9):974-8.
... the disadvantage relates to the use of mesh in all patients
... The „one suit fits all“ approach should not be promulgated
... Let us not create a new generation of „habadashery surgeons“