Do we really need three-dimensional convex inguinal hernia meshes?

Abstract

The aim of our study was to assess the anatomical variability in the curvature of the muscles in inguinal region and to determine the necessity of using three-dimensional convex-shape hernia meshes in spite of typical flat ones. The group analyzed consisted of 180 patients with no abnormalities in inguinal region: 30 males and 30 females for every subgroup, with decreased, normal, and increased BMI. For every patient a 3D software model of muscles in the inguinal region was built, based on the segmentation of pelvic CT images and its outer surface determining the shape of the hernia mesh was created. Correlation was tested between the diameter of sphere describing the shape, the height of mesh top, and BMI. The optimal number and diameter of prefabricated hernia mesh set was obtained. Only a moderate correlation (r = - 0.32) was found between the diameter of sphere and BMI in females and between the height of the mesh top and BMI in females (r = 0.43) and in the whole group of patients (r = 0.33). Accepting fitting error < 5mm for 62 from 180 cases there was no need to use a convex-shape hernia mesh, for the other cases one of 3 prefabricated hernia meshes with diameters: 854mm, 434mm, 298mm was sufficient. For about one-third of patients a commonly used flat hernia mesh is adequate, for the rest of the cases one of 3 convex-shape meshes is sufficient.