The majority of hernias can be satisfactorily repaired by utilizing the tissues at hand. The use of a mesh prosthesis should be restricted to those few hernias in which tension or lack of good fascial structures prevents a secure primary repair. This group includes large direct inguinal hernias and incisional hernias in which the defect is too large to close primarily without undue tension. Most recurrent hernias, because of this factor of tension, are best repaired with a mesh prosthesis.
The conventional method of using a mesh prosthesis has been to do a primary closure of the defect and then to suture the mesh over this repair as a reinforcement. In time the mesh becomes infiltrated with fibrous tissue which adds to the total strength of the repair. If, however, tissues are approximated under too much tension, separation will occur and recurrence will take place regardless of whether or not
USHER FC, COGAN JE, LOWRY TI. A New Technique for the Repair of Inguinal and Incisional Hernias. Arch Surg. 1960;81(5):847-854. doi:10.1001/archsurg.1960.01300050169030