Q: My 38 years old wife is suffering from reccurrence of incisional hernia. She had undergone laparoscopic appendicectomy about three years back. After four days of the operation, one of the ports (above the appendix) got infected and it took a month to be normal following a course of antibiotics. After another six months, she was diagnosed with port site hernia. She underwent general hernia operation seven months after the diagnosis but the surgeon could not use mesh due to its location. Again, after another four months of the hernia operation she was diagnosed with incisional hernia. The doctor has suggested laparoscopic hernia repair at a higher centre. Which operation, laparoscopic or general surgery, is safe and has low recurrence rate? Does quality of mesh have an important role to play in the surgery?

A:One of the more common side effects of laparoscopic surgery is port site hernia. Hernias always need surgery, and most persons will use a mesh. In some situations insertion of mesh may be a problem, and I guess that this occurred in the case of your wife. However, recurrence will be seen in about 40% of patients when a mesh is not used, and in only 5% of patients if a mesh is used. She should undergo reoperation with a mesh. I personally favour open surgery, but some surgeons believe that laparoscopic surgery is equally good. I think you should go to a major hospital and let the surgeon decide: laparoscopic or open. Type of mesh: Don't bother too much about this. The mesh most often used in India is the polypropylene mesh. This is a good mesh. Abroad the Teflon mesh is also commonly used. Teflon and Prolene both have their mild advantages, but I don’t think you should be concerned about this. I always use a Prolene mesh and am very happy. Remember, finally: Laparoscopic surgery and open surgery: both are about equally good. Go for the cheapest. Mesh: all are about equally good. Go for the cheapest.