Free video consultation | Wednesday 14 May
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Wednesday 14 may 2025
With Dr. Andreas Koch
Our approach to hernia surgery
At BioHernia, we understand that facing hernia surgery can feel overwhelming—especially when considering a technique that’s offered by only a few specialists worldwide. That’s why we’ve created this page to walk you through our unique approach to hernia surgery and explain what makes our non-mesh method different. Our goal is to give you a clear understanding of our process and the reasons behind our approach, so you can make a well-informed choice that’s right for you.
Why without mesh?
We are deeply committed to providing hernia surgery solutions that prioritise your safety, long-term health, and quality of life. This is why we have chosen to specialise in non-mesh hernia repair techniques. But to understand why we are one of the few clinics providing this alternative today, we need to take a closer look at how hernia treatment has evolved over the years.
History of hernia surgery
Hernia treatment has a long history, stretching back over a thousand years. In ancient times, attempts to treat hernias were often crude and painful, relying on techniques that didn’t address the underlying issue of tissue weakness. The modern era of hernia surgery began in the late 19th century, with the development of suture-based techniques aimed at reinforcing the weakened area of the abdominal wall.
Surgeons like Edoardo Bassini pioneered early approaches in the late 1800s, which used sutures to stitch together healthy, surrounding tissue to close the hernia defect. These methods marked a significant improvement in outcomes, but they were still associated with relatively high recurrence rates. As hernia surgery advanced into the 20th century, the focus remained on refining suture-based techniques to improve durability and reduce complications. However, the recurrence of hernias remained a challenge, especially amongst inexperienced surgeons, which spurred the search for new solutions.
What is a hernia exactly?
A hernia occurs when an organ or tissue pushes through a weak spot in the surrounding muscle or connective tissue, often causing a bulge. This can happen in areas like the abdomen or groin. The goal of hernia surgery is to close and reinforce this weak spot, preventing the hernia from recurring.
The introduction of plastic meshes
In the mid-20th century, surgical mesh was introduced as a breakthrough in hernia surgery. Surgeons believed that using a synthetic material to reinforce the weakened area would dramatically reduce the risk of hernia recurrence, as it made the operation easier to perform for inexperienced surgeons. Mesh seemed like the ideal solution—it provided extra support and distributed tension across a larger surface, making it more difficult for the hernia to reappear.
The use of mesh gained popularity in the 1980s and 1990s, with many surgeons adopting it as the standard approach for hernia surgery. Mesh was praised for its simplicity and the perceived reduction in recurrence rates, leading to a widespread belief that it was superior to traditional suture-based techniques. It allowed for faster procedures and was marketed as a long-term fix.
However, over time, issues began to surface that revealed the mesh solution wasn’t without significant drawbacks.
Complications due to plastic meshes
While mesh initially appeared to be a game-changer in hernia surgery, it has since become clear that it can cause a host of complications for a large group of patients. As mesh repairs became more common, reports of adverse effects began to accumulate, leading many patients to suffer from chronic pain, infections, and even mesh migration or erosion into surrounding tissues. For many, these complications resulted in additional surgeries and a diminished quality of life.
1.
Rejection of mesh
The plastic meshes are not made of a natural substance, so the body constantly tries to defend itself against it. The natural reaction of the body is to get rid of the mesh.
2.
Mesh movement
Even when securely fixed in place through stitching or adhesive, mesh can sometimes shift within the groin or abdominal area. The body’s effort to reject the mesh may cause it to fold, shift, or move, leading to discomfort or other complications.
3.
Mesh shrinkage
Hernia surgery using mesh rely on scar tissue forming around it to stabilize its position. However, as this scar tissue contracts over time, the mesh can also shrink, creating a hardened area that may press on or entrap nearby nerves.
4.
Mesh stiffness and tissue attachment
Over time, mesh becomes less flexible and may stick to surrounding tissues, nerves, or even organs. This issue is especially common in meshes placed through laparoscopic surgery, where they are positioned inside the abdominal cavity.
5.
Nerve irritation
All meshes, regardless of size or thickness, consist of fibers that form a grid with small holes. During healing, nerves can grow through these pores, sometimes becoming trapped in the mesh, which can trigger chronic pain as the nerves send continuous pain signals to the brain.
6.
Allergic reactions to mesh coatings
To improve the integration of mesh with the body’s tissues, manufacturers began adding protective coatings to hernia meshes. However, some individuals may experience allergic reactions to these coatings, leading to additional complications.
As featured in the BBC documentary by Victoria Derbyshire
In a BBC documentary by Victoria Derbyshire, the widespread issue of chronic pain and complications caused by hernia meshes in the UK is brought to light. Our very own Dr. Ulrike Muschaweck, a pioneer in hernia surgery without mesh, was featured to discuss the benefits of mesh-free hernia surgery.
BioHernia's revival of suture repairs
In response to the growing concerns over mesh-related complications, a small but dedicated group of surgeons—including ours—have returned to refining and advancing no mesh, suture-based techniques. These modern suture repairs draw from the best aspects of historical methods while incorporating modern surgical advancements to make the procedures more effective and less invasive.
BioHernia is proud to be at the forefront of this revival, offering patients a natural, mesh-free alternative that prioritises long-term health and minimises the risks associated with plastic mesh implants. Our suture repairs focus on using the body’s own tissues to reinforce the hernia site, providing a safe and durable solution that promotes natural healing and reduces the risk of complications.
The benefits of suture repairs
Fewer complications
No foreign materials mean less chance of rejection, infection, or mesh-related pain.
A natural recovery process
The body heals using its own tissues, promoting a more stable and long-lasting recovery.
Minimised long-term risks
Mesh repairs can lead to complications years later; we aim to prevent these with a more natural approach.
What people have asked
About our surgery approach
1. Why doesn't my local hospital offer operations without mesh?
Most hospitals don’t offer non-mesh hernia repairs because mesh-based procedures have become the standard. They are quicker, align with surgical guidelines, and can be more cost-effective for hospitals. Non-mesh repairs, however, require specialized skills and expertise, which fewer surgeons are trained in. At BioHernia, we focus on non-mesh methods to avoid the potential risks associated with mesh, like chronic pain or complications, providing a safer alternative for our patients.
2. Is non-mesh hernia repair as effective as mesh-based repair?
Yes, non-mesh hernia repair can be as effective as mesh-based repair, especially when performed by skilled surgeons. Non-mesh repairs focus on carefully strengthening the body’s natural tissues to close the hernia, which, in experienced hands, achieves strong, lasting results. While mesh is often used to reduce recurrence risk, it also brings potential complications. Non-mesh repairs offer comparable success rates without the risks of mesh-related issues, such as chronic pain or infection, making them a safe and effective option for many patients.
3. Will my recovery be different without mesh?
Recovery after non-mesh repair is often smoother, with less risk of chronic pain and other complications. While recovery times may vary based on the individual and the type of hernia, patients often report faster healing and a more comfortable recovery compared to mesh-based procedures.
How do we repair hernias?
In this section, we’ll explain our precise, non-mesh approach to hernia surgery, detailing how we reinforce your body’s natural tissues for a durable, long-lasting solution.
Our operations explained
Our mesh-free hernia repair technique focuses directly on the issue by carefully suturing the weakened area, eliminating the need for a plastic mesh. This method strengthens your natural tissue structure and greatly reduces complication risks, ensuring a safer healing process.
1 — Start of the operation
Using a small horizontal incision of approximately 5 cm, we open the skin directly above the hernia, to access the hernia bulge.
2 — Fixing the hernia
The hernia sac is gently reduced back into the abdomen and the weakness in the abdominal wall is closed with sutures, using either the Shouldice technique or the Desarda technique.
3 — Closing the wound
Finally, the operation wound is closed using sutures and surgical glue. In all, the operation takes about 30 to 45 minutes to complete. After full recovery, a minor scar of 3 to 5cm is left.
Step-by-step explanation operation techniques
Every hernia is unique, and so is the way we approach each repair. The technique we choose for your operation is tailored to your specific condition, ensuring the best possible outcome. Below, you’ll find links to in-depth guides that walk you through each type of hernia surgery technique we offer, so you can fully understand the process and what to expect.
Techniques for men
Techniques for women
Techniques for both
What people have asked
About our operation techniques
1. Is no mesh hernia surgery more complex than hernia surgery with mesh?
Yes, non-mesh hernia surgery is generally more complex than mesh-based surgery. It requires advanced surgical techniques and a high level of precision to reinforce the weakness without synthetic support. This method demands meticulous suturing and an in-depth understanding of anatomy, as the surgeon must carefully avoid damaging key tissues, such as the abdominal muscles, spermatic cord, or surrounding nerves. For these reasons, non-mesh hernia surgery is typically performed by specialists who focus exclusively on this technique, ensuring optimal outcomes for you.
2. How long does a non-mesh hernia operation take?
The duration varies depending on the hernia’s type, size and location, but most non-mesh repairs take slightly longer than mesh-based procedures due to the precision required. On average, the surgery lasts between 60 and 90 minutes.
3. Is non-mesh repair suitable for all types of hernias?
Non-mesh hernia surgery is effective for many types of hernias, particularly inguinal, femoral, and smaller abdominal hernias. During your consultation, we’ll assess your specific case to ensure a non-mesh approach is the best and safest option for you.
Have your case assessed
By choosing BioHernia, you are choosing an organisation that places your well-being above all else. Our independence from industry influence ensures that the treatments we recommend are based on sound medical evidence, free from the bias of commercial interests. You can trust that every aspect of your care is designed with your best interests in mind, leading to safer, more effective outcomes.
Our expertise
Our expertise in non-mesh hernia repair is the result of years of focused experience and dedication. We’ve refined advanced techniques that rely on the body’s natural tissues, offering patients a safer, more durable repair. Our skilled team has successfully treated a wide range of cases, from simple to complex, always prioritising precision and patient well-being.
Years of specialised focus
Our team at BioHernia has dedicated years to mastering non-mesh hernia repair techniques. While many clinics rely on synthetic mesh, we focus on natural tissue repair, providing patients with a safer, more effective alternative that minimizes long-term risks.
Advanced surgical techniques
Our surgeons are trained in advanced suturing methods that strengthen the hernia site using your body’s own tissues. These techniques require precision and skill, ensuring that each repair is strong, durable, and free from foreign materials like mesh, which can lead to complications.
Personalised treatment plans
Every hernia is unique, and so is every patient. At BioHernia, we take a personalised approach to treatment. We carefully evaluate your condition and health history, tailoring a surgical plan that is designed specifically for your needs and long-term health.
Expertise with complex cases
We are equipped to handle a wide variety of hernia cases, from straightforward repairs to more complex or recurrent hernias. Our expertise allows us to tackle even the most challenging cases, ensuring that every patient receives the highest standard of care.
A dedicated, experienced team
From the moment you walk through our doors, you are supported by an entire team of skilled and experienced professionals, each dedicated to your care. Our commitment to excellence extends beyond our surgeons, every member of our team is highly trained and focused on ensuring a smooth, comfortable experience from start to finish. Whether it’s during your consultation, throughout the procedure, or during your recovery, you can trust that our team’s expertise and compassion will be with you every step of the way.
What our experience means for you:
Reduced operation risks
Reduced recurrence rates
Introduction of lighter forms of anesthesia
Less recovery time
Preservering important muscles and nerves
Reduced incision size
Reduced suture materials
Less operating time
Development of post-operative recovery plans for top mobility
Elite athlete treatment
At BioHernia, we understand that athletes need more than just a routine hernia repair—they need a solution that gets them back to performing at their best, as quickly and safely as possible. Our non-mesh hernia repair techniques are ideal for athletes, offering a natural, durable repair that minimizes complications and promotes faster recovery.
Why non-mesh is ideal for athletes—and you
When elite athletes trust us with their care, it speaks volumes about the precision and effectiveness of our non-mesh approach. For people whose careers and well-being depend on their physical health, there’s no room for complications. Non-mesh hernia surgery avoids the risks associated with synthetic materials, like chronic pain or restricted movement, making it a natural, long-lasting solution. The same benefits apply to everyone—whether you’re an athlete or simply looking for a reliable, comfortable recovery.
Fast recovery, fewer complications
For athletes, getting back to full activity quickly is crucial. With non-mesh hernia surgery, the body heals naturally without foreign meshes that can cause complications. This results in a smoother, faster recovery that minimises the risk of chronic pain or stiffness—an advantage that benefits all patients, regardless of how active they are. Our advanced techniques ensure that your body heals efficiently, so you can return to your routine without unnecessary delays.
Tailored treatment for every patient
While we have experience treating elite athletes, our approach is always personalised, no matter who you are. We take the time to assess your unique needs and design a treatment plan that works for your body and lifestyle. Whether you lead an active life or simply want a safe, effective repair, you can trust that our expertise will deliver the best possible outcome for you.
Science & innovation
Our commitment to science and innovation drives everything we do. By staying at the forefront of medical advancements, specifically in hernia surgery, we ensure that our operation techniques are backed by the latest research and cutting-edge technology.
Continuous improvement in techniques
Our approach is built on years of specialised experience combined with the latest advancements in medical technology. We constantly refine our non-mesh techniques to offer safer, more effective solutions. This dedication to continuous improvement means we are always exploring new ways to make surgeries less invasive, reduce recovery time, and deliver better long-term results.
Research-backed solutions
Non-mesh hernia surgery isn’t just a preference—it’s a method backed by solid clinical evidence. We actively engage with ongoing research in hernia repair, ensuring that our practices align with the latest findings in patient outcomes and safety. By staying updated on the most recent studies, we can confidently provide a solution that avoids the risks of synthetic mesh while offering strong, durable repairs.
Innovative technology for precision
We use state-of-the-art technology in every aspect of our procedures. From pre-operative assessments to surgical techniques, the tools we use allow us to perform precise, customised repairs. This innovation not only enhances surgical accuracy but also reduces the risk of complications, ensuring a smoother recovery for our patients.
Patient-focused innovation
At BioHernia, innovation isn’t just about new techniques and technology: it’s about how these advancements improve the lives of our patients. Our focus on science and innovation allows us to deliver personalised, effective care that leads to better outcomes, faster healing, and a return to normal life with fewer risks.
Our innovations in hernia surgery
Our commitment to innovation has led to several important advancements that set us apart
1.
Preservation of the Cremaster Muscle: Unlike the original Shouldice technique, we do not cut the cremaster muscle during inguinal hernia surgery in men, preventing the risk of permanent testicle hanging. This approach preserves your natural anatomy and minimises post-operative complications.
2.
Nerve-sparing techniques: In our inguinal hernia surgeries, we take extra care to avoid cutting any nerves, which helps prevent post-surgical pain, numbness and long-term discomfort often associated with nerve damage.
3.
Use of resorbable sutures: To minimse foreign materials in the body, we’ve introduced the use of resorbable sutures during specific stages of the operation. This not only promotes natural healing but also reduces the long-term presence of foreign objects in the body.
4.
No stitches to remove: We close the skin with resorbable sutures, meaning there are no stitches to remove after the procedure. The sutures dissolve naturally, making the recovery process easier for you.
5.
Lighter anesthesia options: To enhance patient comfort and reduce recovery time, we use lighter forms of anesthesia for most hernia surgeries, allowing you to recover more quickly and with fewer side effects.
6.
Innovations for complex cases: In more complex cases, such as hernia recurrences or after mesh removal, we use resorbable meshes to reinforce the repair. These meshes dissolve completely over time, providing support while avoiding the long-term risks associated with permanent plastic mesh.
Independence: Free from industry influence
Your well-being is prioritised above all else, and that means making decisions that are free from the influence of pharmaceutical companies, medical device manufacturers, or other interest groups. Many hospitals and clinics are influenced by financial relationships with industry players, particularly when it comes to the widespread use of plastic meshes. At BioHernia, we have chosen a different path—one that puts your health first.
The lucrative rise of hernia meshes
When hernia meshes were introduced, pharmaceutical companies quickly recognised the potential for significant profits. Meshes are inexpensive to produce but can be sold for hundreds of pounds each. With hernia surgery being one of the most common procedures worldwide—over 20 million cases annually, including more than 100,000 in the UK alone—the demand for these products skyrocketed.
In pursuit of profit, big pharmaceutical companies began to influence the medical landscape by sponsoring surgery guidelines and funding scientific research that highlighted the supposed benefits of mesh repairs. Meanwhile, research on the complications and risks associated with mesh use was often ignored or underfunded. As a result, new surgeons were primarily trained in mesh repair techniques, and the traditional suture-based methods, which had been used effectively for years, started to fade into obscurity.
- Johnson & Johnson
- Bard
- Medtronic
- Olympus
- Stryker
- Applied Medical
- Ethicon
- Cook Medical
- Gore
- Insightra-Acelity
- FEG/Dynamesh
- MSD
- Covidien Medtronic
- Cousin Biotech
- Karl Storz
- PFM Medical
- Dahlhausen
- B. Braun
- Menke Med
- Tutogen
- Aspide
The influence of industry on hernia guidelines
In hernia surgery, the influence of large pharmaceutical and medical device companies is considerable. The HerniaSurge Group’s international guidelines for groin hernia management serve as the reference for most hospitals and clinics worldwide, shaping the standard approach to hernia surgery and influencing how (new) surgeons are trained. These guidelines are heavily funded by major mesh manufacturers like Johnson & Johnson and Bard, with nearly a third of the authors disclosing financial relationships with the companies involved.
This sponsorship raises concerns about potential bias, as the guidelines heavily favour mesh repairs, while complications like chronic pain or infection are often downplayed. Non-mesh alternatives, despite their proven success, are rarely highlighted as primary options. As a result, the next generation of surgeons is primarily trained in mesh-based techniques, pushing traditional, non-mesh methods aside.
The following companies provided financial support or grants to authors involved in the creation of the HerniaSurge International guidelines for groin hernia management (source):
Focused on you, not profits: BioHernia’s Patient-first approach
At BioHernia, we stand apart from this trend. Our surgeons have no financial ties to pharmaceutical companies or medical device manufacturers. This means we’re free to make unbiased decisions based solely on your needs and best interests. We choose to focus on non-mesh techniques because they reduce the risks of complications, provide more natural healing, and improve long-term outcomes for our patients. We are dedicated to offering treatments that prioritise your health, not the financial interests of the medical industry or ourselves.
Why this matters to you
By choosing BioHernia, you are choosing an organisation that places your well-being above all else. Our independence from industry influence ensures that the treatments we recommend are based on sound medical evidence, free from the bias of commercial interests. You can trust that every aspect of your care is designed with your best interests in mind, leading to safer, more effective outcomes.