If mesh is being used to reinforce a groin hernia repair, it may seem logical that it needs to be firmly fixed in place. During some types of keyhole
hernia surgery, however, the mesh can be positioned without being secured to the surrounding tissues.
This raises an important question: if fixation can help keep the mesh in position, why might a surgeon choose not to use it?
The answer involves balancing mesh stability against the potential effects of fixation itself. Whether fixation is needed can depend on the type of repair , the characteristics of the hernia and what the surgeon finds during the procedure.
Why Might Hernia Mesh Not Need to Be Fixed in Place?
Leaving hernia mesh unfixed does not mean it is simply placed loosely and left to move around. In totally extraperitoneal (TEP) repair, the mesh is positioned in the space between the abdominal wall and the lining of the abdominal cavity, where it covers the weakened area from behind.
A sufficiently sized and properly positioned mesh can remain in place without being attached to the surrounding tissues. Pressure from within the abdomen helps hold the mesh against the abdominal wall, while tissue gradually grows into and around the mesh as healing takes place.
Avoiding fixation also means avoiding the additional step of securing the mesh with devices or other fixation methods. This can matter because fixation may irritate or injure nearby tissues and nerves, potentially contributing to postoperative discomfort or persistent groin pain.
However, non-fixation is not appropriate in every situation. The decision depends on whether the mesh can be positioned securely and provide adequate coverage of the hernia defect without additional fixation.
Does Fixing the Mesh Affect Pain or Hernia Recurrence?
Persistent groin pain and hernia recurrence are two important outcomes when considering whether mesh should be fixed in place. A 2026 review of 16 randomised trials involving 1,608 adults undergoing totally extraperitoneal (TEP) groin hernia repair compared these outcomes between fixation and non-fixation.
Persistent Groin Pain
Patients whose mesh was fixed had a 68% higher relative risk of persistent groin pain than those whose mesh was left unfixed.
This figure needs to be interpreted carefully. It does not mean that 68 out of every 100 patients with fixed mesh developed persistent pain. Rather, it describes how much higher the risk was in the fixation group relative to the non-fixation group.
One possible reason is that fixation can affect tissues or nerves in the groin, depending on where and how the mesh is secured. Avoiding unnecessary fixation may therefore reduce one potential source of persistent discomfort.
Hernia Recurrence
For hernia recurrence, the review did not find a statistically clear difference between fixation and non-fixation. This means the available evidence did not show that leaving the mesh unfixed resulted in a clearly higher risk of the hernia returning.
Taken together, these findings support considering non-fixation for suitable patients rather than routinely fixing every mesh. However, recurrence risk is not determined by fixation alone, and there are circumstances in which a surgeon may still decide that securing the mesh is appropriate.
When Might a Surgeon Still Choose to Fix the Mesh?
The evidence supporting non-fixation does not mean that fixation has no role in groin hernia surgery. A surgeon may decide to secure the mesh when there is concern that it may not remain adequately positioned without additional support.
Factors that may influence this decision include:
- Size of the hernia defect: Larger defects may require greater consideration of mesh stability and the risk of the mesh shifting from its intended position.
- Type and location of the hernia: Different hernia patterns can affect how the mesh sits and whether fixation may provide additional stability.
- Mesh size and positioning: The mesh needs to provide sufficient coverage of the weakened area. If stable positioning cannot be achieved without fixation, securing it may be considered.
- Findings during surgery: The surgeon can assess the anatomy and repair directly during the procedure and determine whether additional fixation is appropriate.
- Individual recurrence risk: Previous hernia repairs and other patient-specific factors may influence how the surgeon approaches the repair.
The decision is therefore not simply between fixation being "good" or "bad". The aim is to use fixation selectively when it may contribute to a stable repair while avoiding it when it is unlikely to provide additional benefit.
Plan Your Groin Hernia Repair With Dr Sujit Singh Gill
Mesh fixation is not an automatic step in every keyhole groin hernia repair. While leaving the mesh unfixed may help reduce the risk of persistent pain in suitable patients, there are situations where securing it may still be appropriate. The decision ultimately depends on the hernia, the anatomy encountered during surgery and how securely the mesh can be positioned.
The Vascular & General Surgery Centre provides assessment and surgical treatment for hernias and other general surgical conditions. Dr Sujit Singh Gill, consultant vascular & general surgeon, can assess your hernia and discuss the considerations involved in planning your repair. Contact us to arrange a consultation with Dr Gilland discuss your groin hernia treatment options
Related Links
- What Are Hernias & When to See a Doctor
- Preparing for Hernia Surgery: What to Expect Before, During and After
FAQs About Mesh Fixation in Groin Hernia Surgery
Can a hernia mesh move if it is not fixed in place?
Mesh that is left unfixed is positioned to provide sufficient coverage of the weakened area. In totally extraperitoneal (TEP) repair, its position, pressure from within the abdomen and subsequent tissue growth can help keep it in place. Whether non-fixation is suitable depends on the individual repair.
Does fixing hernia mesh make the repair stronger?
Not necessarily. Fixation can provide additional stability in certain situations, but it does not automatically mean the repair will have a lower risk of recurrence. The need for fixation depends on factors such as the hernia defect, mesh positioning and surgical findings.
Can mesh fixation cause long-term groin pain?
Mesh fixation may be one factor associated with persistent groin pain after surgery, particularly if nearby tissues or nerves are affected. However, persistent pain can have several causes, and fixation does not mean that a patient will necessarily develop long-term discomfort.
