Mesh Does Not Substitute for a Correct Technique, and Can Turn a Simple Procedure Into a Complex Disease With a Difficult Solution.

In the last decade, surgical mesh has become what is considered the ideal method for repairing hernias of any type. As their use has become routine, the surgical process has undergone changes in such a way that the mesh has taken the leading role in the procedure. Meanwhile, other steps that had been consolidated after years of experience and were considered essential for avoiding recurrences have been minimized or even forgotten altogether. These include: clear identification and dissection of the inguinal ligament, pubis and posterior floor; treatment of the sac; assessment of the internal inguinal ring; treatment of the cremaster; assessment of sliding over the pubis; etc. To illustrate this situation, I present the case of a 65-yearold male, with no medical history of interest or risk factors for deficient healing or immune alterations (no obesity, diabetes, aneurysm; non-smoker; no malnutrition; no liver or kidney failure; etc.), who was referred to us after 8 inguinal hernia surgeries and 12 mesh implants in the abdominal wall. The patient had spent the last 6 years undergoing surgery after surgery, without being able to live a normal life. What started out as a small unilateral inguinal hernia turned into a recurring hernia, chronic seroma, fistula, pubic incisional hernia, infraumbilical incisional hernia and, finally, iliac incisional hernia, as well as an abdominal wall that was fibrous, wood-like, insensitive and deformed (Fig. 1). The patient was monitored until the closure of the skin infection. He was made to walk 1 h per day, and tomographic reconstruction of the abdominal wall was used (defect 10 cm 12 cm on the iliac spine, with intestinal content). After confirming the state of the entire abdominal wall, we operated and found the remains of several surgical mesh implants and cavities. Another 2 whole mesh implants measuring 20 cm had been rejected and located on top of necrotic tissue (one premuscular on the entire midline and another retromuscular on the upper inguinal area); these mesh patches were totally wrinkled and showed no signs of integration (Fig. 2). The implants were removed and the affected tissue