The quick and easy answer is: not often.
The standard of care in the US for more than 30 years has been to repair hernias with mesh. If mesh was dangerous, it would not be used in almost 99% of hernia repairs. Every year, many patients have complications of any surgery, including hernia surgery. Some of these complications can be related to the use of mesh. Because there are many ways to fix hernias, the complication rate is quite variable, depending on the technique used. The biggest problem after hernia surgery is chronic pain. While mesh can contribute to this, hernia repair options that do not include the use of mesh, often are associated with chronic pain as well. As more and more outcome data becomes available, we are learning that not all hernia repairs are created equal. The open preperitoneal repair is associated with a lower risk of chronic pain, and very few mesh complications. For thin patients, a non-mesh repair may be a good alternative. We have been offering the Shouldice non-mesh hernia repair for our patients since 2015 and perform this procedure almost every week.