Evidence based recommendation is to adequately cover the myopectineal orifice of Fruchaud and therefore 15 x 12cm size is adequate to fulfill this requirement in most of the patients.

Thanks for that response.

The real debate here is: a 11 x 6cm mesh is used for open Lichtenstein repair, which is obviously inadequate to cover the myopectineal orifice. Why wasn't the concept of myopectineal orifice cover described during the open era? Probably, only the Stoppa technique of meshplasty addressed this.

The ideal size for most cases is 15x10 cm.

Please read: 

Totte E, Van Hee R, Kox E, Hendrickx L, Van Zwieten KJ (2005) Surgical anatomy of the inguinal region: implications during inguinal laparoscopic herniorrhaphy. Eur Surg Res 37:185–190. (5)

https://www.researchgate.net/publication/7672472_Surgical_anatomy_of_the_inguinal_region_implications_during_inguinal_laparoscopic_herniorrhaphy

Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia [International Endohernia Society (IEHS)];  Surg Endosc. Sep 2011; 25(9): 2773–2843.Published online Jul 13, 2011. doi: 10.1007/s00464-011-1799-6

With best regards

K. Peitgen

Article Surgical Anatomy of the Inguinal. Region: Implications durin...

The mesh which will be placed to cover the miopectineal orifice in laparoscopic hernia repair, will be bigger than that utilised in Lichtenstein repair technique, and also it's our  duty to take into account the shrinkage rate which will be between 20-50%; so we utilize minimum 15x10 cm sized mesh.

15x12 covers the myopectineal orifice,if the mesh shrinks it takes care.But in some situations 15x10 is more convenient to place.Large size 3D Bard covers very well.Please see youtube vedio(profpkreddy).In open surgery it is difficult to fit large mesh.

In bilateral repair we fit in a mesh of 15X30 cm wich is tailored in the Leroy fashion. In unilateral repair we tailor a 15X15 cm mesh. Our experience is that smaller meshen tend to give more recurrences.

I determined the size of suitable mesh during lap. inguinal hernia repair in every case by easy method (percutaneous transabdominal using external needle for estimation of mesh size). This method will be published in one international surgical journal in near future.

we currently use a 15 x 12 laparoscopic self gripping mesh, eventually tailored in small patient. But the minimum size even in smallest patients is 14 x 11. In any case mesh must cover from tuberculum pubis to 3-4 cm laterally from deep inguinal orifice and from the posterior face of rectum abdominis to the posterior peritoneum, adfequately dissected .

There is more than just a Consensus:

The Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia [International Endohernia Society (IEHS)] were published in Surg Endosc DOI 10.1007/s00464-011-1799-6 in 2011.

Our latest update 2014 is finished by now and will be published soon.

The adequate size is 15 x 10 cm or bigger. I doesn't need needles  and the megaporous lightweight meshes show negligable shrinkage rates. 

I'm sorry to strongly disagree with one of the comments: The shrinkage rate of e.g.Ultrapro or Parietene light is 3-5%.

I usually use 15x10 cm prolene mesh. This size is suitable for most patients. The larger the mesh size, the less is the recurrence rate.

I wonder if there is any study that actually  corelated mesh size and recurrenc rates......

There is a very good example in the multicenter study of recurrence rate 5 years after Lichtenstein or TAPP repair in recurrent hernias (18%, 19%!) Ekklund. Some of the implanted meshes were simply too small.

If you read the consensus of the International endohernia society just published  in Surgical endoscopy the minimum size is 15 x 10 cm

Ferdinando, I'm glad to read the same newspapers.

If you want to predict the future, try to create it yourself (with a little help of all friends) 

There is no definite answer to be generalised to all patients.Every case should be taken on its merits.10x15 cm mesh can be used as default for majority of patients.

Sometimes we need to put two meshes of same size& sometimes we use larger size mesh 15x15 for example.What surgeon wants to see at the end is to cover all potential hernia defects in the groin and to have at least 3cm margin from the defects.This is the ideal.I agree that no consensus among surgeons about this and that's why we see different recurrence rates.

In my exprience the above policy has  produced recurrence rate of 0.1%.

According to the literature use of mesh smaller that 15x10 cm almost doubles the risk of recurrence. What we require is to cover all potential hernia defects in the groin and to have at least 3cm margin from the defects

No standardization of mesh quality or mesh size is one of the reasons for recurrences. We will recommend mesh free and tension free open repair in all cases to avoid dangers of a foreign body. Pl. visit www.desarda.com

There is more Consensus on the mesh size than you may think. IEHS Guidelines, Update of IEHS Guidelines, Consensus developement.

Surg Endosc (2013) 27:3505–3519  DOI 10.1007/s00464-013-3001-9

EAES Consensus Development Conference on endoscopic repair  of groin hernias

Recommended reading

We shifted to using 15x10 cm recently after enduring struggles with 15x12 cm meshes in our relatively shorter patients. Don't have our long term recurrence data with the smaller mesh but the struggle of mesh placement has decreased considerably. 

I'm glad to hear it, Naveen. Sharmas come from India? We very often forget (when we speak in cm size) the general differences of physiognomy in different populations. E.g. the tacks developed for overweight populations would probably penetrate through the whole abdominal wall of an average Indian.  

That's right Jan. I am from New Delhi , India. We don't fix the mesh in most instances. We don't do too many huge hernias laparoscopically, either.I did read the article you mentioned and noted your authorship. Pleasure and honor to make your acquaintance.

You can estimate the the ideal size of mesh by simple, easy method (Modified transabdominal external needle for mesh size estimation in laparoscopic hernia repair)

A. E. Lasheen et al. International Journal of Surgery 12 (2014) 1074-1076

Dr Lasheen, the previous discussion was related to Inguinal hernias. Your nice article relates to ventral hernias!

Thank you. Dr. Sharma N.

This method for all types of laparoscopic hernia repair, specialy when the area need to cover by mesh is irregular surface as inguinal hernia.

I think anything over 15 by 10 is ideal but be careful when 15 by 15 used as you need larger dissection to place and secure. would not recommend less than 15 by 10.

Recently i have seen couple of cases where in bilateral.cases i do see some gap-space at midline and minimal to no overlap at midline. I am worried of medial recurrence. So i have started to place 3 meshes. 2 on each side and one in the center.

Vishal

i routinely use only 15x10cms as 5cms above and 5cms below the pubic ligament should be enough.....even a 15cms horizontal length one cannot place till the mesh is well across the midline medially ..possibly larger mesh size will be needed in large medial hernias and in such cases best to go be newer approaches like eTEP