Not always but most hernia surgeons prefer to use mesh unless the hernia hole is very small and the surrounding tissues strong. The vast majority of surgeons use mesh for abdominal wall hernias and have done so for many decades. The mesh is made from sterile inert materials that include polyester and polyprolene and these are now both strong and soft (and it is placed quite deep to the skin so not to feel it). Many studies have proven that mesh significantly reduces the chance of the hernia coming back (and needing a second hernia operation is more problematic than the first). Using mesh on the abdominal wall is also quite a different scenario to using it next to an abdominal organ (such as mesh used by gynaecologists in surgery on female pelvic organs). When used on the abdominal wall the mesh is not in direct contact pressing on an organ, rather within the abdominal wall.