What is the mayo technique?

September 21, 2025 •

4 min read

Developed by Dr. William J. Mayo in the late 19th century, the Mayo technique remains a respected and effective surgical procedure for hernia repair, especially for umbilical and incisional hernias. This classic tissue-based method offers a durable solution by strengthening the abdominal wall. This guide delves into what is the Mayo technique and its key principles.

Quick Summary

The Mayo technique is a surgical method for repairing hernias, characterized by its "vest-over-pants" fascial tissue overlap and strong mattress sutures. It provides a durable, non-mesh repair solution for small to moderate umbilical and incisional hernias.

Key Points

Tissue-based repair: The Mayo technique uses the patient's own fascial tissue, not synthetic mesh, to reinforce the abdominal wall [2, 3].
'Vest-over-pants' overlap: A key feature is the unique method of overlapping the fascial edges to create a strong, double-layered closure [2, 3].
Primary application: It is most commonly used for repairing small to moderate umbilical, epigastric, and incisional hernias [2, 3].
Effective for selected patients: The procedure is highly effective for patients with good tissue quality, but mesh may be better for larger defects or weaker tissue [2].
Developed by Dr. William J. Mayo: The technique was pioneered by one of the co-founders of the Mayo Clinic in the late 19th century [2, 4].
Recovery involves restriction: Patients must limit physical activity, especially heavy lifting, for several weeks to ensure proper healing and prevent recurrence [2].

History and Development of the Mayo Technique

Developed by Dr. William J. Mayo, a co-founder of the Mayo Clinic, the Mayo technique significantly impacted the surgical treatment of umbilical hernias in the late 19th century [2, 4]. Prior to its introduction, hernia repairs often had high recurrence rates. Dr. Mayo's innovative approach involved overlapping the fascial layers, leading to a stronger repair compared to earlier methods [2]. This technique was groundbreaking in utilizing the patient's own tissues for a more reliable closure [2, 4].

The Core Principles of the Surgical Repair

The Mayo technique is a tissue-based repair [2, 3]. Its defining feature is the "vest-over-pants" or "double-breasted" overlap of the patient's abdominal fascia [2, 3]. The process involves incising the fascia around the hernia, creating flaps, overlapping them, and securing them with strong sutures [2, 3].

Key steps generally include:

Incision: A curved transverse cut is often made near the navel for umbilical hernias [3].
Exposure: The hernia sac is found, separated, and its contents returned to the abdomen [2, 3].
Fascial Overlap: The fascial edges are freed, and one side is overlapped onto the other [2, 3].
Suturing: The overlapped layers are secured with strong, often non-absorbable or slowly absorbable mattress sutures [2, 3].

Indications and Patient Selection

The Mayo technique is particularly suited for certain types of hernias and patients [2, 3]. It is commonly used for:

Umbilical hernias: Especially those with small to medium defects (usually under 2-3 cm) [2, 3].
Epigastric hernias: Found above the navel in the midline [2, 3].
Small incisional hernias: For midline defects from prior surgeries [2, 3].

Successful outcomes depend on careful patient selection [2, 3]. It is most suitable for individuals with healthy abdominal wall tissue who are not significantly obese [2, 3]. For larger defects or compromised tissue, mesh repair may offer better results [2, 3].

Mayo Technique vs. Mesh Repair

Choosing between a tissue repair like the Mayo technique and a mesh-based repair is a critical decision in modern hernia surgery [2]. Both approaches have advantages and disadvantages considered by surgeons based on the specific hernia and patient factors [2].


Feature	Mayo (Tissue) Technique	Mesh Repair
Material Used	Patient's own fascial tissue [2, 3]	Synthetic or biological mesh [2]
Suitability	Small to moderate hernias with healthy tissue [2, 3]	Small to large hernias, especially with weakened tissue [2]
Recurrence Rate	Historically higher for larger defects [2]	Lower, particularly for larger hernias [2]
Procedure Complexity	Simpler and quicker for experienced surgeons [2]	More complex due to mesh placement [2]
Recovery	Often quicker with less foreign body reaction [2]	May have more initial discomfort but strong long-term support [2]
Risk of Foreign Material Complications	Absent [2]	Present, though modern meshes are biocompatible [2]

The Recovery Process and Expected Outcomes

Recovery after a Mayo repair typically involves several weeks of restricted activity to allow the abdominal fascia to heal securely [2]. Patients may experience discomfort, bruising, and swelling, managed with pain medication [2].

General recovery milestones:

Immediate Post-Op: Patients are monitored and usually discharged within hours [2].
First Few Weeks: Essential to limit activity and avoid heavy lifting to protect the repair [2].
4-6 Weeks: Most individuals can resume normal, light activities [2].
6+ Weeks: Full recovery and return to all activities, including heavy lifting, should only occur with surgeon approval [2].

Outcomes are generally good for appropriate patients, offering a durable solution, particularly for smaller umbilical hernias [2]. Adhering strictly to post-operative instructions, especially regarding physical strain, is vital to minimize recurrence risk [2].

Conclusion

The Mayo technique, a classic surgical method, remains a valuable option for specific hernia repairs [2]. Its tissue-based approach, utilizing the body's own fascia with a unique overlap, provides a durable repair without synthetic mesh [2]. While mesh-based repairs are also common, understanding what is the Mayo technique highlights the range of surgical choices available for abdominal wall repair [2]. Consulting a surgeon is crucial to determine the most suitable approach for each individual case [2]. For further insights into surgical outcomes, a study on a modified technique is available here: PubMed study on modified Mayo technique [1].

Is the Mayo technique still relevant today?

Yes, it remains a standard and valid option, particularly for smaller umbilical and epigastric hernias in suitable patients [2].

What is the Mayo technique used to repair?

It is primarily used for repairing umbilical, epigastric, and smaller incisional hernias by overlapping the fascial edges [2, 3].

What are the main benefits of the Mayo repair?

It avoids the use of foreign mesh, which can reduce the risk of certain mesh-related complications [2].

How long does recovery from a Mayo repair take?

Most patients can return to normal activities within 4-6 weeks, though heavy lifting is restricted for longer [2].

What are the risks of the Mayo technique?

Risks include wound infection, hematoma, and a potentially higher recurrence rate compared to mesh repair for larger defects [2].

How does it differ from a mesh repair?

Unlike mesh repair, which uses a synthetic patch for reinforcement, the Mayo technique uses a "vest-over-pants" overlap of the patient's own tissue [2].

What types of sutures are used?

Strong, permanent, or delayed-absorbable mattress sutures are used to create and secure the fascial overlap [2, 3].

Does the Mayo technique use mesh?

No, it is a tissue-based repair that intentionally avoids the use of mesh [2].

Who is an ideal candidate for this procedure?

An ideal candidate has a small to moderate hernia defect, healthy surrounding fascia, and a healthy weight [2, 3].

Frequently Asked Questions

The Mayo technique is a surgical procedure primarily used for the repair of hernias, especially umbilical, epigastric, and small incisional hernias. It is a classic tissue-based method that reinforces the abdominal wall by overlapping the patient's own fascial tissue [2, 3].

No, the Mayo technique is specifically a tissue-based repair and does not involve the use of synthetic mesh. It relies on suturing the patient's own fascial layers together to create a stronger closure [2, 3].

Recovery typically involves a few weeks of limited activity to allow the surgical site to heal properly. Most patients can resume normal activities within 4 to 6 weeks, but heavy lifting and strenuous exercise must be avoided for longer, as advised by your surgeon [2].

The key difference is the repair material. The Mayo technique uses the patient's own tissue with an overlapping ('vest-over-pants') suture method. Other modern techniques often use synthetic mesh to cover and reinforce the defect [2].

For carefully selected patients with small to moderate hernia defects and good tissue quality, the Mayo technique offers excellent outcomes. However, for larger hernias, mesh-based repairs are often associated with lower recurrence rates [2].

Yes, over the years, surgeons have introduced minor modifications to the original technique, though the core principle of fascial overlap remains the same. Some studies have investigated newer variations [1].

An ideal candidate for the Mayo technique is a patient with a small to moderate umbilical or epigastric hernia, who has healthy abdominal fascia tissue and is in good overall health. Surgeons will evaluate each case individually to determine the best course of action [2, 3].

The primary benefit is the avoidance of foreign material, which eliminates the risk of mesh-related complications. Some patients prefer this natural approach, especially for smaller hernias where tissue strength is sufficient [2].