Given all the problems a mesh can cause would you recommend the repair of a small inguinal hernia (man, 67) without the mesh? what is the rate of recurrence versus using a mesh?

Use of mesh is standard in repair of inguinal hernias resulting in less operative time and faster recovery as well as much less recurrence of hernia. Of course no one can completely promise no complications of mesh use. If you're not obese and want to avoid use of mesh, be prepared for a more painful procedure and a much longer time to full activities.

Generally pain is higher with a non-mesh repair because the tissue Has to be pulled together tighter, more tension. In addition, there is a higher risk of recurrence. (~5-10%) Mesh repairs theoretically are tension free — therefore less pain but this is variable. They also have a lower risk of recurrence. (0~3%). Surgeon skill, Pt.obesity, smoking, etc. have much bigger effect on recurrence