lower rates of chronic pain while sharing the same rates of hernia recurrence as compared to heavyweight options. This has led to the adoption of lightweight mesh for minimizing the chance of chronic pain after surgery. Biologic mesh is indicated in cases where the risk of infection is a major concern such as cases in which the bowel has become strangulated. They tend to have lower tensile strength than their synthetic counterparts lending them to higher rates of mesh rupture. Biomeshes are increasingly popular since their first use in 1999 and their subsequent introduction to the market in 2003. Some have a similar price to high end synthetic meshes. They can be produced from absorbable, animal-sourced extra cellular matrix, or by other means. Synthetic absorbable meshes are also available. Meshes made of mosquito net cloth, in copolymer of polyethylene and polypropylene have been used for low-income patients in rural India and Ghana. Each piece costs $0.01, 3700 times cheaper than an equivalent commercial mesh. They give results identical to commercial meshes in terms of infection and recurrence rate at 5 years. Lichtenstein technique The Lichtenstein tension-free repair has persisted as one of the most commonly performed procedures in the world. The European Hernia Society recommends that in cases where an open approach is indicated, the Lichtenstein technique be utilized as the preferred method. Recent studies have indicated that mesh attachment with the use of adhesive glue is faster and less likely to cause post-op pain as compared to attachment via suture material. Plug and patch technique The plug and patch tension-free technique has fallen out of favor due to higher rates of mesh shift along with its tendency to irritate surrounding tissue. This has led to the European Hernia Society recommending that the technique not be used in most cases. Other open mesh repair techniques A variety of other tension-free techniques have been developed and include: Prolene mesh system (PHS) Kugel (preperitoneal repair) Stoppa Trabucco (Hertra mesh) Wantz Rutkow/Robbins Modified APP Open non-mesh repairs Techniques in which mesh is not used are referred to as tissue repair technique, suture technique, and tension technique. All involve bringing together the tissue with sutures and are a viable alternative when mesh placement is contraindicated. Such situations are most commonly due to concerns of contamination in cases where there are infections of the groin, strangulation or perforation of the bowel. Shouldice technique The Shouldice