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Hernia repair surgery is a common medical procedure.  Over 1 million inguinal hernia repairs and 600,000 ventral/incisional abdominal hernia repairs are done every year.  Hernia mesh has become a prevalent method for reinforcing weakened abdominal walls. Hernia mesh, also known as surgical mesh, is a material that helps support the weak tissue around the hernia and aids in the healing process. While hernia mesh has proven to be effective in many cases, concerns about its safety have also arisen. In this blog, I will delve into the benefits of hernia mesh, its potential complications, and ways to ensure a safe and successful hernia repair.

Benefits of Hernia Mesh

  1. Reduced Risk of Recurrence: Hernias tend to recur if not repaired with mesh reinforcement. In most hernia repairs, mesh provides critical additional support to the weakened area, significantly reducing the risk of recurrence.
  2. Minimized Recovery Time: Hernia mesh allows for tension-free repair in inguinal hernia repairs, which often leads to a quicker recovery period compared to traditional suture-based repairs.
  3. Strengthens Tissue Healing: The mesh acts as a scaffold for the body's natural tissues to grow, aiding the healing process and creating a strong repair over time.
  4. Necessary for Complex Cases: Hernia mesh is particularly necessary for medium to large ventral/incisional hernias and cases involving weakened or scarred tissue where traditional repairs have failed.  The recurrence rate is so high without mesh that hernia surgery should not be performed if mesh cannot be used.

Potential Concerns and Complications

  1. Infection: One of the primary concerns is the risk of infection. While modern mesh materials are designed to resist infections, there is still a small chance of the mesh becoming a breeding ground for bacteria.
  2. Adhesions: Adhesions occur when scar tissue forms and binds nearby organs or tissues to the mesh, potentially causing discomfort or bowel obstruction.
  3. Migration or Shrinkage: There have been cases of the mesh migrating or shrinking over time, which could lead to discomfort, pain, or recurrence of the hernia.
  4. Allergic Reactions: Extremely rare, some individuals may experience an allergic reaction to the materials used in the mesh.  I have not seen this in my nearly 20 years of practice.
  5. Chronic Pain: Chronic pain around the surgical site is a possible complication with any surgery (ie cardiac, plastic, orthopedic, etc.).  It is often attributed to irreversible tissue damage, nerve damage or the body's reaction to implants.

Ensuring Safety and Success

  1. Choose an Experienced Surgeon: Select a surgeon who specializes in hernia repair and has a track record of successful outcomes using mesh.
  2. Discuss Mesh Options: There are different types of hernia mesh available, including absorbable and non-absorbable varieties. Discuss with your surgeon which option is best for your situation.
  3. Understand the Risks: Before undergoing surgery, thoroughly discuss potential complications with your surgeon and have a clear understanding of the risks involved.
  4. Monitor and Report: After surgery, pay attention to any unusual symptoms or discomfort and promptly report them to your healthcare provider.
  5. Lifestyle Factors: Follow your surgeon's pre-operative instructions.  Many modifiable risk factors are associated with increased surgical risks, such as obesity, smoking, poorly controlled diabetes, malnutrition and immunosuppression.  Be as healthy as possible going into surgery to minimize complications.  After surgery, maintain a healthy lifestyle, and avoid activities that strain the surgical site during the recovery period.

Conclusion

Hernia mesh has provided significant benefits to countless patients by improving the success rate of hernia repair surgeries. While concerns about safety do exist, choosing the right surgeon, understanding the potential complications, and adhering to the surgeon’s instructions can greatly minimize these risks. As with any medical decision, it's important to have an open and informed discussion with your surgeon to determine the best approach for your individual situation.  

Call Dr. Rockson Liu at 510-465-5523 or fill out the consultation request form for an individualized consultation.  He will personally review your medical records and imaging, interview you, and examine you to find the best surgical (or non-surgical) option that is tailored for your specific situation.

What is mesh?

Mesh is a sheet of material designed to reinforce a hernia repair. It can be called a "screen" or "patch" also.

Material

Mesh can be divided into synthetic or biologic, and permanent or absorbable.  Biologic mesh can be made from human, pig, sheep or cow tissue.  The newest meshes are made with a combination of synthetic and biologic material.

Safety

Mesh is safe when implanted properly. It has been around for almost half a century and has been implanted in millions of people without problems.

Choice of mesh

There are many factors that determine which mesh your hernia surgeon will use. Most hernia repairs utilize permanent synthetic meshes that are made with either polyester or polypropylene.

Surgery without mesh?

You developed a hernia because of weakened tissue. Just sewing the weakened tissue with sutures is usually not enough to prevent a future hernia, so mesh is needed to reinforce the repair.

Dissolving mesh

Dissolving mesh can be derived from biologic or synthetic sources.  There is no benefit in using these meshes in most situation.  A hernia specialist at the PATCH Institute will be able to guide you with the choices.

What is the evidence regarding mesh and chronic pain?

The best available evidence shows that using mesh for hernia repairs does not lead to increased chronic pain. However, using mesh decreases recurrences significantly compared to not using mesh. Below are 2 good quality studies in the surgical literature:

van Veen RN, Wijsmuller AR, et al. Randomized clinical trial of mesh versus non-mesh primary inguinal hernia repair: Long-term chronic pain at 10 years. Surgery, Volume 142, Issue 5, 695 – 698.

In this study 300 patients were randomized to open repair with mesh and open repair without mesh. This is the gold standard method of performing a comparison study in surgery. After the surgery, the patients were followed for a median of over 10 years. The patients whose repair did not utilize mesh had a 17% recurrence rate (i.e. 17% failed over 10 years). Patients whose repair utilized mesh had a 1% recurrence rate. The authors also found “that mesh repair of inguinal hernia is equal to non-mesh repair with respect to long-term persistent pain and discomfort interfering with daily activity.” In other words, patients who had mesh did not have more pain or discomfort than patients who didn’t have mesh repair. 

Scott N, Go PM, et al. Open Mesh versus non-Mesh for groin hernia repair. Cochrane Database of Systematic Reviews 2001, Issue 3.

This study is from Cochrane. It is a non-profit, non-government organization formed to organize medical research findings to facilitate evidence-based choices about health interventions faced by health professionals, patients, and policy makers. Cochrane includes 53 review groups that are based at research institutions worldwide. 

This review by Cochrane examines the evidence from studies comparing different types of open surgery for people with groin hernia. They included only randomized studies comparing methods using synthetic mesh versus methods without mesh. There were 20 studies comparing mesh with non-mesh repair analyzed in this study.

Based on their analysis, there was strong evidence that fewer hernias recur after mesh repair than following non-mesh repair. There was a suggestion that people had less persisting pain after mesh repair, but results were only available for nine out of 20 trials. Open mesh methods were shorter to perform than Shouldice procedures (an open non-mesh repair) but took longer than other types of non-mesh repair. They found no clear differences between mesh and non-mesh methods for operative complications and persisting numbness. Overall, people spent less time in hospital and returned to their usual activities quicker after mesh repair.

The leading minimally-invasive general and hernia repair surgeon on the West Coast, serving patients in the greater SF Bay Area. 

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