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Is hernia mesh as scary as the internet makes it sound?
Excellent question and point.
Here is my opinion about the large amount of information on the web against mesh implantation:
1. About a million patients undergo hernia repair annually in the US, almost all with mesh. ¾ of these are inguinal hernias. That’s a huge denominator.
2. For inguinal hernias, there are reports of 20% or more with some sort of twinge, discomfort 3 or months after hernia surgery, and 3% with chronic disabling pain. 3% of 750,000 is a very large number. Presumably, most of these patients have pain directly or indirectly related to the mesh implant.
3. If you look at the old studies before mesh, tissue repair also had its fair share of chronic pain. This is presumably due to the tension in the repair and risk for nerves jury as well.Personally, I don’t recommend mesh in patients who are super thin, small or average build women, or anyone with known fibromyalgia, chronic fatigue syndrome, autoimmune or inflammatory disorder. The risk of mesh-related pain I find to be higher in this group. This, I perform a Shouldice, or Bassini tissue repair for them. And I explain the risks and benefits of this choice. In others, I may choose to place a lightweight mesh, with less total foreign body , inflammation, and therefore pain. There are also hybrid mesh products which have yet to prove themselves as alternatives to lure synthetic mesh products.
I believe we don’t have enough evidence to prove that all mesh should be banned. For sure at this time there are hundreds of thousands of patients annually that do just fine and really need the mesh. However, what we lack is evidence-based decision-making as to who indicidually would benefit from which type of repair, mesh, etc. it’s a complex problem and add Bruce Ramshaw is leading the way to tackle this problem.