Reply To: Hernia Journal Special Issue on Chronic Pain
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Here is the latest article from the new Special Issue. It is about “autoimmunity”, a word that describes when the body develops an autoimmune problem. The conclusion is that mesh does not appear to cause an autoimmune condition. The chronic pain and discomfort results solely from the body’s foreign body reaction to the mesh. It is a physical problem tied to the mesh. Which fits with the result that the problems disappear when the mesh is removed.
It is an interesting article that clarifies the problem, but, again, does not offer a solution or a way to prevent it. So far, the releases for the Special Issue only seem to confirm the problem.
Published: 04 February 2023
Autoimmunity and hernia mesh: fact or fiction?
B. Jisova, J. Wolesky, Z. Strizova, A. de Beaux & B. East
The authors confirm the ~15% chronic pain rate –
“The use of synthetic mesh in hernia repair is well-established [1, 2]. Indeed, hernia guidelines recommend mesh in most hernias to minimise hernia recurrence. Local complications are well described clinically yet they are not quite so well understood from the histological perspective . For example, it is known that approximately 10–20% of patients after inguinal hernia repair suffer from chronic pain to some degree [5, 35]. However, causes of this pain are variable and most likely linked to nerve injury rather than to mesh-related autoimmunity. To add to this confusion, many authors incorrectly mix autoimmunity and chronic foreign body reaction.
Currently, there is little evidence that the use of polypropylene mesh can lead to autoimmunity. A large number of potential triggers of autoimmunity along with the genetic predisposition to autoimmune disease and the commonality of hernia, make a cause and effect difficult to unravel at present. Biomaterials cause foreign body reactions, but a chronic foreign body reaction does not indicate autoimmunity, a common misunderstanding in the literature.”