Reply To: Long Term Mesh Questions – Surgeons/ALL

[Herniator]

1) Mesh shrinkage occurs to about 30% – it incorporates into the normal body tissues and creates neo (new) collagen, but will remain. The mesh composition will decide on amount and degree of new collagen – most data is from animal studies, but overall the risk is very small for you to experience an immunological reaction – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895198/ https://www.ncbi.nlm.nih.gov/pubmed/22575883
2) Chronic groin pain is defined as pain after three months and if neuropathic (pin point sharp pain) then the nerve can be damaged/intertwined or irritated by the mesh or by surgery itself – in lap, mesh will lie in contact with the nerves and can present commonly with pain in the front of the thigh and open will present with groin pain around the groin crease and pubic bone – if you have no pain then the likelihood is that the mesh is not causing you any problems and this is the case for at least 94% of persons as shown in most large hernia registries and randomised controlled trials.
3) If you are young, have prior pain and elect for an open repair then you are more likely to have pain post op – but the incidence remains low around 2-5% – risk of complications is also low and I would seek out a surgeon with relevant experience in this area – all surgery has risks but leaving your hernia and having a later repair increases the chances of you having potential complications from surgery.
4) 30 years is a long time and most long term follow up data is usually up to 3 years – for longer term data I would examine the Danish Hernia registry which has the largest outcome data collected over many years with 10000s of patients. If your mesh has caused you no problems in the first three months then the likelihood of it causing you problems in the future reduce over time although like everything in our profession nothing is absolute https://www.ncbi.nlm.nih.gov/pubmed/11597665

Hope this helps
Good luck
A