Reply To: Mesh – the risk of chronic pain. Is anybody trying to minimize the risk?
Hernia Discussion › Forums › Hernia Discussion › Mesh – the risk of chronic pain. Is anybody trying to minimize the risk? › Reply To: Mesh – the risk of chronic pain. Is anybody trying to minimize the risk?
I found a good review of mesh materials used in hernia repair, pdf link below. I noticed some flaws in thinking, for instance, associating fiber fragmentation during usage with flexibility instead of fatigue resistance, but I think that the authors are not experts in materials. It’s a very broad-based review and seems well-done.
It’s from 2017, so it’s good to see that there is still development work ongoing. Unfortunately, in the meantime, there are still surgeons working from what they learned in 2005, with the same materials. That should be a takeaway for anyone considering hernia repair today. Make sure that your surgeon is up to speed on advancements, and can address the very well-known problems with hernia mesh. Chronic pain and discomfort being the issue most overlooked or discounted.
The section on knitting, on page 12, is very interesting in that it relates back to Bendavid’s paper about SIN (post #1 above), perhaps caused by small “pores” created by the knots and loops of the knitting process. The knit fabrics are designed for flexibility and feel by hand, outside of the abdomen, and one time placement during surgery. The issues with shrinkage and SIN don’t seem to be addressed. This seems to be a big oversight, probably due to “out of sight, out of mind” once the material is implanted, so “easily adapts to the movement of the human body” (from the review) is nonsense, in the long-term. Once the material binds up and shrinks, in the abdomen, it feels like a playing card has been placed inside. It’s no longer soft.
There is hope for better materials, I think, if the right people are working on new materials and design. As better mesh is introduced to the market, maybe the old bad ones can be whittled away, and replaced.