hernia mesh pain?

[DrBrown]

[USER=”2851″]alliecook[/USER]

Elasticity

The abdominal wall stretches and contracts with every movement. In an ideal situation, the mesh should contract and stretch with the body, otherwise, when the abdominal stretches and contracts and the mesh does not then there will be shear stresses where the abdominal wall and the mesh meet. Unfortunately, even the best mesh will stretch only half as well as the abdominal wall. Why use mesh when you know it can decrease the performance of an athlete? [h=2]Shrinkage
In your mind visualize a piece of mesh that has been used to repair a hernia. It is usually placed in between the muscle layers and there are many sensitive structures nearby. Then imagine that mesh shrinking. As the mesh shrinks, it will pull on everything nearby. If the mesh pulls on a nerve, then there will be constant burning pain. If the mesh pulls on the spermatic cord, then sex will be a distant memory. If the mesh pulls on bladder, then there will be spasms when you urinate. If the mesh pulls on the abdominal wall, then there will be pain when you exercise. Most meshes will shrink about 40%.
Youths
Since all meshes shrink with time, it is unthinkable to put mesh in an athlete who has not finished growing. What is going to happen when the athlete grows 5 inches and at the same time the mesh shrinks?[/h] [h=2]Foreign Body Reaction[/h]
All meshes illicit what is called a Foreign Body Reaction. It is the body’s attempt to get rid of what should not be there. (It is nice to know that the body is smarter than many surgeons). Macrophages, lymphocytes, and Giant Foreign Body Cells attack the mesh with acid, free radicals, and enzymes. Mesh usually survives this attack, but the attack does result in a chronic inflammation and pain. [h=2]Pain and Mesh[/h]
About 15% of patients after a hernia repair with mesh suffer chronic pain. The pain usually starts several months after the operation. As we discussed, the pain is caused by multiple factors: shrinkage of the mesh, sensitive structures becoming scarred to the mesh, and the result of the Foreign Body Reaction. When the mesh is removed and then examined under the microscope, there are multiple neuromas indicating nerve damage and there are granulomas indicating the body’s attempt to reject the mesh. Unfortunately, even after the mesh is removed, many athletes still suffer from pain.

Regards.
Bill Brown MD