Is hernia mesh as scary as the internet makes it sound?

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Is hernia mesh as scary as the internet makes it sound?

Dr. Towfigh,

I did not know you did the Shouldice repair for an inguinal hernia. I would consider this type of repair for my inguinal hernia.

quote :

Is hernia mesh as scary as the internet makes it sound? Are complications as common as they seem? The majority of discussion online around hernia mesh is quite negative, as I’m sure many patients and doctors are aware, but that is not particularly reassuring when you’re a potential patient. My doctor told me not to google it, but it’s hard not to! At the same time, there are seemingly no surgeons outside of Shouldice and a private clinic or two on the east coast who perform a ‘pure tissue’ repair anymore, why is that?

I realize happy people likely don’t get on the internet and rave about positive or uneventful experiences with surgery, so what’s the real story about hernia mesh?

Any comments from patients, surgeons, health care providers would be very welcome! Thanks!

[sngoldstein]

Is hernia mesh as scary as the internet makes it sound?

I have been doing mesh hernia repairs for 20 years and standard polypropylene mesh has been in use for at least twice that long. As Dr. Towfigh says, that is a huge denominator and most mesh patients do fine. I do not do any non-mesh repairs except in children because the recurrence rate is so high. If your native tissue failed, it was not strong enough to begin with, and if it is sewn back together it’s likely to be less strong. That is why you need mesh if your hernia is going to stay fixed. Although there are few studies about this, there is not likely any increase in pain or other problems with the use of mesh. In fact, the reason surgeons all use mesh to fix hernias is that the studies have overwhelmingly show better results with mesh.

There have been two major problems with mesh use that resulted in class action suits: one is using mesh transvaginally for incontinence which was, in retrospect, not a great idea. The other involves a mesh product that had a plastic ring which, on occasion, broke and caused bowel injuries. That has nothing to do with mesh, it was a poor product design.

I personally have implanted thousands of pieces of mesh and have seen very few problems. Like anything else, it has to be done correctly and you want an experienced surgeon fixing your hernia. Outside of that, I would not worry too much about mesh. If your surgeon is getting good results with their technique, you will probably get a good result.

[drtowfigh]

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.