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Long Term Mesh Questions – Surgeons/ALL
Dr. Towfigh/Surgeons/and All on this forum who may know the answers,
I’ve posted here a few times and I’m trying to do all the research I can prior to making a decision to move forward with surgery on my inguinal hernia. As I’ve seen in my research, 99% of surgeons use mesh. The products are usually different from surgeon to surgeon, as well as the technique. I’ve also read tons of posts here confirming this detail, so I won’t dwell. Yet, as I’ve continued down this rabbit hole that negatively consumes mesh on the web (and there are factual claims that back up these stories), I’ve become more and more anxious, nervous, and frankly scared to get surgery unless it’s not with mesh. I could use some reassurance.
My questions consist of the following and are specifically in regard to years after inguinal hernia operation (10, 15, and even greater than 30 years later).
1) What are the statistics on mesh degrading over time? I’m young (33) and pretty worried that if I get a perminant mesh implant, it will eventually degrade and cause an infection/auto-immune disorder, chronic pain, or something worse that will require removal. Surgeons: Is there any data from studies that can prove this hypthesis wrong? Will this eventually happen over time to everyone with a mesh implant?
2) I’ve read that following mesh implementation in inguinal surgery, the nerves in the groin (even if uneffected with surgeon placement, both lapro and open) will eventually either grow into the mesh, or grow into the adhesions from the scar tissue, which will cause nerve entrapment and lead to significant/debilitating pain. Surgeons: Is there data proving that this will not eventually occur for all mesh implants?
3) I was dumb and decided to browse the adverse events report on the FDA website. There are a ton of reports relating to the two scenerios I’ve laid out above (thousands). I know there are roughly 700-800 thousand of these procedures done per year in the US, so even a 5% complication rate is still a large number. Surgeons: can any of you provide clear statistics on the people that have complications like this following mesh repair and the likelihood of it happening to a healthy, young adult?
4) My last general question is simple: what are the odds of having ANY issues with mesh in the time periods I’ve noted above (up to 30 years later)?
Thanks for reading and I hope we can get some solid responses for the users on this forum. -
2 Replies
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I agree with Herniator.
Unfortunately, science is a bit behind and we do not have the best of answers for you. The Europeans do a much better job than the Americans in maintaining a national registry that can better answer some of the clinical questions.
– Mesh shrinkage has been determined to be multifactorial. It may contribute to pain if the mesh is already placed in a taut manner. Lighter weight synthetic mesh shrinks less than the denser mesh products. Biologic products tend to have the reverse problem. Mesh degradation is usually not an issue and not related to any mesh-related problems.
– The real % of patients that have true mesh-related problems (immunologic reactions, rejections, allergies) is considered to be very uncommon but is also unknown. It seems to be a greater concern in the US than outside the US. That said, I believe our mesh usage is also higher.
– If you have no symptoms in the first few weeks to months after mesh implantation, the risk of mesh-related reaction is close to nil.
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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/11597665Hope this helps
Good luck
A
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