Mesh excisions – data collection up to 15 years after recommended

[Good intentions]

I think I might have posted this before but I found a source with more free information. The graphical data is very interesting. Most people that have mesh removed have it done after two years. Over half have it done before four years.

https://www.researchgate.net/publication/344344465_Necessary_duration_of_follow-up_to_assess_complications_of_mesh_in_hernia_surgery_a_time-lapse_study_based_on_460_explants

Necessary duration of follow-up to assess complications of mesh in hernia surgery: a time-lapse study based on 460 explants

Springer
October 2021Hernia 25(e2018):3
DOI:10.1007/s10029-020-02297-1
Authors:
K Petersen
J Morrison
Valentin Oprea
D Grischkan
Andreas Koch
Ralph Lorenz
Robert Bendavid
Vladimir Iakovlev

“Purpose: Risk of complications following hernia repair is the key parameter to assess risk/benefit ratio of a technique. As mesh devices are permanent, their risks are life-long. Too many reports in the past assessed mesh safety prematurely after short follow-ups. We aimed to explore what length of follow up would reveal the full extent of complications …

Conclusions: Follow-up of more than 15 years is needed to fully assess complications after mesh hernia repair. Especially longer periods are needed to detect mesh erosion into organs and complications in younger males. Presently, short observations and lack of reporting standard in the literature prohibit accurate assessment of complication risks. …”

[Good intentions]

Here is one of the images.

https://www.researchgate.net/figure/Rise-of-case-percentage-over-time-since-implantation-upper-with-numbers-of-excisions_fig1_344344465

[pinto]

Of those people with excisions, in what proportion do you think scar tissue functions as an effective repair of the original hernia?

[MarkT]

There is no way to answer that question from this study, unfortunately…I would suspect there is tremendous variation between cases.

The 460 cases came from hernia specialists at St. Michael’s Hospital in Toronto, Shouldice Hospital, and other clinics in the U.S., Canada, Germany, and Romania.

The reasons for removal among the 460 total cases: pain (360), recurrence (85), infection (43), erosion into organs (13), and bowel obstruction (4).

Looking at only the 333 groin hernias: pain (300), recurrence (50), infection (3), erosion in organs (0), bowel obstruction (0).

(The sum of the reasons exceeds the total because some cases had more than one reason).

Because plugs are “known to behave differently”, they did look at that subset of cases: “All 40 cases of excised plugs were from the groin. Out of these, 39 were removed for pain and 1 for recurrence. The time lapse for plugs was longer than for flat meshes but it was not statistically significant (4.88 vs. 3.75 years respectively for 50th and 16.01 vs. 14.65 for 95th percentiles, groin hernias). Almost all (98%) plugs were removed for pain in comparison with 89% of flat meshes in the groin. This difference was borderline significant (p = 0.053).”

From the discussion:

“The 50th case percentile in our dataset was reached at 3.75 years after mesh implantation. This indicated that studies of comparable median follow-up time may have a large, up to 50% underestimation of the complication risks.”

“Our 15-year time lapse at 95th percentile may still be a conservative estimate at this point, as younger patients who underwent implantations in the 1990’s will live for several more decades.

Based on our PubMed search, the overwhelming majority of the published studies had follow-up times of less than half of this time. This indicates that there is a large degree of underestimation which is not readily acknowledged in the literature and subsequently not recognized in practice”

There is a fair bit more to the study in terms of discussing methodology and data collection, their results and other research regarding each of the complication types, and standardization of reporting (which, while lacking, can’t replace longer follow-up time that is still necessary).

Of course the specific details are interesting and important, though the broader conclusion is unfortunately not terribly surprising…we have don’t have very good data due to insufficient follow-up time.

[Author]

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