Mesh migration, wound healing, long-term changes

[Good intentions]

A recent article about long-term changes.

https://link.springer.com/article/10.1007/s10029-020-02297-1

Here is a link to a related topic for anyone who comes across this one in the future.

https://herniatalk.com/forums/topic/mesh-removal-training-a-new-field-of-study/

Mesh removal training – a new field of study

[Good intentions]

I imagine that if mesh removal was a true area of research that professionals could dig in to all of this. It’s probably hard to talk about the need for research on mesh removal though. Run away.

[Good intentions]

Here is an article exploring procedural causes for mesh migration.

Apparently there are concerns about the method of placement or the patient’s actions immediately after surgery allowing mesh migration. I can only assume, because I can’t afford to buy these articles, that surgeons are finding mesh where it is not supposed to be and they are trying to figure out how it happens, so these people set up a little experiment.

It’s a bit humorous that there is almost some victim-blaming going on. “You sat up too fast, it’s your fault!”.

https://link.springer.com/article/10.1007/s00464-003-8183-0

“Conclusions
Concern about mesh migration attributable to patients sitting up immediately after surgery appears to be unfounded, at least according to the findings for the current, small, simulated study group.”

[Good intentions]

I would consider any portion of the mesh sheet that moves from its original placement to have “migrated”. Wrinkling, balling up, folding, or the whole flat piece moving downward or sideways or upward are all “migration”.

You will find accounts of surgeons finding mesh where it is not supposed to be. The assumption is that once the mesh is placed that it never moves, therefore the surgeon who placed it must have made a mistake.

I combined wound healing and mesh migration so that a person could try to understand how collagen restructuring can allow the mesh, or portions of it, to move. Most surgeons seem to think of the abdominal wall as a static structure. They don’t seem to consider the stretching and bending that occurs during normal physical activities. Many people get on to this site and discuss situations where “everything has been fine” for months or years then they strained the area and now nothing is the same. If a piece of mesh pulls from its placement on the abdominal wall, does it lay back down exactly where it came free from? If it doesn’t then it can be considered to have migrated. Many of these displacements over time can result in a lot of movement.

I just posted to broaden the view and give some more things to think about. No matter what the method or material a synthetic mesh is a foreign body that the body will continue to try to encapsulate and/or reject for as long as it is contact with body tissue.

[ajm222]

I also see people on Facebook groups saying their mesh migrated to other parts of their body, like into their legs and such. Always seemed kind of ridiculous. Can pieces of pelvic mesh though dislodge or break free and move into other parts of the body?

[drtowfigh]

There are many issues with this manuscript.

First, mesh migration implies the mesh has moved from its originally intended placement. This has been seen with the plugs for inguinal hernias, though it’s not common and likely is related to surgical technique.

Mesh migration is not a major reason for recurrences or mesh related complications. Erosions, folding, and other happenings are more dominant causes.

I see a lot of posts talking about mesh migration. Perhaps patients are referring to mesh eroding or impinging on structures. From a surgeon viewpoint, that is not migration. Mesh tends to stick to where it is placed within minutes to days of its placement.

The comments in the conclusion of the manuscript alludes to potentially greater interest in reporting or studying migration issues. It should not be construed that we are having a greater incidence of mesh migration.

[Good intentions]

When thinking about mesh migration, the process of wound-healing should also be considered. I think that they are linked, just by the nature of the biochemistry.

Laparoscopy is also called minimally invasive surgery (MIS) even though the actual “wound” that is created is very large. The exposed tissue is either created by tearing apart layers (peritoneum bluntly dissected from fascia) or by burning it free using a cauterizing tool. It is then exposed to the toxic gases of cauterization and the dry toxic CO2 sufflation gas during the procedure. After the mesh is placed the newly damaged tissue (the wound) has to heal, then restructuring of the tissues takes places, for years. The typical surgeon considers their job done at about 3 to 6 weeks, after the very early stages of healing have locked the damaged tissues together.

There are many sources to learn about wound-healing but here is one that is concise.

https://www.woundsource.com/blog/four-stages-wound-healing