Questions and Concerns About Hernia Mesh

No discussion on hernia surgery is complete without addressing the many concerns that some patients have about mesh. These concerns were exacerbated in in the past, when counterfeit mesh was sold on the market and subsequently recalled. The bad publicity was further exacerbated by more recent recalls of vaginal and pelvic floor meshes that, over the past several years, have garnered media attention and advertisements from attorneys.

However, patients should know that today’s hernia mesh is very different from the mesh of old. Further, the mesh used for pelvic floor and vaginal surgeries is distinct from hernia mesh. In fact, today, there are more mesh options than we’ve ever had before. Mesh is lighter and more precisely manufactured. There is a specific kind of mesh for every body type and every kind of defect. In fact, today, we even have biologic meshes – those made from animal tissue, and absorbable mesh – which is absorbed into the body. In short, today’s mesh has addressed many of the common concerns of the past.

Perhaps, however, most importantly, mesh reduces recurrence rates dramatically. When tension or suture repairs were the norm, patients’ risk of recurrence was 20% or more. However, by using mesh and modern repair techniques, we have reduced that risk to about 1 to 2%. Considering that recurrent hernias are riskier and more difficult to repair, this more than makes up for any mesh-related risks that a patient may experience.

To that end, there are some risks associated with mesh which must be taken into account for each patient and discussed during consultation:

• First, mesh is a permanent medical device that is implanted in the body. Some patients may not be comfortable with this kind of implant, and for those, there is the option to use an absorbable or partially-absorbable mesh.
• Regular mesh may not be appropriate if there is an infection at the surgery site. If the surgical field is infected, patients may benefit from a biologic or natural-tissue mesh versus the typical, permanent plastic mesh.
• There is the possibility of mesh migrating from the hernia site. This may lead to recurrence and also cause chronic pain if there is nerve involvement. Modern meshes are made with an adhesive backing to reduce this risk, but there is always a small chance.

There is also the possibility of a problem with the manufacturing of the mesh itself, causing curling or other issues. Modern mesh technology and manufacturing is such that this has been reduced significantly.