Should hernia mesh be removed when a hernia recurrence is being repaired?
Sometimes yes. Sometimes no.
This question has no easy answer. If it is clear that the hernia mesh is causing disabiling pain and the patient needs relief of the pain, then yes, the mesh should be removed and the hernia recurrence repaired without mesh. It is rarely clear though. Medical imaging is of no help.
There are some hints. If the pain did not start until the hernia appeared and the pain goes away when the hernia is reduced, the diagnosis of mesh pain is not supported. These are soft signs and are not 100% reliable. It is not typical for an uncomplicated hernia to cause severe pain. This is a soft sign that supports the diagnosis of mesh pain.
So why not just remove the mesh when correcting a recurrence from previous mesh hernia surgery? Because it might be unneccessary. It is a bigger and more expensive surgery with more risks. But not removing the mesh has the risk of not curing the patients pain and requiring additional surgery.