Hernia Mesh Removal
We are often asked, can you remove my mesh?
The question is really "Will my pain get better if the mesh is removed?" That can be a difficult question to answer. Frequently the best answer is "Maybe".
Patients who have mesh can have pain for a variety of reasons. Pain is one of the most common complaints after surgery of any kind. It can be something as simple as scar pain or as serious as infection.
The majority of patients who have mesh do not experience problems. Among the many patients referred to us with mesh pain we estimate that between 5% and 20% of these patients with mesh have chronic pain. Some recent hernia medical literature says that the incidence of chronic pain after mesh hernia surgery may be as high as 20%. See our review of hernia mesh medical literature.
We see three general categories of problems with mesh that cause chronic pain. 1) mesh scar contraction with or without migration, 2) hernia recurrence, and 4) infection. These are in order of declining incidence.
One category that is frequently discussed is called "nerve entrapment". It is our opinion the nerve is an innocent bystander in the pain syndrome associated with mesh. We believe that this diagnosis is used too frequently when consideration should be given to the other causes listed above. In contrast, nerve entrapment is a common cause of back pain in degenerative disease of the spine. Treatment aimed at this diagnosis has been very successful in helping patients with back pain. The results in patients with pain after hernia surgery have been disappointing.
Our approach to patients with pain after placement of mesh is to first rule out other causes of pain. This means doing a thorough history and physical examination; we utilize other studies when indicated such as CT scan, colonoscopy, etc. The surgeon must then apply some clinical judgment. "Is this pain like other patients I have seen who have had mesh removed and have had a good result?" If as a surgeon you never remove mesh then you cannot make that judgment.
Patients with other causes of pain ruled out and those who have pain that we find compelling may be offered exploratory surgery. It is not an exact science. Not every patient who gets surgery improves; many do and that result is far better than telling all patients that nothing can be done.
