Hernia Mesh Removal
We are often asked, why am I having pain?
Patients who are asking these questions typically have been looking for answers and for relief for a long time. These patients are frustrated and disappointed. Typically they have been shuffled from doctor to doctor. They have had multiple tests and scans all of which are normal. Ultimately they end up seeing pain specialists who can do little more than put them on narcotic pain medications and gabapentin. And still they have no answers.
Pain after mesh hernia surgery is a very under appreciated problem in the United States. The European medical literature has a lot more to say about this problem than our own medical literature does. There are several very large European studies which say that the incidence of severe chronic pain after mesh hernia surgery is 20%. The upshot of this is that many physicians in the United States do not recognize this as a problem and may even go so far as to tell patients that their pain is in their head.
Significant pain 3 months after surgery is abnormal. Period. When other likely causes of pain have been ruled out then it is almost certainly the mesh.
The majority of patients who have mesh do not experience problems. American medical literature is inconsistent and you can easily find an article that supports what ever you want to believe. See our review of hernia mesh medical literature. It is our estimate that the incidence of severe chronic pain after mesh hernia surgery is somewhere between 5% and 20%.
Patients who come to see us for mesh removal have had injections, nerve blocks and nerve removals with no relief. There are studies that say that these treatments help and there are studies that say that they don't. It is our impression from the patients that we see that these treatments do not help.
We ask candidates for mesh removal to wait six months from the date of their mesh hernia surgery before having it removed. Waiting this long sometimes results in improvement of the pain. There are patients who should have surgery sooner so this is not a hard and fast rule.
Our experience with mesh removal has been that roughly 80% of patients are cured or significantly improved. These results are good enough to recommend the surgery to patients who have exhausted other treatments and who still have significant pain. We tell patients that if they can manage the pain by other means they should not have the mesh removed.
20% of patient who have removal of mesh for pain do not have significant improvement of their of pain. Fortunately we have not seen anyone who's pain has worsened. We hypothesize that the patients who continue to have pain continue to produce scar tissue no matter what you do. Also, many patients with chronic severe pain from hernia mesh develop PTSD (post traumatic stress disorder) which can be difficult to recover from.
Another more concerning possible issue related to mesh is the possibility that it causes cancer. We have not seen any cases of cancer caused by mesh but we have heard anecdotal cases. It is a well know phenomenon that chronic chemical or mechanical irritation anywhere in the body can cause cancer. Mesh is a constant chemical and mechanical irritant to the body in some patients. The truth is that mesh is not bio-compatible.
A recent publication in a very well repected surgery medical journal says "The value of open inguinal herniorraphy without mesh is being lost. Mesh herniorraphy is being inappropriately used as the standard of care. The complication of inguinodynia is occurring at inappropriately high rates. Ilioinguinal neurectomy is not a simple solution."Am J Surg. 2012 Apr;203(4):550. Epub 2008 Sep 11. Inguinodynia and ilioinguinal neurectomy. Danto LA
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