Hernia Mesh Removal for Pain
Pain is a common problem after mesh hernia surgery
20% of patients develop chronic groin pain after having mesh inguinal hernia surgery. Most of these patients will go undiagnosed and untreated sufferig their pain in silence, confusion and dissappointment in their doctors.
Significant pain lasting 3 months after hernia surgery is abnormal. Period. When other likely causes of pain have been ruled out then it is almost certainly the mesh.
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.
With the more positive results that we experience our patient selection critereon for mesh removal becomes less restrictive. At one time we recommended waiting at least 6 months from the original time of mesh hernia surgery before the mesh can be removed. We have learned that there are exceptions to this 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. Perliminary results of a survey of mesh removal patients is indicated in the graph below.
The average pain score of our patients before mesh removal is 8.4/10. After mesh removal it is 2.6/10.
We are restrictive in the selection of patients for mesh removal because we do not want any patient to have worse pain after mesh removal. Our experience with this so far has been very good. 4% of patients say their pain is a little worse after mesh removal. We do not consider this a reason to stop offering the surgery to the patients with severe pain who have exhausted all other options and have suffered a serious degradation in the quality of their lives.
Our mesh removal patients have a variety of symptoms and complaints that they relate to their mesh. "I never had this problem until after I got my mesh" is a very common statement that we hear. Our experience removing mesh is that many of these symptoms resolve for reasons that we cannot explain and therefore we cannot advise patients to expect as a result. But our expereince has lead us to not discount any symptom that a patient relates to their mesh.
What happens when mesh is in the human body for twenty years and more. Nobody knows? But we are going to find out! Who wants to be part of this experiment?
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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