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 suffering their pain in silence, confusion and disappointment 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 criterion 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. Preliminary 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.
There are very few surgeons in the world who are willing to remove hernia mesh for pain. The most common reason for removing mesh is because of infection. Pain is a special situation because it is a subjective experience of the patient and is not objectively verifiable through testing, imaging or physical examination. To make things worse the government is currently on a campaign to rein in abuse of prescription pain medications which interferes with the care of legitimate patients who have chronic pain.
The doctors that I know of who remove hernia mesh for pain unfortunately also replace it with new mesh. This is a bad strategy and is not effective in relieving mesh pain. In all of my hernia mesh removal patients I do a non-mesh repair if it is needed. I find frequently that no repair is needed.
Most surgeons are unwilling to do an elective operation that does not have a success rate of greater than 90%. Mesh removal success rate is not 90% as described in the chart above. Doctors are also unwilling to do surgery that they do not know what the complication rate is and if they do not know they tend to be pessimistic.
I look at hernia mesh removal surgery like I do cancer surgery. When weighing the risks and benefits, if the scale tips towards extending and improving the quality of life of the patient who is otherwise losing his life, we have an obligation to over come our own ignorance and offer the surgery.
This makes sense for patients who have severe chronic pain. It does not apply to patients who have mild chronic pain. We do not do mesh removal surgery for patients who have mild chronic pain.
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 experience 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 respected surgery medical journal says "The value of open inguinal herniorrhaphy without mesh is being lost. Mesh herniorrhaphy 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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