Tension Free Hernia Surgery
The myth of tension free hernia surgery
With out a doubt hernia mesh has applications that enhances surgical correction of abdominal hernias. But it is this authors' opinion that the promotion of and enthusiasm for hernia mesh has gone a little to far dominating professional and public perception about what is important in hernia surgery.
The problem with hernia mesh is scar formation around the mesh. Scar formation is a natural and normal process of healing injured tissue. In the early phases of healing the body builds up scar tissue in and around the injury. After the build up the body removes and remodels scar tissue. The scar contracts and all but disappears. The process of scar contracture is a very powerful force and has significant consequences in the healing of all tissue throughout the body.
The problem of scar contracture is most well demonstrated in the difficulty in treating burn patients. Devitalized skin can be removed and replaced with skin grafts but these grafts turn into scar as they heal. And as they heal they contract. This causes pain and debility by restricting movement of extremities. This is the huge remaining challenge of treating burn patients.
When a mesh is used to repair a hernia the body builds up scar tissue around the mesh. This is true for every mesh. In most patients this does not create a problem. But in a significant minority of patients the body's reaction is excessive build up of scar. The scar then contracts. As the scar contracts the mesh shrinks. As the mesh shrinks tension is created where the mesh is anchored. We have seen many cases where the anchors have disrupted under this tension and the mesh continues to shrink and shrivels up into a ball. This is the mechanism of hernia recurrence in mesh hernia surgery. This is also how hernia mesh causes pain. The problem is that as long as the mesh is in the body the body builds up scar tissue around it and the pain never goes away.
At one point the manufactures of mesh tried to control the problem of mesh shrinkage by reinforcing the mesh with a rigid ring around its edges. In a few patients the forces of shrinkage overwhelmed the rings which then snapped turning into pointed fragments injuring patients. These products have since been taken off of the market by the FDA and personal injury lawyers are hard at work recovering damages for injured patients.
Currently the manufactures of mesh are working on the mesh shrinkage problem by producing light weight, partially reabsorbable, absorbable and biologic meshes. The jury is still out on these new products.
If your hernia surgeon recommends mesh be sure that he can explain the risks of mesh and how they weight against the advantages of mesh. In most cases it is possible to repair a hernia successfully without mesh.
