Hernia Mesh

According to a recent publlication in a very respected medical journal "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

Hernia surgery is one of the most common and safest operations performed in the United States. Hernias are a leading cause of preventable death. There are about 2,000 deaths from hernias each year in the United States. The shame of it is that all of these death were preventable with an inexpensive and safe operation which is the cure for hernias.

Patients without insurance are frequently told by physicians that their hernias are not life threatening and that they can put off the surgery. This is advise is only given to them because they are uninsured and the doctor or hospital does not want to do the surgery without getting paid for it. You can rest assured that anyone with insurance and a hernia is advised to get their hernia fixed without delay.

Mesh hernia surgery is the most common type of hernia surgery currently preformed. Anyone who is contemplating hernia surgery is well advised to educate themselves about the problems associated with mesh. Chances are that they will be advised to have mesh hernia surgery. Enthusiasm for this procedure has been heavily promoted by the manufacturers of mesh for obvious reasons and as a consequence the disadvantages have been all but covered up. Awareness of the potential problems with mesh will encourage patients to consider other options which may be better in their case. Beware of the phrase "Tension Free". It is a marketing slogan invented by the manufactures of mesh.

Hernia mesh after removal

The following is an email sent to me by a patient who had mesh hernia surgery, which speaks for itself (unedited):

Dr. Petersen - Thank you for reviewing this

Brief case history - Detailed history available

I am a normally physically active, fit 49 year old male living in Arizona . On December 5th, 2008 I went in for repair of what was diagnosed as a right side inguinal hernia. It was recurrent. The previous one had been 23 years earlier and had been repaired the old way without any complications. The new one was repaired using prolene plug and polypropylene mesh. I was not told this ahead of time or warned of the potential complications. The decision to have this done was unquestionably the worst decision I have ever made in my life. Almost immediately I knew something was wrong. I went through all the usual post op swelling, bruising etc. And I experienced a sharp stabbing pain at the incision site that has never gone away. Within the 1st 4-5 weeks I also experienced a ‘tugging’ feeling radiating out from below the incision down the right side to my pubic area. At the 5th week this started to turn into a burning pain in my groin and in my penis. Over the next week or so this continued to worsen to the point where I was having perineal pain and rectal pain. As of today I have constant sharp burning pain in and radiating out from the op site as well as deep pelvic pain like my whole abdomen is on fire. This is 24/7. I am 4 months post op and in constant agony. I have seen up to 10 doctors, surgeons, urologists, neurologists etc. and had every imaginable test. No one will step up and help me and no one wants to try and figure out what is going on. I just get pushed off to pain clinics. I've taken nerve drugs, pain killers, anti-inflammatories all to no avail. My latest attempt at relief came in the form of a visit to a top neurosurgeon with a full course nerve block injections including genitofemoral, ilioinguinal, pudendal and IMPAR ganglion blocks, the latter 2 being very invasive, involving the insertion of needles through my buttock into the center of my pelvic region. Not fun. They didn’t help. MRI shows inflammation around the plug/mesh. I am currently trying a course of Toradol but can only take this for a few days since it causes GI problems. My life has essentially been shut down. No more physical activities or sports, limited socializing and sex life is over. It even hurts to urinate. Just live on Vicodin to get through a day at work. All because of this mesh. The kicker is that I never even had a true hernia. It was just some pre-peritoneal fat that had broken away, no intestinal break. The opinion of most recent consultants is that I need to get this mesh out of my body ASAP.

Can you help me ?

Mesh is a screen that is used to patch repair a hernia. It covers the hole where the intestine is poking through the abdominal wall. The abdominal wall is supposed to hold all of the digestive organs and the intestine inside of the abdomen. If the intestine works its way out through an injury to the abdominal wall it becomes what is known as a hernia. The injury to the abdominal wall may be patched with mesh to keep the intestines inside or the injury may be repaired and closed with stitches to put it back to the way it is supposed to be.

The number one problem with mesh is that many patients will react to the mesh as if they were allergic to it. Their body tries to reject the mesh and builds up excessive scar tissue around it. This excessive scar tissue results in the patient having chronic pain. When this happens there is no effective treatment for it and the patient will live with chronic pain for the rest of their lives. Medications, injections, physical therapy and neurolysis are ineffective in getting rid of the pain. The only effective treatment is to go back to surgery and remove the mesh. Current medical literature says that as many as 20% of patients with hernia mesh develop chronic pain.

Scar formation around mesh is what causes all of the problems with mesh. Another problem is mesh migration. A natural property of scar tissue is contraction. This contraction will cause a mesh patch to shrink and pull away from its anchors. The mesh then moves away from the hernia defect that it is covering and the hernia then comes back. The mesh can actually shrivel up into a ball and become what is known as a meshoma. If the mesh shrinks but the anchors hold tight a great deal of tension can be created causing the patient pain.

The more severe complications of mesh occur when the mesh touches bowel. This can lead to bowel obstruction, bowel fistula, abscesses and severe infections. The worst mesh known as the Kugel mesh causing these more serious problems has been taken off of the market by the FDA but these problems can occur with any of the mesh remaining on the market.

It is not necessary to use mesh to repair a hernia with a low recurrence rate. There are plenty of reported studies showing recurrence rates will below 5% in the 2-3% range. With these low of recurrence rates without mesh there is no reason to expose hernia patients to the potential complications of mesh.

These are the questions that we recommend you ask your doctor:

1. What are my chances of getting chronic pain from hernia mesh?
2. How is the chronic pain treated and can I be cured if I am unfortunate enough to get chronic pain after mesh hernia surgery?
3. Are you well experienced in non-mesh hernia repairs?
4. What is your recurrence rate with non-mesh hernia repairs?

If your doctor cannot answer these questions to your satisfaction then you need another doctor.

If you are looking for a surgeon who is experienced in non-mesh hernia repair then you have come to the right place

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Why do some surgeons say that hernia mesh should not be removed?

"Milan—Chronic groin pain after hernia surgery is now considered the most important issue facing inguinal hernia surgeons and their patients. Yet, there is still much uncertainty surrounding what causes the pain and how to prevent it." - Victoria Stern, General Surgery News

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