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 LAHernia 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:
- What are my chances of getting chronic pain from hernia mesh?
- How is the chronic pain treated and can I be cured if I am unfortunate enough to get chronic pain after mesh hernia surgery?
- Are you well experienced in non-mesh hernia repairs?
- 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
Search:
Introducing The Hernia Letter
Seven reasons not to have mesh hernia surgery
Hernia Repair
Cognitive Dissonance
What Patients Know
Mesh Bandwagon
Onset of Hernia Mesh Pain
Hernia Mesh Symptoms
Shouldice Hospital - Canadian Hernia Society Meeting
Results - Mesh Removal Survey II
Why does hernia mesh hurt?
Open Letter in Support of Mesh Pain Patients
Pain related sexual dysfunction after inguinal herniorrhaphy
Advice to patients with chronic pain after mesh hernia surgery
A note to hernia surgeons
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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