Surgical mesh is a woven material that looks much like a large celled fabric, made of various types of plastic or natural fibers. Such mesh is used to repair a number of problems in the abdominal region, including organ prolapse (organs, such as the bladder, slipping down into unfavorable positions) and hernia (when an organ, often the intestines, pushes through the wall of the cavity that contains it, often the abdominal muscle wall). These meshes can be dissolving, where the body heals the spot and over the course of time the mesh itself dissolves and is reabsorbed by the body, or they can be permanent, the intention being that scar tissues will grow over the mesh, and the repair will become a permanent part of the body.
Repairing a Hernia
One of the most common uses of surgical mesh is to repair incisional hernias – when the muscles of the abdominal wall tear because they have been subject to multiple surgeries, allowing the intestines to push through (Gandhi et al, 2011); in fact, as many as 15% of abdominal surgeries eventually lead to an incisional hernia (Gandhi et al, 2011).
Such hernias can cause pain but are also dangerous because they can lead to complications including strangulation or tearing of the intestine itself. Hernia repair surgeries can be open (a large incision) or laparoscopic (multiples small incisions to allow the use of small tools and a camera). Mesh is used to strengthen the abdominal wall, rather than simply pulling at the intestines with stitches; hernias repaired with mesh represent 90% of hernia surgeries and have a lower hernia recurrence rate than repairs without mesh (FDA, 2018). In addition, the popularity of less invasive laparoscopic surgery has made mesh repairs more common.
Despite their popularity, there are possible complications with mesh repairs. Postoperative complications from both mesh and non-mesh repair includes (FDA, 2018), “pain, infection, hernia recurrence, scar-like tissue that sticks tissues together (adhesion), blockage of the large or small intestine (obstruction), bleeding, abnormal connection between organs, vessels, or intestines (fistula), fluid build-up at the surgical site (seroma [or hematoma]), and a hole in neighboring tissues or organs (perforation).”
Most of these complications happen within hours, days, or weeks of the surgery (Gandhi et al, 2011). But there are also complications that can happen months, years, and perhaps even decades later, including mesh migration and mesh related adhesions (Gandhi et al, 2011).
Hernia Mesh Migration
There are few openly documented cases of mesh migration in published literature, until one medical team encountered a woman who, after two abdominal surgeries, developed an incisional hernia (Gandhi et al, 2011) and later migration. The hernia was repaired through an open surgery, with polypropylene mesh. While this type of mesh has been known to cause complications, including “hematoma and seroma, foreign body reaction, organ injury, infection, mesh rejection, and fistula”, it was commonly used because it encourages the body to make a lot of scar tissue, naturally closing the hernia (Gandhi et al, 2011).
In the case of this woman, all went well, and she had no problems until eight years later, when she began experiencing abdominal pain. Ten years after the hernia surgery, the pain became so intense that it sent her to the emergency room (Gandhi et al, 2011). There, tests revealed that her surgical mesh had migrated (moved) to the cecum, a pouch at the juncture of the small intestine and the large intestine. This was the first mesh migration into the cecum after an open hernia repair ever recorded in the literature (Gandhi et al, 2011). Surgical removal, at the time, was deemed too dangerous, and the patient was sent home to be watched and simply live with the pain.
Mesh Related Adhesions
Adhesions are the formation of connective scar tissue that adhere one organ to another, for instance, as scar tissue forms around the mesh on the abdominal wall, it might adhere to the intestines and begin to grow around it. This can cause immobility in the intestines, blockages, pain and more.
One 2016 study looked at 124 patients who had mesh hernia repair (Langbach et al, 2016). Using an MRI, they found that 20-50% of the patients experienced mesh shrinkage (another possible complication), while a full 60% had adhesions between the abdominal wall and the bowel. According to the study, most of these patients had no bleeding, pain or any symptoms of adhesions, with only 5% reporting pain during normal activities and 13% reporting pain during moderate activity. Surprisingly, reports of pain were actually lower in those who did have adhesions; no reason was given for why this might be true. It is important to note that adhesions can lead to serious bowel obstruction issues, so it is imperative that those who have had mesh repair pay attention to any abdominal symptoms.
Know Your Body
Incisional hernias are quite common and using mesh in repair is known to minimize the chance of recurrence (Gandhi et al, 2011). Most hernia surgeons will tell you that mesh is your only viable option and will minimize the possibility of complications. However, complications – such as mesh migration and adhesions – do happen. And when they do, they can be painful, dangerous, and even life altering.
Only you know your body. If you have had hernia repair surgery that used mesh, and you have pain, bleeding, excessive gas or inability to pass gas, tenderness, or other symptoms, seek medical treatment immediately. Be sure to tell them about your past surgery and ensure that they check for complications due to your hernia mesh. Document your pain, document your doctor’s visits, and consider consulting with a hernia mesh lawyer.
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Hernia Mesh Migration
“If hernia mesh detaches after surgery, there is a risk it can migrate through the abdomen.It can lead to adhesions, fistulas, abscesses and bowel obstruction or perforation.COMPLICATION REPORTED TO THE FDAAn Ethicon Physiomesh implant detached and migrated. It attached to the patient’s intestine and the skin. Doctors had to remove the mesh and part of the patient’s intestine. Detachment is more likely to happen in laparoscopic (minimally invasive) hernia surgery techniques. Migration may result in excess pain, or it may be symptom-free until it causes more severe damage.” https://www.drugwatch.com/hernia-mesh/complications/
Hernia mesh References
FDA (2018). Hernia surgical mesh implants. Retrieved from, https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/herniasurgicalmesh/default.htm
Gandhi, D., Marcin, S., Xin, Z., Asha, B., Kaswala, D. and Zamir, B. (2011). Chronic abdominal pain secondary to mesh erosion in cecum following incisional hernia repair: a case report and literature review. Annals of Gastroenterology, v24(i4), pp.321-324. Retrieved from, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959323/
Langbach, O., Holmedal, S.H., Gradal, O.J., and Rokke, O. (2016). Adhesions to mesh after ventral hernia mesh repair are detected by MRI but are not a cause of long term chronic abdominal pain. Gastroenterology Research and Practice, v2016. Retrieved from, https://www.hindawi.com/journals/grp/2016/2631598/