Hernia Mesh Complications
All abdominal hernias must be surgically repaired as they do not recover spontaneously. Hernias are best treated when they are small and before the risk of complication through strangulation occurs. There are essentially two choices for hernia surgery: conventional open surgery and minimally invasive surgery. Minimally invasive surgery is also termed laparscopic surgery, and is cosmetically preferred because of the small entrance wound. The effects of trauma inside the abdomen are the same for both types of surgery. More importantly, minimally invasive surgery must always involve use of a mesh.
Patient considerations when contemplating hernia surgery include the following:
- The the risk of ongoing pain
- The risk of hernia reappearance
- Simplicity of treatment in case of complications
- Quickness of recovery
- The cosmetic appearance of the surgical wound
Hernia mesh shrinkage
A remaining concern with hernia surgery is mesh shrinkage or contraction. The shrinkage of mesh has been reported as a possible reason for hernia recurrence. Does expanded polytetrafluoroethylene mesh really shrink after laparoscopic ventral hernia repair? It is said that because mesh is not biologically inert, that all mesh will experience shrinkage after implantation. Abdominal Hernias and Surgical Meshes. However, the degree of shrinkage and its cause have not been clearly determined. A conclusion has been drawn that shrinkage depends on type of mesh used and its means of anchoring. Mesh shrinkage depends on mesh properties and anchoring device: an experimental long-term study in sheep. In that study, two mesh forms were used, PhysiomeshTM (large pore, lightweight) and VentralightTMST (small pore, mediumweight), with three forms of anchor, ProTackTM, SecurestrapTM or GlubranTM. Shrinkage of PhysiomeshTM was significantly higher (17.7% to 35.7%) than that of VentralightTMST (19.3% to 22.2%), but it was observed that shrinkage was higher with the ProtackTM anchor that with either GlubranTM or SecurestrapTM. Moreoever, it is said that mesh fixation can be done either with sutures or with metal tacks, and in one study it was observed that shrinkage was greater when tacks were used than when sutures were used. Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation.
Much is unknown about the risks of using a mesh in hernia surgery. Of great concern is the risk of hernia mesh causing chronic pain, but doctors don’t agree on the severity of that risk. The risk is generally estimated as between 0% and 60%, so doctors commonly estimate the risk at around 20%. Many doctors believe that hernia mesh causes serious chronic pain in a large percentage of patients. Many doctors also believe that hernias can be surgically repaired without the use of the mesh while still maintaining a low risk of recurrence. www.noinsurancesurgery.com/hernia/hernia-repair.htm
Symptoms of Hernia Mesh Complications include:
- Difficulty urinating or passing gas and stool
- Excessive pain, bruising, or swelling
- High fever (101 degrees)
- Increased redness or drainage from the incision
- Nausea, vomiting or other flu-like symptoms
- Stiffness in the abdomen
Today, the use of mesh products in hernia surgery has been widely adopted, with estimates that more than 80% of all hernia operations involve use of a mesh. The source of the dispute over hernia meshes often comes down to materials used in the construction of the mesh. Various forms of meshes have involved composites, polymers, biodegradable biomaterials, and even metals. There are many varieties of meshes and there is strong disagreement over performance and success of surgical procedures involving particular types of meshes. The wanted characteristics of meshes are inertness, avoidance of infection, adequacy of long-term tensile strength to resist early recurrence, quick compatibility with host tissue, flexibility to prevent fragmentation, and little likelihood of cancer risk. NCBI
Non-mesh hernia repair options
The dispute over the use of a mesh in hernia surgery continues today. According to many doctors, mesh is not necessary for most hernia repairs. Many non-mesh hernia surgeons successfully complete repairs with recurrence rates of less than 3%. At the same time, those doctors feel that the mesh offers a high risk of continuing complications from this relatively simple surgery. A suspicion is that it is the profit motive of medical manufacturers that drives the incidence of use of the mesh. Most surgeons are viewed as having become dependent on mesh and anti-mesh researchers are often not heard. Studies do continue in any event, and a dispute continues to rage.
Hernia mesh contraction, mesh erosion and shrinkage is caused by a defect in the hernia mesh medical device and is not an acceptable risk of being implanted with mesh.