The People's Perspective on Medicine

What Are the Benefits and Risks of Mesh in Hernia Repairs?

The mesh used for surgical hernia repairs can reduce the rate at which the repairs fail, but at the same time increase the risk of complications.
CC0 from https://pixabay.com/en/hospital-surgery-medical-health-721240/

When people need surgery to fix abdominal hernias, the surgeon often uses a piece of mesh to strengthen the hernia repairs. The investigators reviewed the records of all surgical hernia repairs in Denmark between January 1, 2007 and December 31, 2010. That included 3,242 patients who were followed up to the end of 2014.

How Much Does Mesh Help?

Surgical mesh is woven or knit of synthetic materials such as polypropylene. Using this patch material reduced the likelihood that the hernia would return within five years and require a second operation. Only 12.3 percent of those on whom mesh was used needed to go back to the operating room compared to 17.1 percent of those who did not get mesh.

But What About Problems with Mesh?

That good news is counterbalanced by a higher rate of complications in the surgeries using mesh. People receiving mesh had more bowel obstructions and perforation. They also were more likely to develop surgical site infections, late abdominal abscesses, fistulas, non-healing wounds and chronic abdominal pain following surgery. After five years, 5.6 percent of the people whose hernia repairs included mesh had experienced a significant complication in comparison to 0.8 percent of those operated on without mesh.

The authors conclude that “the benefits attributable to mesh are offset in part by mesh-related complications.”

JAMA, Oct. 18, 2016

This is not the first time that the safety of surgical mesh has been questioned. You can read an earlier report here.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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    My husband is scheduled for hernia repair with mesh open surgery this coming January 2019. After reading so many problems from patients with mesh implant, I am having second thoughts now on behalf of my husband’s situation. I don’t want my husband to experience these horrible experiences with mesh implant. I need advice for my husband hernia repair. I am considering a NO MESH hernia repair, but I heard it will cost a lot because the doctor who is popularly known for for no mesh surgery in Las Vegas does not take any insurance. Any advice, pls. Thanks.

    I had an umbilical hernia when I was 5 years old (I can only presume no mesh was used). Was all sorted back then with no problems. At 39 years old, after having a child, I gained 2 hernias. This time, mesh was used. It was not explained to me any of these possible complications prior to the operation.

    And I didn’t even consider, since the operation, that all my discomfort could’ve actually been due to a piece of plastic mesh. Since then, my tummy has lost a certain amount of feeling around my navel, there is constant swelling and pressure, so it is always uncomfortable to sit down. I can’t bear to have anyone hold me or put any pressure on my tummy, which is hard when you play with a toddler.

    I constantly have to tell my child to be careful of Mummy’s tummy.
    It all makes sense now, now I saw mesh on the news a couple of days ago, it explains a lot . I suppose there’s nothing I can do now it’s been 3 years since I had it put in. I guess now, I am stuck with discomfort and pain forever.

    No! Don’t think that way! Three years is nothing! Ive been implanted for 12 yrs now and am planning on have the mesh removed. Juat be certain NOT to use a general surgeon or the ones who put in the mesh because it’s the “standard.” They are also just general surgeons.

    I would like your take on the correlation between mesh implants and autoimmune disease, since I have a friend with this correlation and we are having a hard time getting answers. There seem to be a lot of cases, but disagreement as to whether autoimmune causes sensitivity to mesh or mesh causes autoimmune or some other correlation. The common pattern, though is that many people in many countries, including my friend started suffering pain and infection and other symptoms immediately after surgery. The problems escalated until they became debilitating and then they discovered they were not alone. They discovered this without help from the medical professionals they trusted to treat them and now are looking for solutions to the problems. My friend had mesh implanted in 2013 and was recently diagnosed with leukemia, and was put on 50 weeks of steroid treatment. Now they think it is some other type of autoimmune disease, but are unsure what. My friend would like to have the mesh removed, but would like to have it done by a surgeon with some experience removing mesh and a track record.

    I had a mesh repaired femeral hernia on top of a previous repair that did not use mesh. This was about 20 years ago. All been okay but just lately I have had strange sensations in that area. Hard to describe but a dull ache and a feeling like bubbles going through veins. Most odd. Anyone else had this?

    Great testimonials! If you’re looking for some help and truth this column has the info. Make sure you try to get more publicity so everyone knows what’s going on about Hernias. I never knew what the Desarda technique was. In fact, I never heard of it. I kept telling my wife “Why can’t they open that area up and just stich the split, leaving an opening for the little veins and tubes to come through?” I would think the opening would have to be collared to give extra strength to the tissues around the opening. I don’t know, I guess that’s why they call me MR. Jackleg!

    I just had two small meshing put in to repair two hernias. A lot of initial pain lasting up to 2 weeks; then, things began settling quite rapidly. Yes, I am nervous of the longer term outcomes; not regarding the hernias, which to me were minor upper abdominal tears (too much strenuous sit ups when I was younger) but more so on internal adhesion cause by scar tissue formation.

    Light/gentle self massage has made the area heal better whilst increasing overall mobility to the said area in just after 2 days. I remember how it initially aggravated the area a little but then loosened the entire area remarkably. I hope things continue down this path. Not a fan of the medical profession or operating doctors: feel they are too text book and narrow research driven; but I guess I accepted them on this one occasion.

    Will keep you all posted on my progress in weeks and months to come. Note: I will not be doing any sport i.e. swimming for at least 6 months and that includes sit ups and weights. Nice to share my story; and, equally kind for those taking the time to read and place a comment.

    Do a google search for Hernia repair with mesh and pain. About 20% of people get CHRONIC pain from it, life long. They think it might be due to the inflammation produced by the foreign mesh, the inflammation causes the healing, but still – it’s inflammation and some people have pain that doesn’t go away – it cripples them. If the hernia doesn’t cause you pain, and there is only a remote chance of getting incarcerated – then, like the MD my husband saw – there is no rush. But I’d advise against getting it done with mesh.
    It’s too bad that the OLD old fashioned method is a lost art.

    I could never ever recommend using mesh for hernia repairs. First of all, as far as I can tell, no actual long-term studies were done on the safety of it before it was put into general use. My mother who is 92 and a friend who is 76 both had hernia repairs using mesh. They’ve had nothing but trouble since. My mother is in constant pain and has been for 20 years. It has affected my friend’s bowel function for a long time, complicating other issues she has.

    I had surgery to remove 10″ of my colon due to cancer. The wound was closed, but 3 weeks later I had a rupture. They had to go back in and use mesh to keep the wound closed. I was on a wound vac for 3 months. I was told they thought this would happen because I am obese. They told me it was hard to keep the wound closed when a person carries a lot of weight in their stomach area. I feel the mesh was totally necessary for my surgery. I don’t think it has caused any problems…So, another reason to lose weight!

    I had a ventral hernia mesh repair years ago (late 1980’s) and it caused a bowel obstruction and it was not a simple bowel repair.

    CORRECTION. The Desarda based surgery was completed in May 2014. So my experience now is 2 and one half years.

    Inguinal hernia surgery is said to be a bread and butter business for surgeons. It is perhaps the most common of all surgeries for males and by age 80 inguinal hernias seem to affect over 30% of males.

    While there is some post surgery tracking of outcomes, my sense is that it hasn’t tracked for long enough times, assessed adequately for recurrence, pain and complications. I think mesh surgery may have its place. In respect to inguinal hernia repair, I have concerns. I had laparoscopic mesh surgery in 1999 after roughly 2 years of experience with hernia. The repair lasted for a number of years but I experienced pain in lifting my leg on that side in running. I would run through the pain and this seemed eventually to reduce the pain.

    By 2012 or so the hernia returned. Presumably the scar tissue formed in response to the mesh and stitching of the mesh failed to hold. Wearing a truss helped for a time but pain eventually affected exercise choices. Using mesh is like trying to patch a balloon meant to be inflated again. The internal pressure within the abdominal cavity carries part of the burden of weight much like a hydraulic system. Eventually the pain intruded on daily activities. Swelling of the inguinal area was obvious.

    This time I reviewed surgical options more carefully. The choices with the onset of the Desarda technique which uses cutting and suturing of the aponeurotic strip opened up another possibility beyond prior surgical techniques. I searched at length for a local surgery to provide information and support. Strangely, the Desarda method has and seems to the present to have few surgical centers offering the technique.

    Eventually I opted to have the surgery done in Ft. Myers in May 2015 and pay for the surgery at my cost rather than use the Canadian/BC health system. The flaw here is both with private and public health service as none of the private clinics offered the Desarda method either despite its relative simplicity against other approaches. I was found to have both direct and indirect hernias. I didn’t fully realize that the mesh would be left behind as the Desarda technique doesn’t require invading the abdominal cavity. This is an important point for those thinking of having mesh based surgery.

    There is no Plan B that readily addresses removal of the mesh once installed and left for any time long enough to become embedded in fascia and scar tissue. Healing with mesh can leave sensations of something foreign in the abdomen, discomfort and stiffness in that area of the abdomen. Tacking with metal sutures may be a problem.

    I was relatively mobile shortly after surgery but directed not to be involved in athletic activities for some months. The cut in the intestinal wall healed fairly quickly. Black and blue marking below took longer. Post surgical pain from the surgery itself was not particularly a problem.

    I did experience pain later in healing that I attributed to the retained mesh and supplements I was taking that seemed to enhance healing (and possibly activation of fascia). Pain, in the latter case, could shoot to 5 or 6 out of 10 when active or standing. Fortunately it would abet at sitting or lying after a time. Eliminating or reducing the supplements allowed the pain to stay away.

    I was told by one surgeon that removal of mesh isn’t recommended for pain below 7 out of 10 (think of this before considering mesh). If there are any lessons from this for me it was that western medicine has yet to effectively address prevention or repair of inguinal hernias.

    The rarity of the Desarda option surprised me given that the sole concern I could dredge up was whether the aponeurotic strip was sufficient to carry the burden. So far I’ve had no trouble with inguinal hernias since the second surgery. A reasonable wait period could be 10 years which means 8 and a half years to go. I have returned albeit gradually to playing basketball and weight lifting. My concern is that aging comes with enough damage to mobility without letting it dominate. I’m 73. Stay away from mesh if at all possible. Weigh the various surgical techniques carefully (including Shouldice which keeps the sutured tissues under constant strain and removes all cremasteric structures (muscle, vessel and genitofemoral nerve)).

    Thank-you for sharing your experience on your surgery and Desarda research.
    I know of only Desarda and the Shouldice method which do not require mesh. And I would feel much more comfortable getting my hernia repair (inguinal hernia, fair small and asymptomatic) repaired without mesh.

    Like many readers here, I have huge reservations about placing a polypropylene mesh inside me for the rest of my life. It would be fine if it was easily reversible (mesh removal) but as it absorbs and integrates into tissue, removal is perhaps more complex than the initial repair. My primary concern is chronic pain. I am less concerned with recurrence (requiring additional repair).

    Does anyone have any reliable stats on chronic pain outcomes for non-mesh treatments (Shouldice or Desarda?)
    Why are neither method commonly offered (particularly in Australia?) Is this inertia or the medical profession?

    I had mesh implant surgeries over 30 years ago using a system that was called (I think) the Canadian Stitch. This involved an open cut and ‘hand stitching the implant in place. I believe that today they use an arthroscopic method. While less invasive in terms of the exterior cut the new pop-open devices are not as consistent and may be making the patient more prone to infection or relapse of the surgery.

    I had a large inguinal hernia repaired in the mid 1950s when I was 6 or 7, don’t remember exactly, and for sure, no mesh was used. The hernia was large enough that if I squeezed (as if to take a bowel movement) it produced a visible lump, about 1 inch high, which I could push back down. There was no pain. But I guess the hernia was quite large if it popped out that much.

    Whatever old fashioned method they used, I never had a recurrence, the area was strong from then on. The scar was large, about 6 inches long, really old fashioned. I was in the hospital for days, I don’t remember if it was a week or not, and the pain well, they didn’t give little kids pain drugs back then. It hurt when they made me walk a lot, and they did want me to walk. I was OK if I just laid down. But the pain was not so much that it made me scream or anything. By the time they took the stitches out, there was no pain. I’ve been fine since. Now, this was OLD school stuff- and NJ and NY surgeons (Jewish) were GOOD.

    There are doctors that remove mesh.
    http://www.noinsurancesurgery.com/hernia/hernia-mesh-removal.htm#gsc.tab=0

    read that info.

    I’m old now :) – my husband has two hernias and of course, the doctor we found said there is no rush, he’s not in pain, but he does use mesh. One of them is labelled large, but it doesn’t show at all. He only discovered it when he got a CT scan and MRI – the two hernias showed up on that. So mine must have been bigger since it definitely showed – a 1 inch lump popping up.

    I researched it. 20% of people get that chronic pain and well, it’s just not worth it, not at all. Dr. Tomas that does Desarda method is right near us. If hubby has to get this done, we’ll probably go to him or someone that doesn’t use mesh.

    The OLD fashioned repair was the best I think – and unfortunately, it’s a lost art.

    What would seem to be a no-brainer surgery appears to have more complications that one would ever expect. And this not only involves the mesh but the hernia surgery itself as some people have two, three, and sometimes four additional surgeries due to the previous operative failure. My own surgeon said that he operated on a Doctor friend of his and he ended up with chronic pain issues in that area? Why is this surgery so subject to all of these problems?

    My question to surgeons was if the entire hernia area is losing strength of the tissues, muscles, etc., and therefore tearing open what are you going to attach the mesh to that will properly hold it? Basically I was told “Trust me.” Given all that I have researched I have decided to put up with the hernia rather than take a chance on ending up with a worst problem than what I started with.

    Anyone have any experience with exercises that will repair a hernia? Some say you can fix a hernia using exercises specific to the area of the hernia while many others say you can not.

    Infections are a big risk. My husband developed Flesh Eating Bacteria within days of the surgery. Of course it took 3 days to figure out what was wrong so as soon as a diagnosis was made he was in line for emergency surgery. After this there were 6 days in intensive care, 26 day in hospital care, then a week of nursing care at home and a lifetime of periodic pain along the 22 inch incision made to clean out the infection.

    Bob,
    NO exercise will repair a hernia. DO NOT pick up anything using your stomach muscles, don’t strain them at all. eg, push ups – NO GOOD, anything like that – DO NOT do it.

    Back in 2007 my husband had hernia surgery at a Hernia Clinic in northeast Ohio. That Doctor used Gortex instead of mesh. He also
    Had my husband walking a half mile that same afternoon and walking twice a day for the next two days, then went back to work doing heavy lifting on day four. No pain and no complications.

    Why aren’t more doctors learning about and using the Desarda technique for hernia repair that doesn’t require mesh? When doctors thought I had a hernia, I began doing research and was dismayed to learn the high failure rate and problems associated with traditional hernia surgeries. Fortunately, my problem was not a hernia, but if I had to have hernia surgery, I’d definitely want the Desarda technique.

    i had mesh used in my repair almost 20 yrs ago; worked fine. sometimes i have what feels like a minor ache, but nothing special.

    I had the advantage of an amazing surgeon whose skills and careful operating hygiene made me sail through the hernia repair, with mesh. Now retired, he was the premiere and most sought-out general surgeon in Tyler, Texas for many years.

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