Hernia mesh is a woven plastic material that has been used in hernia surgery over the last 40 years. The benefits of hernia mesh is a significant reduction in the risk of a recurrence of the hernia. This is well documented in the literature for over 20 years. However, over the last several years it has become clear that hernia mesh can cause significant complications . The most common complication is chronic ongoing discomfort or pain in the area of the repair. There are definite but rare incidences of a true allergy to the mesh material which can present with systemic manifestations. These include but are not limited to:
Most commonly used mesh materials such as polypropylene, polyester, and polytetrafluoroethylene (PTFE) will last forever and rarely ever lose their strength.
Some newer mesh materials are absorbable and will break down over 6 - 18 months depending on the material. Clearly, these materials rarely have to be removed. The downside to absorbable mesh materials is the question of long term durability of the hernia repair. This is the subject of ongoing investigation.
Hernia mesh has a long history of enhancing positive outcomes from hernia repair.
Despite the predominant success of hernia mesh, hernia mesh failure can occur. Failure of the material can occur if it is extremely light weight with a low density. Attempts to design a very light weight mesh has been attributed to failure based on fracture of the fibers of the material. This failure is manifested by hernia recurrence. Most hernia recurrences are not related to failure of the material and are usually related to technical issues with the technique of the initial repair.
Another type of failure of mesh implantation is when a patient has discomfort or pain from the mesh placement. This is not a common occurrence, however, an unhappy patient after hernia mesh placement can be considered a type of hernia mesh failure. Pain and or discomfort from mesh is one of the most common reasons for mesh explantation.
Rejection of hernia mesh is a rare occurrence . The mesh materials are designed to be inert and avoid these types of issues. Many patients are told that they rejected their hernia mesh when they actually have an infection of the mesh which will require removal. Infection of mesh is an uncommon occurrence and can be confused with "rejection " of mesh.
When there is infection of the mesh - usually the mesh will require removal. Mesh infection is uncommon.
In the extremely rare event that a mesh is responsible for an allergic reaction.
The most common reason for mesh removal is when a patient experiences too much pain or discomfort in the area of the hernia repair for greater than 6- 12 months.
Hernia mesh is designed to reduce hernia recurrence by allowing the patient's own tissue to incorporate the mesh with ingrowth through and around the openings (pores) in the mesh. If the mesh requires removal then this tissue ingrowth is what makes mesh removal complicated. The surgeon who removes mesh needs to do everything they can to remove the mesh without any damage to the tissue that it was adjacent to. A surgeon removing mesh requires a skill based on expert anatomical understanding and meticulous surgical technique in order to avoid any injury to the surrounding tissue. There are several surgeons in the United States who have gained this skill through years of experience and study.
Most hernia mesh complications present as discomfort or pain in the area of the implant. This can be a result of an individual’s sensitivity to the synthetic mesh. It may also be from increased pressure on the surrounding tissue due to a fold or irregularity in the placement or location of the mesh.
Rarely (mostly of historical significance) can mesh can become infected. This is usually a result of contamination at the time of the operation from the patients own skin. Mesh infection is inevitable in the rare circumstance that an opening in the intestine is made at the time of the hernia surgery. Minimal contamination of bacteria from with the small or large intestine can result in the rare occurrence of infection of the mesh.
While rare, some people can develop a systemic immune reaction to the mesh. This can present in many unusual ways. A rash or itch can be present near the mesh. Some describe chronic fatigue or “brain fog” as a reaction to their mesh. Some present with diffuse pains in their joints.
If mesh causes any complications, it can be removed.
The incidence of mesh infection is very low when compared to the high number of hernia surgeries performed.
The most common source of infection is the patients own skin coming in contact with the synthetic implant. The second most common source would be related to a small opening in the intestine created at the time of exposing or repairing the hernia. Robotic surgery techniques are making infection extremely uncommon.
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