Hernia Mesh – Truths and Myths
Hernia mesh can be a touchy subject for some. To be sure, there has been some controversy over the use of hernia mesh, even though it represents one of the biggest advances in hernia repair technology. In fact, mesh makes for a much more reliable hernia closure and longer-term repair than traditional tension repairs, which typically have a far higher rate of recurrence. As a result, most hernias today are repaired with mesh.
With that said, there’s still a lot to discuss about hernia mesh, and in this article, we want to separate the truths from the myths.
The truths about hernia mesh
Truth #1: It’s true that hernia meshes are more reliable than traditional tension repairs. Mesh creates a tension-free lattice over which the body’s natural scar tissue can grow. The scar tissue, combined with the strength of the artificial mesh, makes for an extremely strong bond and barrier over the hernia defect.
Truth #2: It is also true that hernias can recur even with a mesh repair. Mesh can migrate over time, curl, or fail in some other way. However, there are ways to mitigate these concerns. First, newer, modern mesh is thinner and more precisely manufactured than ever before. Second, an experienced hernia surgeon has the knowledge to choose the right type and size of mesh for your circumstance. Finally, taking your time during recovery and following your recovery instructions all help ensure a proper repair.
Truth #3: There is also still debate over the role of mesh in chronic inguinal pain. Estimates vary as to how many inguinal hernia patients experience chronic pain after surgery. However, advances in surgical technique and technology have certainly reduced this risk over the years. Unlike in the past, tacks are no longer used to affix the mesh to the musculature in the area. We also know more about the inguinal anatomy and are better able to avoid irritating nerves in the area. Finally, with better mesh technology, the mesh itself does not cause as much irritation as it once did. It is also worth noting that patients who come in with pain prior to surgery have a higher likelihood of pain in the future.
Myths about hernia mesh
Unfortunately, there are a few myths and lots of misinformation surrounding hernia mesh. We will discuss some of them here and let you know why we still believe that mesh is the gold standard in hernia repair.
Myth #1: Hernia mesh is inherently dangerous and has been recalled. You may have seen lots of commercials on television about defective mesh. These legal advertisements discuss pelvic mesh and not the same mesh that we use during a hernia repair. There was a recall of mesh over a decade ago, but even this was because of counterfeit product and not because the authentic product was problematic.
Myth #2: Absorbable and biologic mesh is a better option than synthetic mesh. There is a role for absorbable and biologic mesh, including in patients who have significant abdominal infection. However, these meshes do have inherent weaknesses and can be significantly more expensive. Synthetic meshes, when used properly, are very safe and effective.
Myth #3: Hernia mesh surgery cannot be revised. In case of failure, which is more common in hernia meshes placed over a decade ago, many believe that they are stuck with long-term concerns and pain. To be sure, revising a hernia mesh procedure is difficult and riskier than the primary procedure. However, an experienced hernia surgeon can discuss the risks of a subsequent procedure to correct the original hernia repair.
Myth #4: All hernias need to be repaired. Not all patients require a hernia repair even if they have a hernia. For example, asymptomatic hernias are typically not repaired. Larger hernias in older patients may also be watched instead of repaired due to the inherent risk of surgery and the age and health of the patient. Only a discussion with an experienced hernia surgeon such as those at MASJAX can offer the appropriate course of action.