A hernia happens when an organ pushes through a weak spot or tear in the muscle or tissue holding it in place. Hernias often occur in the abdomen, groin, or upper thigh. While not always painful, they can cause discomfort and problems over time if not treated. Surgery is typically required to fix a hernia. Hundreds of thousands of hernia repair operations happen in the U.S. every year.
During surgery, a mesh is often used to patch or reinforce the weak spot to prevent the hernia from coming back. This mesh is usually made from synthetic plastic-like material or animal tissue. At first, surgeons thought mesh would be inert once implanted. But over time, some patients started having issues likely caused by their mesh. This has raised concerns over mesh safety. Some patients may consider undergoing a procedure to remove their hernia mesh.
When Hernia Mesh Removal May Help
For many patients, hernia mesh repairs go smoothly and mesh solves the problem. But serious complications can occur in some cases. Studies estimate 1% to 3% of patients with hernia mesh later require removal. Reasons for mesh removal surgery may include:
Pain That Won’t Go Away
Some patients experience chronic pain after hernia mesh repair, even long after surgery site has healed. This pain may be sharp or burning, and range from mild to severe. Pain could signal an issue with the mesh, like it rubbing or putting pressure on nearby nerves. If medications and other treatments don’t relieve pain, mesh removal may help.
Infection
Mesh is a foreign object that can potentially allow bacteria growth. In some cases, lingering infection may develop around the mesh weeks or even years after hernia surgery. Signs include redness, fluid drainage, and fever. Powerful antibiotics may be tried first, but removing infected mesh often becomes necessary.
Mesh Erosion
Over time, mesh can erode through adjacent tissue. Surrounding organs or tissue can become irritated. In severe cases, mesh may actually perforate organs. Erosion usually requires surgical mesh removal.
Other Complications
Rarely, hernia mesh can cause a blockage or kinking in the intestines or other problems. Immune reactions to mesh may happen. Mesh could potentially detach or migrate from original implantation spot. These issues may also require considering mesh removal if other options fail.
When Hernia Mesh Should Stay In Place
Mesh removal is complex surgery with potential risks. Other treatment options are always tried first. Not every patient with mesh complications requires or is a candidate for removal. In some situations, the benefits of removing mesh likely will not outweigh the risks. Considerations include:
- Type and severity of complications. Mild pain or discomfort may not warrant surgery.
- Overall health status of patient. Those with multiple medical issues may face increased surgical risks.
- Time since mesh implanted. Over time, tissue grows into mesh fibers making removal harder.
- Location and type of mesh. Large pieces of mesh adhered in multiple locations can be difficult to take out.
- Likelihood of hernia returning without mesh support. For many patients, risks of living without mesh may be too high.
If mesh removal seems too risky, surgeons may opt to just remove problem portions of mesh if possible. They can drain infections or snip any eroded pieces instead of attempting full removal.
What Makes Hernia Mesh Removal Surgery Safer?
When mesh removal is necessary, steps can be taken to reduce risks of complications. But patients should realize additional surgeries may be required down the road. Important factors for improving safety include:
Finding an Experienced Surgeon
Mesh removal is extremely delicate and complex procedure requiring special skills and experience. The surgeon must carefully dissect at spots where mesh adheres to tissue and diligently remove mesh fibers embedded in the tissue. This often happens laparoscopically through tiny incisions guided by camera. Choosing a board-certified surgeon who has successfully completed many mesh removal procedures decreases risks. Those without proper training can potentially damage internal organs during removal.
Waiting for Initial Healing
Mesh removal too soon after initial implantation requires pulling apart an unhealed surgical site. This raises infection risk and can cause more trauma. If mesh must be removed, it may be safer waiting at least around 3 to 6 months for some tissue regrowth to occur before attempting removal. However, waiting too long also increases risks as mesh integrates more over time.
Using a Tissue-Sparing Technique
The goal should be removing all problematic mesh while preserving as much healthy original tissue as possible. Aggressive removal can sometimes do more harm than good. Surgeons may leave some non-problematic portions integrated in place if they can fully address problem areas. A meticulous, tissue-sparing removal approach helps avoid extra trauma and improves safety.
Knowing Risks and Limitations
While mesh removal may help certain patients, it does carry short and longer-term risks that should be considered:
- Bleeding, infection risk after surgery as with any procedure
- Nerve damage if mesh entwined around nerves
- Organ injury during removal around closely adhered mesh
- Hernia could return without mesh support
- Lingering pain, discomfort frequently continues after removal
- May not be able to fully remove all mesh on first attempt
- Possible need for additional future surgeries for complete removal
Patients should discuss these risks and potential benefits unique to their situation with their surgical team. Realistic expectations are important. Some patients feel mesh removal resolved their symptoms, but results vary.
What Does the Future Hold for Hernia Mesh Solutions?
Synthetic mesh continues to be used for most hernia repairs. But concerns over complications are motivating innovation of safer surgical materials and techniques. Many companies and researchers are at work on better solutions.
Improved Mesh Materials
One major focus is developing newer mesh materials less prone to complications. Examples include:
- Mesh coated with special barriers to guard against tissue attachment
- Animal tissue mesh (porcine or bovine) seen as lower risk option
- Mesh incorporating slowly releasing antibiotics or antimicrobial substances
- Biologic mesh derived from patient’s own tissues
- Mesh fabricated from absorbable materials that gradually dissolve over time after implantation
Though promising, these newer mesh options have not yet been studied thoroughly enough to demonstrate they resolve all safety issues. More clinical research is still needed.
Robotic and Laparoscopic Methods
Many surgeons now perform hernia repair through robotic or laparoscopic approaches. Smaller incisions, 3D visualization, and robotic precision could optimize mesh placement and reduce risks from mesh removal if needed later. However, access and visibility may still be restricted compared to open surgery. Again, more evidence over the long-term regarding outcomes is required.
Non-Mesh Alternatives
Non-mesh options for hernia repair also being investigated, like suture repairs to close defects or bioglues to reinforce weak spots. But for now, these methods appear most suitable only for minor hernias or those in low stress locations. Reinforcement with mesh is still typically recommended for complex hernias in vulnerable areas prone to high pressure.
Summing Up
In summary, hernia mesh removal may provide symptom relief for select patients with complications not responsive to other options. But undergoing removal surgery still holds substantial risks. There are no perfect solutions yet for those experiencing issues with hernia mesh. Surgeons must carefully balance potential benefits and harms based on each patient’s unique circumstances. Advancements in materials, surgical techniques, and more rigorous testing of newer options will hopefully improve treatment and outcomes following hernia repair surgery. But for now, mesh remains a standard component of hernia repair, and removal procedures are still considered somewhat high-risk. Patients who have received hernia mesh should be aware of potential complications, and that removal options, while available in some cases, are not without considerable risks of their own. Further progress is still needed to address the problems faced by some patients following hernia mesh repair procedures.