What's the deal with mesh?
Patients in my clinic are consistently asking more about mesh and its implications. Discussing the benefits and risks of mesh is a discussion I have on a daily basis. A recent mesh recall last year heightened the public’s attention to mesh, due to the onslaught of lawyer firms seeking clients with Physiomesh.
The origin of mesh began in an attempt to decrease the unacceptably high rates of hernia recurrence. Hernia recurrence refers to the hernia coming back after it is repaired. As our society has become on average more overweight and more obese, this is needed even more. Closing large hernia defects with suture only puts tension and stress on the repair that make it highly likely to tear and to fail, leading to hernia recurrence. Mesh acts to reinforce the repair and disperse the forces placed on the repair to the surrounding abdominal wall.
Many patients hear anecdotal stories found on the internet or from friends. Mesh has several uses in surgery and those uses carry very different risks. For example, mesh is often used in the pelvis as a bladder sling and placed near the vagina. Mesh reacts differently and has very different risks depending on whether it is placed in the pelvis, the groin or in the abdominal wall.
Some patients with inguinal hernias come to me wanting to have a tissue repair done. Many are surprised to find that the same material is used for both procedure. “Tissue” repairs still require polypropylene, permanent suture, or in the case of the Shouldice clinic, stainless steel wire. Mesh is generally made of polypropylene or polyester.
So many patients are surprised to find out that even if they have a tissue repair, they still will have permanent polypropylene suture in their groin.
Mesh is not alway necessary. Some hernias, such as small umbilical hernias may be repaired without mesh placement. A discussion is had preoperatively regarding the patient’s goals and personal preference and a treatment plan is formulated together.