Dr. Anthony Tannous

    The Use of Mesh in Hernia Repairs

    8/21/2018 12:00:00 AM

    Healthy Living – August 21, 2018
    Anthony Tannous, MD – Eastern Maine Medical Center
     
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    Abdominal wall hernias are a common medical problem that we see in clinic and the Emergency Department on a daily basis. It is usually caused by a weakness in the abdominal wall that results in an outpouching or sac, in which bowel or other abdominal contents can get stuck. This usually results in a bulge that the patient will feel and it can also be associated with significant discomfort thus affecting the patient’s quality of life. In more severe cases, the bowel that is stuck can lack blood flow which would need emergent surgical intervention before it progresses into a life threatening situation. With time and exercise including our activities of daily living, hernias can grow if not repaired.

    Because of these potential complications, we advise that in appropriate surgical candidates, hernias should be surgically repaired. In the past, some surgeons advocated waiting and observing smaller inguinal hernias but that has changed as we know most of them grow to cause problems eventually.
    There many types of abdominal wall hernias and even more types of surgical repair techniques, some laparoscopic, some open. The technique chosen for a specific hernia will depend on the size and type of hernia and usually will be the product of a conversation between the patient and their surgeon. We tend to individualize the repair to the patient and their particular problem and you should always ask your surgeon what your options are and what they imply in terms of post-surgical pain and recovery time.
    A question I commonly get asked is whether a mesh is absolutely needed to properly fix a hernia. A mesh is a flat sheet of prosthetic material which can be synthetic or biologic in nature and that is used to cover or plug a hernia. The way a mesh works is that it acts as a foreign body that causes a significant inflammation reaction by the body thus resulting in a stronger scar and less change for the hernia to come back.

    Not all hernias require mesh. Some smaller belly button hernias have a very low chance of recurrence and the benefit of a mesh is lost on them. These tend to be stitched closed. Larger ventral hernias and the great majority of groin hernias do require mesh however in order to minimize the chance of recurrences. Without them that risk can be as high as 25 to 50 percent of repairs.

    Are meshes safe? They do have a great safety profile but they are not without potential complications. A mesh is a foreign body which means it is at risk of getting infected and colonized with bacteria which may require removal of the mesh and a second riskier surgery. Some meshes can also migrate from where they were initially placed.

     A lot of patients are also concerned because they’ve heard of mesh companies being subject to major lawsuits some of them very well mediatized. There is a great variety of meshes that are manufactured by several companies. A certain lightweight mesh that was used for inguinal hernia repairs had a higher occurrence of breakage and is the subject of a major lawsuit. But most meshes commonly used do not have that problem. It is always wise to check with the surgeon about the type of mesh they intend to use.

    What we know is that the use of mesh is the standard of care and it is backed by the science, including innumerable clinical trials in the United States and elsewhere so it should always be offered unless there is some particular reason related to the hernia itself where it would not be advantageous.
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