On mesh and hernia repairs

10 Jul 2014 | Evidence Based Medicine, Hernia, Uncategorized

There have been a number of articles published in the popular press recently discussing the use of mesh in surgery, and associated complications.  Unfortunately this is a complex topic, and the published articles have in many cases made it more confusing.

The use of artificial materials in surgery is something that has been going on for some time, with many benefits.  Millions of people have benefited from joint replacements, mechanical heart valves, and artificial lenses to restore sight following cataract removal.  The role of surgical mesh is to reinforce or reconstruct areas of soft tissue loss or weakness.  Surgical mesh may be a tight weave where the mesh itself provides strength or an open weave to encourage natural scar formation to provide strength.  Mesh may also be artificial, usually polypropylene, or made from natural animal tissues.

The highly publicised problems from mesh use have almost always occurred when artificial meshes have been placed in direct contact with abdominal organs such as to repair weaknesses in the pelvic floor or around the diaphragm.  In some cases, artificial mesh has eroded in to the nearby organs, causing serious infection.  However, in many cases, the same operations are now able to be performed using natural tissue meshes without risk of complications.

The other very common area for mesh to be used is to strengthen the abdominal wall to repair hernias.  Artificial mesh has been used since 1989 to repair groin hernias, and is now used for most open hernia repairs and all laparoscopic hernia repairs.  In hernia repair, artificial mesh is placed in the muscular layers of the abdominal wall, not adjacent to abdominal organs.

The use of mesh in hernia repairs has been extensively studied, with outcomes published for tens of thousands of patients.  Some of the best quality evidence comes from a study combining the results of multiple different trials on using mesh for open groin hernia repairs.  When examining the outcomes of over 4000 patients, randomly assigned to open groin hernia repair with or without mesh they found that the use of mesh was associated with a lower risk of the hernia coming back, lower risk of ongoing pain in the groin after hernia repair, and no change in the risk of infection or other complications after surgery.

Despite the recent articles in the popular press discussing the risks of artificial mesh inside the abdomen, there is little doubt that modern surgical techniques using an open weave artificial mesh is the ‘gold standard’ best way of repairing a groin hernia.  On a follow-up post I will also discuss the option of laparoscopic hernia repair with mesh, and its potential advantages over open hernia repair.