Can Hernia Mesh Be Removed? Should It Be?

Hernia mesh is a woven plastic material that has been used in hernia surgery over the last 40 years. The benefits of hernia mesh is a significant reduction in the risk of a recurrence of the hernia. This is well documented in the literature for over 20 years. However, over the last several years it has become clear that hernia mesh can cause significant complications. The most common complication is chronic ongoing discomfort or pain in the area of the repair. There are definite but rare incidences of a true allergy to the mesh material which can present with systemic manifestations. These include but are not limited to:

fatigue

rash

joint and muscle aches.

Most commonly used mesh materials such as polypropylene, polyester, and polytetrafluoroethylene (PTFE) will last forever and rarely ever lose their strength.

Some newer mesh materials are absorbable and will break down over 6 - 18 months depending on the material. Clearly, these materials rarely have to be removed. The downside to absorbable mesh materials is the question of long term durability of the hernia repair. This is the subject of ongoing investigation.

Hernia mesh has a long history of enhancing positive outcomes from hernia repair.

Despite the predominant success of hernia mesh, hernia mesh failure can occur. Failure of the material can occur if it is extremely light weight with a low density. Attempts to design a very light weight mesh has been attributed to failure based on fracture of the fibers of the material. This failure is manifested by hernia recurrence. Most hernia recurrences are not related to failure of the material and are usually related to technical issues with the technique of the initial repair.

Another type of failure of mesh implantation is when a patient has discomfort or pain from the mesh placement. This is not a common occurrence, however, an unhappy patient after hernia mesh placement can be considered a type of hernia mesh failure. Pain and or discomfort from mesh is one of the most common reasons for mesh explantation.

Rejection of hernia mesh is a rare occurrence . The mesh materials are designed to be inert and avoid these types of issues. Many patients are told that they rejected their hernia mesh when they actually have an infection of the mesh which will require removal. Infection of mesh is an uncommon occurrence and can be confused with "rejection " of mesh.

When there is infection of the mesh - usually the mesh will require removal. Mesh infection is uncommon.

In the extremely rare event that a mesh is responsible for an allergic reaction.

The most common reason for mesh removal is when a patient experiences too much pain or discomfort in the area of the hernia repair for greater than 6- 12 months.

Hernia mesh is designed to reduce hernia recurrence by allowing the patient's own tissue to incorporate the mesh with ingrowth through and around the openings (pores) in the mesh. If the mesh requires removal then this tissue ingrowth is what makes mesh removal complicated. The surgeon who removes mesh needs to do everything they can to remove the mesh without any damage to the tissue that it was adjacent to. A surgeon removing mesh requires a skill based on expert anatomical understanding and meticulous surgical technique in order to avoid any injury to the surrounding tissue. There are several surgeons in the United States who have gained this skill through years of experience and study.

This technique is usually beneficial when the previous hernia repair was performed with a surgical incision with the mesh placed outside of the muscular abdominal wall. The mesh can be removed with a surgical incision over the area of the previous mesh placement. Technical precision is enhanced with loupe magnification and enhanced lighting. Extensive surgical experience is necessary for safe mesh removal in order to avoid any injury to the surrounding tissue.

When hernia repair was previously performed with laparoscopic or robotic techniques the mesh is usually behind the muscular wall. If mesh removal becomes necessary after this type of mesh placement, robotic surgery is likely the most precise and safest technique available for removal. This technology utilizes small incisions and 3D Ultra high definition vision and delicate articulated instrumentation.

Despite the complexity of mesh removal, patients undergoing mesh removal can often be discharged within hours of the operation. Often the patient will experience relief of symptoms within hours or days of the surgery. This can be a life changing operation for many.

Contact us today to discuss your options for hernia mesh removal.