Mesh and hernia repair

hernia repair reinforcement and has been a safe addition to the tool bag for surgeons to restore strength to torn muscles where hernias have occurred. The primary area where mesh reinforcement has resulted in problems have been when the mesh was placed in the pelvic floor adjacent to the vaginal wall and resulted in erosion into the vaginal wall, which produced drainage, and sometimes pain, requiring surgical removal of the mesh. The overwhelming majority of negative publicity and lawsuits related to mesh have occurred in this pelvic floor vaginal erosion area. It is probably worth understanding that hernias that are repaired with native tissues, that is to say without any mesh, have been shown to have a higher rate of recurrence. This is true for inguinal hernia repairs, ventral hernia repairs, and incisional hernia repairs. The recurrences can be fairly benign, but they can also, in some cases, be very serious or life-threatening, resulting from strangulation of intestine within that recurrent hernia. For this reason, the expert consensus advice, and the position statement of the American hernia society, is that all hernias should be reinforced with reinforcement material such as synthetic mesh. Surgeons and patients, as well as the medical device companies that produce mesh materials, have all recognized the need to continually improve the reinforcement materials. In order to improve comfort and reduce awareness of mesh materials in hernia repair reinforcement, the manufacturers have produced reinforcement mesh that is significantly lighter and more pliable than previous generations of mesh. This translates to greater comfort, less awareness of the mash, and yet maintains the long term strength and durability of the synthetic mesh material. Our study which examined the long term comfort and awareness level of mesh in ventral and incisional hernia repairs on the abdomen was published in 2012 (Article JSLS Ventral Hernia Proof 11.06.2013), one very notable finding was that only a small percentage of patients experienced any awareness whatsoever of the mesh material used for hernia reinforcement, even years later. There are rare risks associated with mesh reinforcement of hernia repairs in the inguinal or ventral hernia realm. Erosion, infection of the material, and pain, are all possible although quite uncommon. Each individual is best served by speaking personally with his or her surgeon prior to undergoing a hernia repair procedure. Understanding the concerns and risks on all sides of the equation will help you make the most informed decision and the one about which you are the most comfortable. Kent Sasse, M.D., MPH, FACS, FACRS Minimally Invasive Solutions]]>