Mesh advice for patients

There has been much information in the media recently re mesh concerns raised by mainly members of the public. The mesh issues were predominantly raised after increasing chronic pain complaints that were seen in women that underwent operations which involved mesh placement in gynaecological operations, particularly vaginal mesh used in pelvic floor prolapse surgery.

As a guide to both Consultants and patients, we as an organisation would like to first of all allay any worries that individuals have with regard to mesh and its use especially in hernia surgery.

1. Mesh has been used in surgery for the past four decades in both groin and abdominal wall hernia surgery to great effect and very safely.
2. The use of mesh has predominantly reduced the incidence of recurrence in hernia repairs as the prosthetic material reinforces what is already a weakened area of the abdominal wall/groin.
3. The use of mesh can be regarded in a similar fashion to the use of any foreign material such as seen in cardiac and orthopaedic surgery, e.g. stents and joint replacements respectively
4. Mesh can cause complications and may in certain circumstances require removal – but this is a rare event – mesh removal in both groin and abdominal wall hernia surgery if needed, is offered in the NHS at Manchester University Foundation Trust (MFT)
5. In groin repairs the use of mesh is required in laparoscopic surgery
6. Open groin surgery maybe undertaken with the use of mesh or a suture repair
7. MFT offers a sutured or mesh free repair of groin hernias, but this is mainly reserved for younger patients and sports hernias as there is evidence in the literature especially from the Danish hernia registry that suture repair of 18-29 years old patients is a feasible option.
8. Sutured repair for a groin hernia does have a slightly increased risk of recurrence and reoperation rate especially after 5 years.
9. For the large majority of groin operations a mesh repair is undertaken as this results in a significantly reduced incidence of recurrence, with an internationally quoted risk of chronic groin pain of up to 4-6%, although large centres with recognised expertise in this area do quote a chronic groin pain & recurrence risk of up to 2%.
10. Mesh maybe the cause of chronic groin pain in some patients, but this is not always the case and for many patients the cause of groin pain maybe due to another undiagnosed problem.
11. For groin hernia surgery whether you have an open repair with no mesh, open repair with mesh or a laparoscopic repair, there is no significant difference in the risk of chronic groin pain and this is shown in a publication examining data from over 5000 patients.
12. Mesh is overall considered very safe and recommended for use in both groin and abdominal wall hernia repairs.

This advice is mainly a guide and your surgeon/ clinician will discuss with you all the points that have been raised above as well as details of the operation that you are due to undergo in addition to all the relevant risks and complications. MFT offers a comprehensive abdominal wall/groin hernia service with expertise also in chronic groin pain and mesh-free repairs.

Further information can also be obtained from the British Hernia Society website on www.britishherniasociety.org

References:

1. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.
2. Pilkington JJ, Obeidallah MR, Zahid MS, et al. Outcome of the "Manchester Groin Repair" (Laparoscopic Totally Extraperitoneal Approach With Fibrin Sealant Mesh Fixation) in 434 Consecutive Inguinal Hernia Repairs. Front Surg. 2018;5:53. Published 2018 Sep 18. doi:10.3389/fsurg.2018.0005
3. Öberg S, Andresen K, Klausen TW et al. Chronic pain after mesh versus nonmesh repair of inguinal hernias: A systematic review and a network meta-analysis of randomized controlled trials Surgery. 2018 May;163(5):1151-1159.
4. Bisgaard T, Bay-Nielsen M, Christensen IJ et al. Risk of recurrence 5 years or more after primary Lichtenstein mesh and sutured inguinal hernia repair..Br J Surg. 2007 Aug; 94(8):1038-40.
5. Haastrup E, Andresen K, Rosenberg J. Low reoperation rates in young males after sutured repair of indirect inguinal hernia: Arguments for a tailored approach.