Hernias occur when the intestines or other organs push through the wall of muscle and fiber that typically contains them. To repair hernias, surgeons for at least the last a few decades have been using a loosely woven sheet of surgical mesh — both synthetic and derived from cow or pig tissue.
In recent years, however, questions have emerged about the safety of surgical mesh.
Is sugical mesh safe?
Some surgical mesh products used in hernia repairs that have caused problems have been the subject of recalls by the U.S. Food and Drug Administration since March 2010.
The safety of mesh used in repairing hernias is still the No. 1 question his patients ask, says Marcelo W. Hinojosa, MD, a UCI Health surgeon who specializes in gastrointestinal and bariatric surgery.
“We look at the risks and benefits together — and discuss the reasoning behind using mesh — to help them make informed decisions,” Hinojosa says of his patients.
Benefits and risks of using mesh
The main benefit of using mesh to repair a hernia is to strengthen a wider area around the opening to minimize the chance that of recurrence.
“For most hernias, mesh — when used and placed correctly — will help reduce risk of recurrence with minimal risk of complications,” says Hinojosa, an assistant professor in the UCI School of Medicine’s Department of Surgery.
He classifies the general risk of recurrence after hernia repair surgery this way:
- High: Stitches without mesh
- Medium: Stiches with biologic mesh
- Low: Stitches with synthetic mesh
Most problematic mesh has been recalled
Analysis by the FDA found that the most common adverse events for surgical repair of hernias — with or without mesh — are:
- Hernia recurrence
- Scar-like tissue that sticks tissues together (adhesion)
- Blockage of the large or small intestine (obstruction)
- Abnormal connection between organs, vessels or intestines (fistula)
- Fluid build-up at the surgical site (seroma)
- A hole in nearby tissues or organs (perforation)
In addition, mesh may also migrate or shrink.
According to the FDA, many of the complications reported to the agency relate to mesh products that have since been recalled.
“Like everything, mesh has some risks,” Hinojosa acknowledges. “That risk depends on the kind of hernia, its location, how it is placed, and whether the surgery is an emergency or nonemergency”
Research on mesh usage ongoing
Research published in 2014 in the Journal of the American Medical Association (JAMA), which analyzed some 2,000 surgeries from 1980-2012, indicated that use of surgical mesh results in fewer recurrences of hernias over five years.
However, a 2016 study published in JAMA found that for some people whose hernias occur at the site of a previous abdominal surgery, the long-term success of surgical mesh may be “offset in part by mesh-related complications.”
For Hinojosa, mesh does offer benefits.
“Mesh is needed in certain hernias and when placed correctly — and under the right circumstances — it is safe,” he says.
Much research remains to be done, however. “We’re still looking for that perfect mesh,” Hinojosa says.