Concerns Regarding ‘Mesh’

Concerns Regarding ‘Mesh’

Below are some of the concerns you may have.  If there are any other questions that you want to ask that are not covered please email me.  What is written below is a combination of my personal experience and the “evidence” from the surgical literature.  The evidence however is, in the main, of poor quality.  That’s another way of saying it is unreliable.

One thing I suggest  – when you read on the internet or elsewhere, about the numbers, ask yourself where do these figures come from.  Who did the research?  How robust is the evidence.

Q:- I read or hear about ‘chronic pain’ after hernia repair.  I am worried that I will have a problem – chronic pain and other things – if my hernia is repaired with mesh. How common is it?

A:- Really severe, long lasting pain is rare, and if you look at the figures available it occurs in perhaps 2 or 3% of patients.  At least that is what is reported.  There are problems with the available evidence though.  I struggle to understand the ‘horror stories’.  I simply don’t see it in my practice.

ALSO- pain following inguinal hernia repair is not a new thing, and occurred before the use of mesh (Read more) and see this article by Cunningham from 1969 about patients who had no mesh for their inguinal hernia repair

I truly believe, because it is my personal experience, that

a) the surgical repairs which result in severe pain are being badly done – just poor surgical technique.  And this applies to both open and keyhole (laparoscopic) repairs.   I see them weekly in my out-patients.

b) there is undoubtedly a group of patients who are having an inguinal hernia repair operation, although they don’t have an inguinal hernia.  They have groin pain for some other reason.  I see them after their operation elsewhere, and when I speak with them there is nothing in the history of their symptoms that suggests an inguinal hernia.  When I ask them if they could see or feel a swelling before the operation they often say ‘no, but the surgeon said it was there’.  It is surprisingly and alarmingly common.  This link  [to be written] will take you to some actual cases.

Q:- Why do you use mesh if it is such a problem?

It is not a problem if the operation is correctly done.  Before the introduction of mesh around 20% of inguinal hernias failed.  The hernia came back after a variable period of time.

Before the introduction of mesh around 10% of patients had long term pain after a non-mesh repair.

A:- I don’t see mesh as a problem in my practice.  I have carried out many thousands of hernia repairs and in my experience long-term discomfort is very rare.  Critics would say this is ‘anecdotal’ – just relying on my memory, and is not based on good or objective ‘evidence’.

Q:- How many of your patients have chronic pain, long term discomfort or other symptoms after their hernia repair?

A:- Very few indeed. As I write this – early in 2019 – I am about to contact all the patients I operated on over the past 3 years to see how they are.  I hope to have some meaningful results by the middle of this year.  If you can find another surgeon who has done this please let me know.

Q:- Do NHS hospitals and NHS surgeons know the results of the hernia repairs carried out by the various surgeons in their hospital?  In terms of recurrences or long term discomfort.

A:-No they don’t.  There is no way of finding out a hospital’s results.  The data simply does not exist.  If I am wrong, and you do obtain these figures, please let me know.