Last month I removed some interesting pieces of mesh
In Photo 1, the patient had had a laparoscopic hernia repair about 12 years ago. Lightweight prolene mesh was used. He started to have pain 8 months after the operation. He tolerated the pain until he fell with a twisting motion late last year and then the pain became debilitating. Rest, Steroid injections, and analgesics were not helpful. As you can see from the photo then flat mesh had scarred into a complicated three-dimensional mess. No wonder he was having so much trouble with that lump of mesh. So far he is doing well.
In Photo 2, the patient had a laparoscopic hernia repair 4 years ago. Six months after the operation he noticed a bulge and pain. Physical examination and ultrasound documented a recurrent inguinal hernia. At the time of surgery, the mesh did not completely cover the inguinal floor. I do not know if the mesh was placed incorrectly or if the mesh contracted with time. A pure tissue repair was done for this patient. No complications after surgery.
In Photo 3, The patient had a Lichtenstein hernia repair and had pain almost immediately after surgery. He reported allodynia in the distribution of the ilioinguinal nerve. Repeated nerve blocks provided only temporary relief. He dealt with the pain for 6 months with the hope that he would improve with time, unfortunately, he did not improve. As you can see in the photograph, the ilioinguinal nerve was densely scarred to the mesh. The mesh was removed and a neurectomy was performed. The defect was repaired without mesh. The patient is doing well.
In Photo 4, The patient had pain and spasms during intercourse, especially during ejaculation. On physical examination, the spermatic cord was stuck to the mesh. Spermatic cord blocks provided temporary relief. Analgesics and time did not help. I suggested that he consider becoming celibate, but he did not like that option. When the mesh was removed the vas deferens was scarred to the mesh. He reports that he has been able to enjoy intercourse again.
In Photo 5. It is very common for the epigastric artery and vein to be scarred to the mesh after inguinal hernia repair. Several times in previous patients having mesh removed I accidentally damaged those vessels and had to deal with significant hemorrhage. I try to learn from my mistakes. Now, I identify the vessels early and I am prepared to ligate the vessels quickly if they are damaged. The scarring of the mesh to the epigastric vessels is probably not a source of pain but can make mesh removal much more difficult.
If you have mesh questions please contact Dr. Brown at:
Bill Brown MD