Hernia Repair With Mesh or No Mesh?
To repair an inguinal hernia there are two basic methods. The first method uses sutures to repair the hernia through a small incision. Your own tissues are used to fix the hole. The second method of repair involves putting in a piece of mesh or plastic to patch the hole. If the mesh is inserted with a laparoscope, then the mesh is placed so that it patches the hole on the inner surface or the deep side. If the mesh is placed through a skin incision, then mesh is placed so that it patches the hole on the outer or the superficial side.
The argument for a hand sewn repair (i.e. no mesh), is that there is no foreign body placed in the body. It is common for people to develop scar tissue around the mesh. This causes the mesh to become stiff and hard. Then when you bend and twist and the mesh does not bend and twist with you, the sheer stresses causes pain. Sometimes one of the nerves or spermatic cord gets stuck to the mesh and severe pain can result. Then exercise becomes impossible because of pain, and ejaculation causes a severe burning sensation in the spermatic cord and testicle.
Chronic pain after mesh hernia repairs has been reported to be as high as 16%. A significant number of those patients with pain have to have the mesh removed with another operation. Even after removing the mesh, the patient is often only about 80% better. The argument for a mesh repair is at the mesh increases the strength of the area, and thus decreases the chance for a recurrent hernia.
The chance for a recurrent hernia after a mesh repair is probably about 3%. The chance for a recurrent hernia after a non-mesh repair is about 4%. But to achieve this 1% lower recurrence rate the patient runs about a 16% chance of chronic pain.
I strongly feel that since the risk of chronic pain from the mesh is so much higher than the recurrence rate, that hernias should be repaired without mesh.
Learn more about Dr. Brown’s approach to hernia repair without mesh. Contact Dr. Brown today.