What is Mesh?
Mesh is a sheet of cloth that looks like a fine fishing net. Mesh can be used to reinforce and repair hernias. Most Meshes are made with a monofilament fiber (like a fishing line) such as Polypropylene or Polyester. Below is a photo of some mesh:
Pore size is a measure of the size of the holes in the mesh. If the pore size is too small, then the strands of the mesh are very close together. In that situation, the scar tissue that forms around one strand can bridge with scar tissue around the adjacent strand. When this happens, the strands get pulled together, and the mesh will shrink and get stiff.
The abdominal wall stretches and contracts with every movement. In an ideal situation, the mesh should stretch and contracts with the body. Otherwise, when the abdominal stretches and contracts and the mesh do not, then there will be shear stresses where the abdominal wall and the mesh meet. Unfortunately, even the best mesh will stretch only half as well as the abdominal wall. Why use mesh when you know it can decrease the performance of an athlete?
In your mind, visualize a piece of mesh that has been used to repair a hernia. It is in between the muscle layers, and there are many sensitive structures nearby. Then imagine that mesh shrinking. As the mesh shrinks, it will pull on everything nearby. If the mesh pulls on a nerve, then there will be constant burning pain. If the mesh pulls on the spermatic cord, then sex will be a distant memory. If the mesh pulls on the bladder, then there will be spasms when you urinate. If the mesh pulls on the abdominal wall, then there will be pain when you exercise. Most meshes will shrink about 40%.
Since all meshes shrink with time, it is unthinkable to put mesh in an athlete who has not finished growing. What is going to happen when the athlete grows 5 inches, and at the same time, the mesh shrinks?
The surgeon is asking for a bad result.
Foreign Body Reaction
All mesh illicit what is called a Foreign Body Reaction. The body attempts to get rid of what should not be there. (It is nice to know that the body is smarter than many surgeons). Macrophages, lymphocytes, and Giant Foreign Body Cells attack the mesh with acid, free radicals, and enzymes. Mesh usually survives this attack, but the attack does result in chronic inflammation and pain.
Pain and Mesh
About 15% of patients after a hernia repair with mesh suffer chronic pain. The pain usually starts several months after the operation. As we discussed, the pain is caused by multiple factors: shrinkage of the mesh, sensitive structures becoming scarred to the mesh, and the result of the Foreign Body Reaction. When the mesh is removed and then examined under the microscope, there are multiple neuromas indicating nerve damage, and granulomas are indicating the body’s attempt to reject the mesh. Unfortunately, even after the mesh is removed, many athletes still suffer from pain.
None of the current meshes are compatible with the body. Because of this, chronic pain is a significant problem. If the benefits of mesh greatly outweighed the difficulties of mesh, then it might make sense to use mesh. But that is not the case! When you compare the results of a sports hernia repair with and without mesh in athletes, the long term results are much better without mesh. None of the Sports Hernia Experts use mesh. Also, when you compare the results of inguinal hernia repairs in young men, the results are better without mesh. In all other groups of patients, non-mesh hernia repairs have less pain than mesh hernia repairs.
Please do not let your surgeon use mesh.
Hybrid meshes use a combine a standard polypropylene with a biologic material. The biologic component is supposed to make the mesh more compatible with the body. These meshes have only been available for a few years, and so we do not know anything about the long term results. Zenapro is one of the newer hybrid meshes. It is made from pig intestines. How anyone thinks using pig intestines to fix a hernia not going to cause trouble is crazy.
Do Not Use Mesh. Period.