What is Mesh?
Mesh is a sheet of material that looks like a fine fishing net. It is used to reinforce and/or repair hole in the abdominal wall. Most Meshes are made with a monofilament fiber (like a fishing line) such as Polypropylene or Polyester. ePTFE (i.e. Gortex, the same material used in high end ski clothes) is also used to create sheets of material. 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 connect or bridge with scar tissue around the adjacent strand. When this happens, the strands get pulled together by the scar tissue and the mesh will shrink and get stiff.
The abdominal wall stretches and contracts with every movement. In an ideal situation, the mesh should contract and stretch with the body, otherwise, when the abdominal stretches and contracts and the mesh does 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 usually placed 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 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?
Foreign Body Reaction
All meshes illicit what is called a Foreign Body Reaction. It is the body’s attempt 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 a 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 there are granulomas indicating the body’s attempt to reject the mesh. Unfortunately, even after the mesh is removed, many athletes still suffer from pain.
Do Not Use Mesh. Period.
As we discussed, none of the current meshes are compatible with the body. Because of this incompatibility, chronic and sometimes debilitating pain is a major problem. If the benefits of mesh greatly outweighed the problems 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 when one of the Classic Suture Repairs is used than when mesh is used.
In regard to an ordinary direct or indirect inguinal hernia, if the patient is less than 35 years old then, again, the results are better with one of the Classic Suture Repairs than when mesh is used.
None of these Sports Hernia experts use mesh: William Brown M.D., Ulrike Muschaweck M.D., Gilmore Clinic, William Meyers M.D.
Please do not let your surgeon use mesh.