According to the Society of American Gastrointestinal Endoscopic Surgeons, about 600,000 hernia repair operations are performed in the U.S. each year. Surgeries may be performed using conventional or "open" surgical techniques or by laparoscopic surgery, which typically involves a smaller incision. The vast majority of surgeries are performed to insert a mesh patch to repair or "close" the opening in the abdominal wall.
Following surgery, some patients experience swelling due to fluid trapped in or around the mesh insertion. In some cases, the fluid dissipates without medical intervention. In others, the doctor may need to drain the fluid (typically an in-office procedure).
Some patients develop infections after surgery. In many cases, those infections can be treated with a brief course of antibiotics and they do not recur.
Some confirmed reports have been made regarding surgically implanted mesh becoming dislodged and allowing a recurrence of the hernia. While such complications are relatively unlikely, any swelling or unexpected pain in and around the treated hernia should be examined by your doctor. A fever may also indicate a complication requiring medical treatment; contact your doctor if you have a fever following surgery.
Recalls, Polyester, and other Problems with Mesh
In 2006, the US FDA recalled Proceed Surgical Mesh products because the layers can separate, and when the polypropylene layer is exposed to the bowel, patients had an increased risk of adhesions and bowel fistulization. In 2005, the US FDA recalled Composix Kugel Mesh Patches because they can break and cause bowel perforations or fistulas. The Composix product recall was expanded in 2006 and 2007 to cover other product models.
Although a number of problems and recalls of mesh material have occurred over the years, repairing an abdominal hernia with mesh is still the preferred method.
A study published in 2000 compared patients who had either hernia mesh repair or suture repair. Three years after their surgery, 43 per cent of patients who had suture repair had hernia recurrence, compared with 24 per cent of those whose hernias were repaired with mesh.
A long-term study conducted at Baystate Medical Center Campus of Tufts University School of Medicine in Massachusetts concluding in 1994 found that the use of multifilamented polyester mesh resulted in a significantly higher rate of complications per patient, including infections and more recurring hernias, yet the placement technique had no bearing on patient outcome. The study concluded that polyester mesh should no longer be used for incisional hernia repair.
What Is a Hernia?
While most hernia surgeries involve abdominal hernias, the term "hernia" can refer to any place in the body where part of an organ sticks out through a weakened area or a tear in a muscular wall. With an abdominal hernia, the intestinal tract may be "caught" in the herniated portion of the abdominal wall.
The majority of hernias require surgery. Hernia surgery usually is required to reposition any the portion of the organ that is protruding from the opening and to close the opening.
History of Hernia Mesh
In the 1800s, medical practitioners noted that an artificial material was needed to reinforce the walls of the abdomen following trauma or surgery. It was a century later, in 1959, when Francis Usher introduced a polythene mesh. Today, biomedical mesh materials are classified based on the physical characteristics of the material---most importantly, pore size and related porosity.