Hernia Mesh

According to the U.S. Food and Drug Administration, using hernia mesh may improve a patient’s outcome because the surgery and recovery may take less time compared to other treatment options. However, the agency links recalled meshes to many reports of hernia mesh complications. Some patients require hernia mesh removal surgery to treat these complications.

Why Do Surgeons Use Hernia Mesh?

A main reason surgeons use hernia mesh is to lower the risk of a hernia recurring, or coming back.

There is a high chance of hernias returning after repair surgery. Conventional hernia surgery stitches torn tissue back together. Some studies have shown that surgeries using mesh lead to fewer hernia recurrences. Others have found there are other complications that are more common with mesh.

Hernia mesh products come in many sizes and shapes. The different designs can repair specific types or sizes of hernias.

Each type of hernia mesh may also fall into other categories. These describe how they function in the body or the materials they are made from.

Absorbable

Absorbable mesh degrades and loses strength over time. It is not used to provide long-term reinforcement to the repaired hernia. “As the material degrades, new tissue growth is intended to provide strength to the repair,” the U.S. Food and Drug Administration explains on its website.

Non-Absorbable

Non-absorbable mesh is a permanent implant. It remains in the body indefinitely. Non-absorbable mesh is supposed to provide lasting reinforcement to the repair site.

Synthetic

The most common hernia mesh products are made of synthetic materials that come in woven or nonwoven sheets. These synthetic materials can be absorbable, nonabsorbable or a combination of both. The most popular types of surgical mesh are made from polypropylene, a synthetic plastic.

Coated or Composite

At least one hernia repair technique can leave mesh in contact with the intestines. This can cause the intestines to adhere to the mesh, which can result in severe complications. Some polypropylene meshes may come coated with absorbable fatty acids, cellulose or collagen. Manufacturers claim these coatings prevent adhesions.

Animal-Derived

Some manufacturers make hernia mesh from animal tissue. They may use the intestine or skin of animals. It usually comes from a pig or cow. Manufacturers process and disinfect it. This type of mesh is also absorbable.

Dozens of companies make hernia mesh. Manufacturers range from the start-up TELA Bio to Johnson & Johnson – the world’s largest medical products company.

Hernia mesh provides a lucrative market that draws in medical device makers. Grand View Research estimated the global market was worth $177 million in 2016. The market research firm predicted steady growth through 2025. The potential for profit attracts all sizes of companies.

Surgery is the only treatment that can permanently repair a hernia. Hernia mesh is used in about 90 percent of those surgeries, according to the FDA.

Surgeons can perform repairs with or without hernia mesh. But mesh has become more common since the 1980s.

Doctors may use minimally-invasive techniques to implant hernia mesh. This is called laparoscopic surgery. It requires only small incisions. Surgeons place surgical tools through the incisions to implant the mesh.

Open repair is another technique. It requires a large incision that opens the body to the hernia. Surgeons attach the mesh to the damaged tissue then close the wound.

Recovery time is shorter for laparoscopic surgery. But the operation takes longer and is more expensive.

Research is mixed on how long a mesh hernia repair will last. Recurrence was the most common complication before the hernia mesh’s invention. A 2022 study in the journal Hernia followed 100 patients for ten years after a ventral abdominal hernia repair.

No recurrence was recorded after 3 years, while about 10% had a recurrence after roughly 8 years. Two patients had a central breakdown of the mesh at about 7 years. Mesh had stretched across the defect by an average of 21%. Mechanical testing showed that the mesh lost its elasticity at low forces.

A 2014 study in JAMA Surgery looked at 190,000 hernia repairs. Researchers found hernias recurred in only 2.7 percent of mesh repairs. This is compared to 8.2 percent of repairs with stitches alone.

But an October 2016 study in JAMA warned that there may be a serious trade-off.

Researchers looked at 3,242 patients. They found that other hernia mesh complications increased in the first five years after mesh repairs.

These complications included bowel obstructions and perforation. The authors said their work showed that more research into the long-term effects of hernia mesh is needed.

The U.S. Food and Drug Administration tracks reports on hernia mesh complications. Doctors and patients report complications they have experienced. Manufacturers also have to tell the FDA about reports they receive.

The FDA has analyzed thousands of these reports.

Reports also detail mesh shrinking or migrating in the body after surgery.

Thousands of people have filed hernia mesh lawsuits after suffering serious complications. A federal panel has combined lawsuits over three brands of hernia mesh into three separate multidistrict litigations (MDL). MDLs allow several similar lawsuits to move more efficiently through the legal system.

The FDA has blamed recalled hernia mesh for most cases of bowel obstruction and perforation. Many of these products are no longer on the market. But some recalled meshes are still available.

Hernia mesh manufacturers have recalled more than 200,000 units between 2005 and 2014. Ethicon also ordered a “market withdrawal,” taking mesh off the market without a recall.

Alternatives to hernia mesh include at least five surgical procedures. All involve stitching the damaged tissue back together. But each uses a different method to repair hernias.

In some cases, doctors may recommend “watchful waiting” before hernia surgery. The doctor will monitor the patient’s condition until it requires surgery. Watchful waiting is an option if the patient exhibits no signs or symptoms. People should only consider this alternative if their doctors recommend it.