Many patients have concerns and ask questions about hernia mesh: “I’ve heard of lawsuits due to mesh” is a common topic which is raised. There is an abundance of negative information online and throughout the patient community on all of the risks and complications that can be associated with the use of hernia mesh.
However, there isn’t clear, easily understood information about the benefits of using mesh in hernia repairs. While our center often provides no mesh tissue repairs for hernias, we hope that by reading the information below, you’ll understand more about why hernias occur, why most patients will benefit from a mesh hernia repair, and some of the actual risks of hernia mesh.
How Hernias Form
As discussed elsewhere on our website, hernias are caused by a tear in the muscles of the abdominal wall. Once the muscles tear, fat and internal organs push through the muscles to create a ‘hernia’. However, before the hernia completely develops, there is often a period of prolonged weakening of the muscle over many years. After some amount of time, ultimately the muscle gets to the point of being too weak to support the internal organs, the muscle tears, and a hernia develops. Therefore, it’s important to understand that hernias are not usually just a simple tear in the muscle which is surrounded by normal healthy muscle. There is usually a surrounding area of muscle weakness around the actual hernia. 
Why ‘Primary’ Repair or ‘Tension’ Repair is Not An Option for All Patients
Over many years and through 100’s of medical studies, surgeons have learned that when the muscles around a hernia are simply sewn back together and closed ‘primarily’ (tension repair), hernias recur at a higher rate. This makes good sense since hernias develop due to a weakening in the muscles all around the area of the hernia. By simply sewing these weakened muscles back together, surgeons basically are just pulling together thin, damaged muscles to repair the hernia. Over time, the muscles continue to weaken, the tear in the muscle returns, and the hernia ‘recurs’.
Can a No Mesh Tissue Hernia Repair be Performed?
Yes. When repairing a hernia without mesh, the hole in the muscle is closed, sewing together a patient’s own natural surrounding tissues. This contrasts with mesh hernia repairs in that an artificial mesh is placed over or under the hernia repair after it is closed to provide additional reinforcement and strength to the repair. Obviously without this added strength, no mesh repairs come with an increase in recurrence rates, or the chances that a patient’s hernia will return in the future.
Since patients undergoing a no mesh repair do not have the added strength of a mesh, this surgery is only offered to appropriate candidates:
- Patients who are thin and healthy
- Patients who have relatively small sized hernias
- Patients who wish to avoid the use of mesh in their hernia repair
There is no definitive cut off for the criteria above. Instead, making the decision to use mesh or not should be made on a case by case basis with a qualified surgeon. This includes balancing a patient’s personal priorities against their hernia characteristics. In the end, a patient’s desires and expectations should guide the overall approach. A patient who prioritizes avoiding a mesh at all costs, may be a better candidate for no mesh compared with a patient who prioritizes minimizing his/her chances that the hernia will recur in the future.
About Hernia Mesh – Why Mesh is Used
To help reinforce weakened muscles in the area of a hernia, meshes were invented to implant into the surgical site. By implanting a mesh into the area of weakened muscles, the body creates scar tissue which brings strength back to the weak damaged muscles around a hernia. Medical studies have shown that long term recurrence rates of hernias repaired with mesh (tension free) are lower than those hernias repair ‘primarily’ (tension repair). Most studies show a recurrence rate of about 4-20% without mesh, and about 1-2% with mesh. 
The unbiased government agency The National Institutes of Health performed a study of whether mesh should or should not be used for hernia surgery. Read the article by clicking on the logo to the right.
About Hernia Mesh – Risks of Mesh
When mesh was first invented for hernia repairs, the materials used to create the mesh were very stiff, hard pieces of plastic. With time, these pieces of plastic contributed to chronic pain and nerve injury in the groin. These thick pieces of plastic would create a significant amount of scar tissue which also contributed to pain after the surgery.
In the past, some mesh used for non-hernia related surgeries (female pelvic slings) had metal pieces inside of them. These pieces of metal over time eroded out of the mesh and into the intestines. 99.9% of lawsuits today is due to this specific type of metal reinforced meshes and NOT the mesh used for hernia repairs.
Today, these types of hard plastic meshes, and metal containing meshes are not used by most busy hernia surgeons. Thus, patients should separate the ‘risks’ and ‘lawsuits’ due to older types of mesh, and non hernia meshes, from what is used by hernia surgeons today.
Our Philosophy
For patients who desire a no mesh hernia repair, our office commonly performs natural tissue repairs on patients who are appropriate candidates. However, many patients and hernias will not be candidates for a no mesh repair and thus will require and benefit from a mesh repair. Therefore, seeing a surgeon who can perform the entire spectrum of hernia repair options is the most important aspect to ensure the best outcome after surgery.
| No Mesh Tissue Repair | Mesh Hernia Repair |
|---|---|
| Considered a ‘Tension’ repair because the muscle is pulled together under tension | Is a ‘Tension Free’ repair because the muscles are not completely closed around the mesh |
| Over time the muscles around the hernia can continue to weaken | The muscles around the hernia are reinforced by the hernia mesh |
| Recurrence rates of 4-20% | Recurrence rates of 1-2% |
| Can only be performed in a select subset of patients who meet specific criteria | Can be performed in all types of patients without concern for size of hernia or patient body habitus |
| Requires open hernia repair surgery | Allows the use of laparoscopic hernia repair when desired |
Our Approach
Our office specializes in the surgical repair for all hernia types. We provide patients with the full spectrum of treatment options from open no mesh hernia repairs to advanced minimally invasive laparoscopic techniques. Dr. Harris and our team perform over 500 hernia repairs each year making us the busiest center on the West Coast, and one of the top 3 in the country.
For over 10 years we have partnered with the Abdominal Core Health Quality Collaborative (ACHQC) to track the outcome of every surgery we perform. Year over year, our nationally leading outcome data shows a lower chance of hernia recurrence and a lower risk of developing chronic pain – data which we actively publish on our website. Our commitment to cutting edge hernia care, the full spectrum of surgical options, as well as research and transparency in our data, helps ensure you will have the best outcome after your hernia surgery.
Dr. Harris, Thank you for saving Justin’s life. You saw how much he suffered. When no pediatric surg/gi would touch him, you saved him!
