Hernia Repair: Secrets Your Doctor May Not Tell You

Jane Akre
June 23, 2021

Mesh Medical Device News Desk, June 23, 2021~ You've been diagnosed with a hernia. What about watchful waiting you ask, where you basically do nothing and hope the condition doesn't worsen.

You risk strangulation of the bowel, the doctor suggests. You will need surgery. And we use surgical mesh.

Now you stop. Is that my only option?

The answer for 95 percent of doctors or surgeons who address hernias in this country is yes, it is your only option. Unless you seek a non-mesh repair surgeon, you are likely going to be implanted with a polypropylene mesh, used to reinforce the weakened area in your abdomen.

The complications with a hernia mesh are numerous, mesh eroding and shrinking, perforating surrounding tissues and organs, causing chronic pain and infection. Men have been known to lose a testicle if the mesh wraps around the spermatic cord. Mesh can perforate the colon causing deadly sepsis.

Dr. William Brown, Surgeon, Fremont, CA

What's the chance of that happening?

According to surgeon, Dr. William Brown of Fremont California, there are one million hernia surgeries performed annually in the U.S. Of those, upwards of 10 to 15 percent will have pain, and ten-thousand patients will have to have a second, very extensive operation to get the mesh out. If there is nerve damage, that pain will never fully go away. You likely will never return to 100 percent, he says.

Doctors have largely been trained in mesh repairs but Dr. Brown argues,

" It's a stupid decision. If you do the absolute numbers, going from 4 to 3 percent recurrence sounds like mesh is much better, but its not a very big difference and if you run a ten percent risk of getting troubles from the use of mesh, that doesn't make any sense at all."

Why do the bulk of surgeons use polypropylene mesh? It's easy to teach a new surgeon, versus training on a pure tissue repair where one must be schooled in the layers of the body needed to make a tissue-only repair.

"Then there's the financial incentive to use mesh because of the huge profit margins. So the lack of time during training, the ease of teaching the mesh repairs, the profit margins, all go against the surgeons getting trained on pure tissue repairs and probably there's not too many professions out there who remember how to do it the old way. People who train the younger surgeons on the mesh repairs are getting older and retiring."

Pure Tissue Repair

Dr. Brown, featured in this weeks Mesh News Desk Podcast - Hernia Mesh Insights (here) - can only name a handful of surgeons around the country who do a hernia repair without mesh. Mesh News Desk has a growing list of doctors. Please request a copy of the list by becoming a member and signing up for our Newsletter.

Suggestions if you are facing a hernia repair and don't want to use mesh include:

* Seek an older surgeon who was trained in pure tissue repair and performs them on a regular basis

* Polypropylene is polypropylene, resist promises about a "new" mesh compared to the mesh that was the focus of pelvic mesh litigation. Pore size may vary.

* Shouldice Clinic in Toronto will perform a non-mesh repair on patients who must be a good candidate. Both Sen. Rand Paul and consumer advocate Ralph Nader went to Shouldice Clinic for their hernia repairs.

* Once there is a complication with mesh, it is very difficult to remove without taking healthy tissue and muscle and possibly causing nerve damage.

* Younger, male athletes who get back to the gym too quickly after a hernia mesh repair using mesh are often seen with complications.

* If you go to an HMO or health care system, you may have difficulty connecting with your surgeon again if you have complications.

* Being referred to a pain clinic is not a sustainable, permanent solution for a hernia mesh complication. You do not just "have to deal with it".

* Most injuries, with pain felt immediately after surgery, are most likely from a surgical mistake.

* Pain that lasts more than six months is considered chronic pain. About 10-15% of patients with hernia mesh end up with chronic pain which can be debilitating.

* About one percent of patients have complications that will necessitate the mesh be removed and the abdominal wall reconstructed.

* About six months after your hernia mesh operation the mesh becomes hard and scarred and begins to shrink.

* Check with ProPublica (here) Dollars for Doctors, to see if your surgeon is a representative of a mesh manufacturer. It may not include trial work as an expert.

* Types of pure tissue repair include Shouldice method, done at their Toronto Hospital, Desarda, Bassini, among others. Providers may not live in your immediate area but may save you thousands of dollars and save you debilitating life-altering complications.

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