What is mesh?

Mesh is a sheet of material designed to reinforce a hernia repair. It can be called a "screen" or "patch" also.

Material

Mesh can be divided into synthetic or biologic, and permanent or absorbable.  Biologic mesh can be made from human, pig, sheep or cow tissue.  The newest meshes are made with a combination of synthetic and biologic material.

Safety

Mesh is safe when implanted properly. It has been around for almost half a century and has been implanted in millions of people without problems.

Choice of mesh

There are many factors that determine which mesh your hernia surgeon will use. Most hernia repairs utilize permanent synthetic meshes that are made with either polyester or polypropylene.

Surgery without mesh?

You developed a hernia because of weakened tissue. Just sewing the weakened tissue with sutures is usually not enough to prevent a future hernia, so mesh is needed to reinforce the repair.

Dissolving mesh

Dissolving mesh can be derived from biologic or synthetic sources.  There is no benefit in using these meshes in most situation.  A hernia specialist at the PATCH Institute will be able to guide you with the choices.

What is the evidence regarding mesh and chronic pain?

The best available evidence shows that using mesh for hernia repairs does not lead to increased chronic pain. However, using mesh decreases recurrences significantly compared to not using mesh. Below are 2 good quality studies in the surgical literature:

van Veen RN, Wijsmuller AR, et al. Randomized clinical trial of mesh versus non-mesh primary inguinal hernia repair: Long-term chronic pain at 10 years. Surgery, Volume 142, Issue 5, 695 – 698.

In this study, 300 patients were randomized to open inguinal hernia repair with mesh or open repair without mesh, which is considered a strong method for comparing surgical outcomes. After surgery, patients were followed for a median of more than 10 years. The group whose repair did not use mesh had a 17% recurrence rate, meaning 17% of repairs failed over that period, while the group whose repair used mesh had a 1% recurrence rate.

The authors also found that mesh repair was equal to non-mesh repair with respect to long-term persistent pain and discomfort interfering with daily activity. In other words, patients who had mesh did not experience more pain or discomfort than those who had repair without mesh.

Scott N, Go PM, et al. Open Mesh versus non-Mesh for groin hernia repair. Cochrane Database of Systematic Reviews 2001, Issue 3.

This study is from Cochrane. It is a non-profit, non-government organization formed to organize medical research findings to facilitate evidence-based choices about health interventions faced by health professionals, patients, and policy makers. Cochrane includes 53 review groups that are based at research institutions worldwide. 

This review by Cochrane examines the evidence from studies comparing different types of open surgery for people with groin hernia. They included only randomized studies comparing methods using synthetic mesh versus methods without mesh. There were 20 studies comparing mesh with non-mesh repair analyzed in this study.

Based on their analysis, there was strong evidence that fewer hernias recur after mesh repair than following non-mesh repair. There was a suggestion that people had less persisting pain after mesh repair, but results were only available for nine out of 20 trials. Open mesh methods were shorter to perform than Shouldice procedures (an open non-mesh repair) but took longer than other types of non-mesh repair. They found no clear differences between mesh and non-mesh methods for operative complications and persisting numbness. Overall, people spent less time in hospital and returned to their usual activities quicker after mesh repair.