A hernia occurs when an internal organ or fatty tissue protrudes through a weakened area in the surrounding muscle wall, often appearing as a visible bulge. Surgical mesh is a common treatment for these conditions, used in the majority of hernia repairs in the United States. While designed to provide stable support, hernia mesh can move from its implanted location. Although uncommon, mesh displacement is a recognized complication.
How Hernia Mesh Works
Surgical mesh functions as a scaffold to reinforce weakened muscle walls and prevent organs from pushing through. Its primary purpose is to strengthen the repair site and reduce the likelihood of the hernia recurring. Mesh products are broadly categorized into synthetic and biologic types. Synthetic meshes, often made from materials like polypropylene, can be permanent or designed to absorb over time. Biologic meshes, derived from animal or human tissue, are typically absorbable and promote the growth of new tissue.
During a hernia repair, the surgeon places the mesh over or under the defect in the muscle wall. It is commonly secured using sutures, tacks, or surgical glue to hold it in place. Over time, the patient’s own tissue is intended to grow into the mesh’s pores, creating scar tissue that further strengthens the repaired area.
Why Mesh May Shift
Several factors can contribute to the displacement of hernia mesh after surgery. Inadequate fixation during the initial surgical procedure is a primary cause, meaning the mesh was not sufficiently secured to the surrounding tissue. External forces or undue pressure can also cause the mesh to separate from its anchors. The size, shape, and material of the mesh itself can influence its stability, with some designs potentially more prone to migration if they do not adequately promote tissue ingrowth.
Patient-specific factors also play a role in mesh movement. Excessive physical activity too soon after surgery can disrupt the healing process and dislodge the mesh. Conditions that increase abdominal pressure, such as chronic coughing, straining, or obesity, may also contribute to displacement. An inflammatory reaction to the mesh can also cause it to erode, shrink, and move. Infections at the surgical site can also weaken the tissue’s hold on the mesh, leading to its migration.
Signs of Mesh Displacement
If hernia mesh moves, it can lead to various signs of a complication. Localized pain, which can be new or worsening, is a common indicator. Patients might also notice a palpable lump or a new bulge in the area of the surgical repair. Signs of infection, such as fever, redness, or warmth around the surgical site, can also be present.
Displaced mesh can lead to more severe issues, including bowel obstruction. This may manifest as nausea, vomiting, abdominal cramping, or difficulty passing gas or stool. Nerve impingement, where the mesh presses on nerves, can cause numbness, tingling, or a burning sensation in the affected area. Sexual dysfunction or impotence has been reported, particularly with inguinal hernia repairs. These symptoms may appear immediately after surgery or develop months to years later.
Managing Mesh Movement
When mesh displacement is suspected, medical professionals begin with a physical examination of the affected area. Further diagnostic imaging, such as ultrasound, CT scans, or MRI, confirm the mesh’s position and identify any related complications. These imaging tests allow doctors to visualize whether the mesh has shifted or is impacting nearby organs.
Treatment approaches for mesh movement depend on the severity of symptoms and any resulting complications. If symptoms are mild, conservative management may be considered; surgical intervention is often necessary to address displaced mesh. This may involve surgically repositioning or removing the mesh entirely, especially if it has eroded into surrounding tissues or organs. Additional surgical procedures may also be required to repair any damage caused by the migrating mesh, such as bowel perforations or obstructions.