Hernia mesh is a surgical implant designed to reinforce weakened tissue in hernia repairs. Its primary purpose is to provide structural support, helping to prevent the hernia from recurring. This reinforcement is intended to be long-lasting, integrating with the body’s natural tissues. Patients often wonder if these implants require replacement.
Understanding Hernia Mesh Implants
Hernia mesh implants are typically made from synthetic materials, such as polypropylene or polyester, woven into a mesh screen. Some meshes are non-absorbable, meaning they remain in the body indefinitely to provide permanent support. There are also absorbable meshes, often derived from animal tissues like pig or cow, or made from absorbable synthetic polymers, which are designed to dissolve over time as new tissue grows to strengthen the repair site.
The mesh functions by providing a scaffold that allows the body’s own tissues to grow into and around it, creating a stronger repair. This integration helps to reduce the likelihood of hernia recurrence, a benefit compared to repairs done with stitches alone. Permanent mesh materials are generally intended to be a permanent load-bearing implant.
Reasons for Mesh Removal or Revision
While mesh is designed for long-term placement, it may need removal or revision for several medical reasons. Infection is a concern, presenting as either an acute problem shortly after surgery or a chronic issue developing much later. Such infections may not respond to antibiotics alone, necessitating mesh removal.
Chronic pain that persists for over three months and does not improve with other treatments is another common reason for intervention. This pain can result from nerve irritation by the mesh or from the formation of scar tissue, known as adhesions. Mesh migration, where the mesh shifts from its original position, can also occur, sometimes leading to irritation or obstruction of nearby organs.
In some instances, the mesh can erode into adjacent organs, such as the bowel or bladder, causing complications like bowel obstruction, fistulas, or perforations. Hernia recurrence, despite mesh placement, can also indicate mesh failure, potentially due to the mesh shrinking, folding, or not adequately integrating with the surrounding tissue.
Recognizing Signs of Mesh Complications
Patients experiencing mesh complications may notice new or worsening chronic pain at the surgical site. This pain can range from a dull ache to a sharp, burning sensation, sometimes radiating to the groin, testicles, or abdomen. Swelling, redness, or warmth around the incision site can indicate inflammation or infection.
A persistent fever, especially when accompanied by chills or flu-like symptoms, suggests an infection. Some individuals might feel a palpable lump or rigidity in the abdominal region, which could signal mesh dislodgement, a seroma (fluid collection), or a recurrent hernia. Changes in bowel habits, such as constipation, difficulty passing gas or stool, nausea, or vomiting, may point to bowel obstruction or perforation caused by mesh interaction.
The Decision to Remove or Revise Mesh
Determining the necessity of mesh removal or revision involves a thorough medical evaluation. A surgeon typically begins with a physical examination, checking for visible bulges, tenderness, or other abnormalities at the hernia repair site. The patient’s medical history, including details of the original surgery and the type of mesh used, also informs the diagnostic process.
If the physical exam is inconclusive, imaging studies are often performed to gain a clearer picture of the internal anatomy. These may include ultrasound, CT scans, or MRI, which can help identify complications like mesh migration, erosion, infection, or recurrent hernias. The decision to remove or revise mesh is highly individualized, weighing the severity of the patient’s symptoms and the confirmed complications against the potential risks of another surgical procedure. Not all complications necessitate full mesh removal; sometimes, a revision or alternative treatments are sufficient.