Hernia mesh is a medical implant used in surgical procedures to provide structural support for organs and tissues. Its primary function in hernia repair is to reinforce weakened muscle walls, preventing hernia recurrence. Mesh can be synthetic (e.g., polypropylene) or biological; some types are absorbed by the body over time, while others are permanent.
Identifying Signs of Mesh Failure
Several signs can indicate hernia mesh failure or complications. Persistent or new pain at the surgical site is a common indicator, ranging from mild to severe, and may feel burning, sharp, or stabbing. This pain can sometimes radiate along nerve pathways.
A new or recurring bulge at the original hernia repair site is another significant sign, occurring if the mesh fails to hold tissue. Swelling, tenderness, warmth, or redness around the surgical area can indicate infection or inflammation.
Flu-like symptoms, such as fever, chills, body aches, nausea, or vomiting, may also signal an infection. Changes in bowel habits, like constipation, or a feeling of internal shifting, may also occur.
Common Complications of Failed Mesh
Hernia mesh failure can manifest as various medical complications.
Infection is a serious concern, occurring when bacteria colonize the mesh. The mesh’s lack of blood supply makes it difficult for immune cells and antibiotics to clear the infection. This can lead to localized inflammation and systemic symptoms.
Hernia recurrence, where the hernia reappears despite mesh placement, is another complication. This can happen if the mesh breaks, tears, shrinks, or if the initial repair was insufficient. While mesh is intended to reduce recurrence rates, it does not eliminate the possibility.
Mesh migration occurs when the mesh moves from its original implanted position. This detachment can cause pain, and in some instances, the mesh may shift into adjacent organs, potentially leading to further damage. Factors like improper fixation or postoperative inflammation may contribute.
Adhesion formation is the development of scar tissue that binds the mesh to surrounding organs or tissues. Excessive adhesions can cause organs to stick together, leading to pain, bowel obstruction, or other functional issues. This process is influenced by the body’s inflammatory response.
Mesh erosion describes the mesh wearing through adjacent tissues or organs. This rare but serious complication occurs when the mesh physically penetrates into nearby structures, such as the intestines or bladder, potentially creating holes.
Chronic pain, distinct from general discomfort, is a persistent and often debilitating pain. It can arise from mesh integration, nerve entrapment by the mesh or scar tissue, or ongoing inflammation.
Diagnosis and Treatment Approaches
Diagnosing failed hernia mesh begins with a physical examination. Imaging studies, such as CT scans, ultrasound, or MRI, are crucial for confirming complications and understanding their extent. These can visualize the mesh, detect its position, identify fluid collections, or show signs of inflammation or organ involvement. Laboratory tests, like blood work, may check for infection or inflammation markers.
Treatment varies widely depending on the complication and its severity. Minor issues or initial discomfort may be managed conservatively with pain medication. If an infection is present, antibiotics are typically prescribed, though deep-seated mesh infections are challenging to treat with antibiotics alone due to bacterial biofilm formation.
Surgical intervention is often necessary for significant complications, ranging from mesh removal to revision surgery. Mesh removal, a complex procedure, may be required for severe infection, persistent chronic pain, or organ erosion. Sometimes, removal necessitates rebuilding the abdominal wall, occasionally involving a plastic surgeon. Revision surgery involves repairing the hernia again, potentially using a different mesh type, a non-mesh technique, or a combination. Treatment choice is tailored to the patient’s condition and the nature of the mesh failure.