Mesh and the Media: is mesh for hernia repairs a bad thing?
About eighteen months ago, New Zealand’s Herald on Sunday ran a series of articles raising concerns about the use of mesh in surgery. The origin of the concern was problems that can occur when mesh is placed transvaginally for women who have problems of urinary incontinence, usually a legacy of childbirth. It is recognised by the medical profession that mesh in this situation can cause complications, due to erosion of mesh through the thin vaginal lining, or from scarring and contracture in the same area. Unfortunately, because hernia repair involves the use of mesh in the majority of instances (and it is the same sort of mesh), folk who had problems following hernia repair assumed that mesh must be the cause of their problems too. This led to more articles in the paper describing the use of “controversial mesh” in hernia repair on more than one occasion. An editorial stated that “it is time that medical authorities reviewed its (mesh) use”, describing “excruciatingly painful complications which are socially debilitating, with incontinence a common consequence”, going on to say that “surgeons are divided on its use”.
While the above comments may apply to transvaginally placed mesh for incontinence, there is nothing controversial about the use of mesh in hernia repair. It is well recognised that mesh is associated with less pain and less recurrence than suture repair and all surgeons are in agreement on this. Mesh has been around at least 30 years, in widespread use for hernia repair for at least 20. I personally have used mesh in over 6500 laparoscopic inguinal hernia repairs and have never had to remove a piece on account of chronic pain. Problems can occur, as with any operation, but they are infrequent and are related to technical details, such as how the mesh is placed and how it is fixed, rather than to the mesh itself.
It was unfortunate that these articles caused something of a “climate of fear” regarding the use of mesh in any situation at the time. I had to do a lot of reassuring and explaining to concerned former and future patients. The paper published a statement by me defending the use of mesh in hernia repair, but the topic continues to be revived from time to time. Even though such articles usually identify transvaginal placement, they continue to generate concern regarding mesh for hernia repair.