Mesh For Hernia Repair
What is it?
Mesh is simply a material that surgeons will use to reinforce weakness in native tissues. We use it to bridge gaps in muscles and to bolster tissues that we think may fail under normal strains and the wear and tear of typical human activities. We use it when we know that statistically the repair is more likely to fail than not if we do not strengthen it is some manner. Modern hernia repairs invariably utilize mesh to decrease the chance of failure or hernia “recurrence”.
There can be a degree of apprehension on the part of patients to know that there may be some “foreign material” left in their body at the conclusion of a case. Again, when mesh is used by a surgeon it is because the benefit outweighs the risks. Fortunately the placement of mesh typically results in a faster procedure, less pain and a more durable repair. There are really no “bad” meshes but complications can happen. Because mesh is not a living structure it has no ability to fight an infection so if it does become contaminated during the course of placement or even later from unforeseen consequences it may have to be removed. Fortunately these scenarios are very rare.
Dr. Gillian has been involved in teaching hernia repair techniques to surgeons utilizing a variety of meshes since 1998. He has also helped in the design and evaluation of hernia meshes. Consequently the choice of mesh for each patients hernia repair is not random or simply picking what is “on the shelf”. Every hernia repair and patient is unique and consequently the choice of mesh and the manner of fixation will vary from patient to patient. If you are going to have a hernia repair with our practice please feel to ask questions about the mesh being utilized in your case. We want you to be confident about the repair and not anxious about the materials being used.
Please visit our You Tube Channel to see surgical videos and examples of hernia repairs with mesh being used by Dr.Gillian.
Are Biologic Meshes Better?
Biologic Mesh refers to a very diverse group of products designed to reenforce soft tissue repairs. They are used in many areas of surgery like Plastic Surgery,Neurosurgery and General Surgery. Some are basically sterilized tissue harvested from animals and human cadavers, while others have literally been created in the lab with living microorganisms.
The very nature of how these products are produced means they are expensive. Therefore we have an obligation to use them only when we think there is an advantage for the patient. In general surgery they are occasionally used to help close the defects in complex abdominal wall reconstruction. Particularly when there is a wound contamination or active infection. These products are either reabsorbed by the body or naturally breakdown over a variable period of time. This is why they may be safer to use in complex wounds where permanent meshes create a higher chance of chronic wound infection. Unfortunately because they do “go away” they may only be a very temporary solution for some patients.
We do not use absorbable or biologic mesh products in this practice to repair abdominal or inguinal hernias as a primary repair because the recurrence rates are too high. We do use theses types of products to reenforce our hiatal and paraesopahgeal hernia repairs because there has been data to suggest that doing so may reduce recurrences in this area versus a primary or “non-mesh” repair. Although permanent “non-biologic” mesh has been used successfully in this area there is a valid concern that a permanent mesh in this location could create damage or an erosion into the esophagus.
In short, biologic meshes are not “better” but they do have advantages when appropriately utilized.