The Drama with Medical Mesh: What You Need to Know About Mesh vs. Non-Mesh Surgery

I have two words for you: surgical mesh.

When you type those two words into the search bar on Google, you’re met with a few more word combinations including surgical mesh lawsuit, surgical mesh recall, surgical mesh complications, surgical mesh problems, surgical mesh pain, and even surgical mesh class action lawsuit. That’s a lot of wordplay for a single piece of plastic invented over 50 years ago to help patients heal safer and quicker. Here’s what you need to know about mesh vs. non-mesh hernia surgery … drama-free.

Not all Patients are Created Equal

Our clinic is a high-volume hernia specialty. The patients who seek our expertise and care typically have done their research and know not only that they have a hernia, but what type of surgical repair they think they want. Every patient has undoubtedly heard, read, or been told about surgical mesh and they’re upfront with us at their very first consult.

As a physician, it’s my responsibility to inform patients about my background, my preferred surgical methods, and vast history of surgeries. And prior to deciding whether or not to bring mesh into the equation, you’ll need to meet with a surgeon to discuss your options based on the following factors:

  • Previous surgeries
  • Personal medical history
  • Body distribution
  • Height & weight

All of these come into play to ensure you have the best possible outcome from your surgery. People sometimes call wanting to schedule surgery without this crucial consultation. We feel there is no substitute for an in-person consultation to discuss surgical options. Non-mesh repair can be a great option – but isn’t for everyone. This decision can be made after we discuss your medical and surgical history and examine you. While the drama around hernia mesh may be intimidating, be assured that not all mesh is created equal.

Not all Mesh is Created Equal

When it comes down to it, not all medical mesh is the same; it’s important to distinguish this factor prior to moving forward with the repair. The term “mesh” is used to describe a flat sheet of prosthetic material used to cover, or rather, patch a hernia. And this prosthetic material (plastic) has been around for 50 years.

Polypropylene, the most common material in hernia mesh, is incredibly safe to implant. It’s a plastic that repels water and because the body is made up of mostly water, there is little to no chemical degradation in polypropylene implanted in the body, even for decades. Every year, over one million patients undergo surgery or repair with it. Additionally, the material of the sutures we use is the exact same as the mesh. People say they don’t want plastic in their bodies because to them it’s considered unsafe. With a non-mesh repair, you will still get a small amount of polypropylene suture to repair the hernia. In the mesh repair,  a sheet of plastic is used but it’s the same composition. It’s plastic; it’s safe.

In our experience and through our data review, our incidents of mesh-related or chronic pain is lower or the same as a non-mesh repair — yet some people aren’t aware of this. And if patients decide to choose us, they’re automatically going to get a low incidence of any complication related to a hernia operation.

Not all Surgeons are Created Equal

Another “bad” piece about mesh is that not all surgeries are created equal — not all surgeons are created equal. As with any surgery in any context, there is always room for the human margin of error. Certain surgeons will place the mesh in different layers of the abdominal wall, leading to a variable risk of post-operative nerve damage and chronic pain. These complications have often been blamed on the mesh used, rather than the surgeon or procedure performed.

Our philosophy is to place the mesh behind the abdominal wall, away from nerves whenever possible — which is 99 percent of the time. Boston Hernia believes that by doing a high volume of operations (300+ inguinal hernias a year), we are able to understand the anatomy better than a surgeon that may perform hernias 100 times per year or less — and avoid the nerve-related complications that may be likely to happen elsewhere.

Non-Mesh Repairs

For patients in good health on the thinner side, non-mesh repairs take the mesh out of the equation. Initially, this alternative seems like the ideal option for most individuals. The trade off is it’s a more painful operation; it takes longer for the person to recover, and likely over time, they will have a higher chance of the hernia coming back. If someone meets the requirements and is set on not using mesh, it’s a great first-op choice. The disclaimer here though is they may have to come in for a second operation down the road.

Boston Hernia understands why more and more people are asking for no mesh operations; there’s a non or zero-mesh movement happening right now. When a patient comes in, we can clearly tell them if they can or can’t go the no-mesh route. And if it’s the first operation and they’re set on not using mesh, it can be a great approach. But remember, this isn’t a one-size-fits-all screening. Sometimes the BMI limitations don’t fit for other reason for people who have:

  • Recurrent hernias
  • Larger bellies

People call all the time and want to know if they’re a candidate. We need to conduct an in-person consultation every time. We do this to ensure the safety and integrity of the operations we offer.

Don’t Believe Everything You Hear

Mesh is bad. You hear this all the time — on the news or lawsuit commercials. Well, we are here to tell you don’t believe everything you hear about mesh. Americas Hernia Society (AHS) Advisory approved a message on October 21, 2018, regarding mesh implants; they fully support using appropriately selected mesh reinforcement for the majority of inguinal and ventral hernias, especially if there is a likelihood of the hernia coming back at a later time in life. AHS recommends all surgeons should be well-informed about the pros and cons of using mesh hernia prior to a consultation with the patient.

Mesh Repair from Boston Hernia

Our team at Boston Hernia is here to inform you of the benefits of using medical mesh for your hernia procedure. Only 10-20 percent of our patient wants no mesh. 75 percent of patients ask about the safety of mesh and it’s our job to provide them with the best science and data we have. By rigorously evaluating our outcomes we can ensure we are performing at the highest level we can. Contact Boston Hernia today for a consultation.

Michael Reinhorn

Dr. Michael Reinhorn is a board-certified general surgeon and a Fellow of the American College of Surgeons, as well as a father, husband, cyclist and swimmer. Dr. Reinhorn’s focus is entirely on ambulatory hernia and pilonidal patients and in creating a focused practice servicing the entire New England region.