Why we remove mesh
As more mesh is implanted for hernia repairs, mesh-related complications may increase, with some requiring mesh removal. We describe our experience as to indications and perioperative factors that surround hernia mesh removal.
All patients who underwent hernia mesh removal from the abdomen (ventral, flank) and pelvis (inguinal, femoral, obturator, perineal) were captured from a single hernia center database.
Over 4.5 years, we removed 105 mesh. Most were in males (58%), average age 53 years, with average pain score 5/10. Males most commonly had mesh removed from the pelvis (65%), and females from the abdomen (63%, P = 0.009). Pain score was significantly higher prior to removal of hernia mesh from the pelvis (5.7 vs 4.5, P = 0.047). Type of mesh implanted and positioning of mesh showed no difference in pain (P > 0.05). Indications for hernia mesh removal significantly varied between the abdomen (infection, 43%) and the pelvis (pain, 91%, P < 0.0001). Mesh reaction became a more frequent indication for mesh removal in the pelvis, reaching 1/3 of patients by 2017. Most required general anesthesia (87%), with inpatient stay (53%, mode 1 day). Open technique decreased with time (82–17%), laparoscopic decreased (20–10%), and robotic increased (0–70%).
This is the largest and most comprehensive study detailing why we remove mesh. We provide awareness of indications and operative options to help guide physicians as they encounter patients who may require hernia mesh removal.
KeywordsMesh removal Chronic pain Laparoscopy Robotic surgery Mesh reaction Mesh
Compliance with ethical standards
Conflict of interest
Authors RS, NF, EZ declare no conflict of interest. Author ST declares conflict of interest not directly related to this work but is broadly relevant to hernia mesh and hernia repair. This includes role as Principal Investigator with research grant funding by Bard/Davol, Inc. and Intuitive Surgical, Inc. Author ST also has a patent pending that is not directly related to this work but is broadly relevant to hernia mesh.
This study was reviewed and approved by the Cedars-Sinai Institutional Review Board.
Human and animal rights
This article does not contain any studies directly involving human participants, as it is a review of data already collected in a hernia database.
Written informed consent was obtained by all patients enrolled prospectively in our hernia database.
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