Why we remove mesh

Abstract

Purpose

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.

Methods

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.

Results

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%).

Conclusions

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    Simons MP, Aufenacker T, Bay-Nielsen M et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403

    CAS  Article  Google Scholar 

  2. 2.

    Liang MK, Holihan JL, Itani K et al (2017) Ventral Hernia Management: expert consensus guided by systematic review. Ann Surg 265:80–89

    Article  Google Scholar 

  3. 3.

    Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316(15):1575–1582

    Article  Google Scholar 

  4. 4.

    Allied Market Research (2018) Global opportunity analysis and industry, forecast, 2013–2020. https://www.alliedmarketresearch.com/hernia-repair-devices-market. Accessed 23 Jan 2018

  5. 5.

    Cunningham LA, Ramshaw B (2016) Mesh removal for chronic pain: a review of laparoscopic and open techniques. In: Jacob B, Chen D, Ramshaw B, Towfigh S (eds) The SAGES manual of groin pain. Springer, Cham, pp 301–317

    Google Scholar 

  6. 6.

    Arlt GD, Lamm T, Klosterhalfen B (2003) Mesh removal in inguinal hernia repair. Eur Surg 35(1):42–44

    Article  Google Scholar 

  7. 7.

    Bueno-Lledo J, Torregrosa-Gallud A, Carreno-Saenz O et al (2017) Partial versus complete removal of the infected mesh after abdominal wall hernia repair. Am J Surg 214(1):47–52

    Article  Google Scholar 

  8. 8.

    Johanet H, Contival N (2011) Mesh infection after inguinal hernia mesh repair. J Visc Surg 148(5):e392–e394

    CAS  Article  Google Scholar 

  9. 9.

    Jacob BP, Chen DC, Ramshaw B et al (2016) The SAGES manual of groin pain. Springer, Cham

    Google Scholar 

  10. 10.

    The HerniaSurge Group Hernia (2018) International guidelines for Groin Hernia Management. Hernia 22(1):1–65

    Article  Google Scholar 

  11. 11.

    Reinpold W (2017) Risk factor of chronic pain after inguinal hernia repair: a systemic review. Innov Surg Sci 2(2):61–68

    Google Scholar 

  12. 12.

    Slooter GD, Zwaans WAR, Perquin CW et al (2018) Laparoscopic mesh removal for otherwise intractable inguinal pain following endoscopic hernia repair is feasible, safe and may be effective in selected patients. Surg Endosc 32(3):1613–1619

    CAS  Article  Google Scholar 

  13. 13.

    Burcharth J, Pedersen M, Bisgaard T, et al. (2013) Nationwide prevalence of groin hernia repair. Burney RE, ed. PLoS One. 8(1):e54367

    CAS  Article  Google Scholar 

  14. 14.

    Dabbas N, Adams K, Pearson K, Royle G (2011) Frequency of abdominal wall hernias: is classical teaching out of date? JRSM Short Reports 2(1):1–6

    Article  Google Scholar 

  15. 15.

    Amid PK (2004) Radiologic images of meshoma a new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. Arch Surg 139(12):1297–1298

    Article  Google Scholar 

  16. 16.

    Society of American Gastrointestinal and Endoscopic Surgeons (2018) Risks of laparoscopic versus robotic-assisted mesh removal after inguinal hernia repair. https://www.sages.org/meetings/annual-meeting/abstracts-archive/risks-of-laparoscopic-versus-robotic-assisted-mesh-removal-after-inguinal-hernia-repair/. Accessed 23 Jan 2018

  17. 17.

    NHS England (2017) Mesh Oversight Group report. Leeds: NHS England. https://www.england.nhs.uk/wp-content/uploads/2017/07/mesh-oversight-group-report.pdf

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to S. Towfigh.

Ethics declarations

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.

Ethical approval

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.

Informed consent

Written informed consent was obtained by all patients enrolled prospectively in our hernia database.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sharma, R., Fadaee, N., Zarrinkhoo, E. et al. Why we remove mesh. Hernia 22, 953–959 (2018). https://doi.org/10.1007/s10029-018-1839-4

Download citation

Keywords

  • Mesh removal
  • Chronic pain
  • Laparoscopy
  • Robotic surgery
  • Mesh reaction
  • Mesh