Hernia repairs
With or without mesh?

The standard procedure in the UK
And why BioHernia is different

In hernia surgery such as is carried out in British hospitals, a plastic mesh is used during the operation (as shown on the right hand side). These meshes are used to assist the recovery of the hernia, but remain in your body for the rest of your life. In the long run, the meshes can cause pain and discomfort. That’s why at BioHernia we prefer an operation without a mesh, because we believe that the body is strong enough to support the recovery of the hernia.

hernia mesh

A hernia mesh as is commonly used in hernia surgery

Pros and cons of each operation method

Open repair WITHOUT the use of mesh

√ No plastic material in your body

√ Sustainable in the long term

√ Low risk of a recurrence, 98% success rate ⁽¹⁾

√ Best method for women ⁽¹³⁾

– Not available in the UK

– Succes only guaranteed with experienced surgeons

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Open repair WITH the use of mesh

√ The mesh is placed manually by means of a small cut of 3-5cm

– Mesh is easier to remove in case of pain

– The mesh is placed over the hernia

X Chronic pain in 11-37% of cases ^{(2) (3) (4) (5) (6) (7) (8) (9)}

X Higher risk of numbness and pain after surgery ⁽¹⁰⁾

Laparoscopic repair WITH the use of mesh

√ Smaller scar after operation

– The preferred method in UK hospitals and private clinics

X The hernia is not repaired, but is covered with a mesh from the inside

X Risk of damage to internal organs during surgery

X The mesh is difficult to remove in case of pain (often only partially removable)

X Chronic pain in 11-37% of cases ^{(2) (3) (4) (5) (6) (7) (8) (9)}

Own tissue vs. plastic meshes

The human body will always tolerate its own natural tissues, and hernia operations are no exception. The abdominal wall is a complex system of several levels, which are made up of different layers of muscle tissue and fascia (connective tissue). It is designed to contract, stretch and endure tension so that you can bend and turn your upper body. Anything that restricts or disturbs the normal abdominal movement causes unnatural and often harmful force in that part of the body.

> Possible complications due to hernia mesh

Rejection of the mesh

The plastic meshes are not made of a natural substance, so the body constantly tries to defend itself against it. The natural reaction of the body is to get rid of the mesh.

Movement of the mesh

Even though the mesh is anchored in place (sewn or glued) it can come loose and move in your groin or abdominal area. The mesh can also fold, or move as the body tries to repel the mesh.

Shrinkage of the mesh

The succes of hernia repairs with mesh depends on the growth of scar tissue through the mesh. This solidifies the position of the mesh inside the body. However, as the scar tissue shrinks, so does the mesh, creating a hard substance which could entrap nerves.

Nature of the mesh

After some time, the mesh hardens and becomes less flexible. Meshes can also attach themselves to surrounding tissue, nerves and organs. This applies in particular to meshes that have been placed by means of a laparoscopic operation, because they are placed on the inside of the abdominal cavity.

Irritation of nerves

All meshes, regardless of their weight or thickness, have fibers that form a grid of holes or pores. During the normal healing process, nerves grow back and grow through these pores. They can then become trapped in the structure of the mesh, which in turn can release pain signals to the brain leading to chronic pain sensation.

Allergic reaction to mesh coating

For a better adhesion by the tissue in the human body, mesh manufacturers started to add a protective layer around hernia meshes a few years ago. This protective layer may induce an allergic reaction in some people.

Long term effects on the human body
What happens with hernia meshes after 30+ years?

Short answer: That is not yet known

Although operation methods with plastic meshes have existed for more than 50 years, there is still much unclear about the long-term effect of plastic mesh on the human body. Nevertheless, we can conclude that the mesh is often the instigator of many problems in patients with chronic pain. The body often has difficulty adjusting to the mesh, which in the long term can lead to:

Infection
Skin rashes and / or sensitivity
Pain in joints
Pain during sex
Pain in leg, groin and / or testicle(s)
Abnormal sweating (eg. night sweat)

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Why are hernias only treated with mesh in the UK?

In the past, no mesh was used to repair hernias. This frequently resulted in a high rate of recurrence among less experienced surgeons. A surgeon must perform hernia operations without mesh on a regular basis in order to be successful. After a few studies demonstrated that using a plastic mesh reduced the likelihood of recurring inguinal hernias, surgeons began to specialize in these techniques. Mesh-based surgical procedures are simpler to perform and quickly became the “gold standard” of hernia surgery worldwide. Surgeons in training are now only taught the latest mesh-based surgery procedures.

Nothing was known at the time regarding the potential risk of chronic pain caused by the meshes. Despite the fact that we can clearly witness the potentially negative consequences of the meshes on patients, surgeons continue to focus their research on lower recurrence rates. Today, if you have a hernia, you have a routine laparoscopic operation scheduled for you without even looking at your circumstances. Before recommending a specific surgical procedure, we like to consider all options and consider our patients’ own preferences.

Comparing hernia surgeons

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Conflict of interest?

The working group of the European Hernia Society creates the European guidelines for hernia surgery. Almost all hospitals and clinics in Europe base their hernia surgery policy on these guidelines. The foreword to the guidelines contains the following text:

All members received a grant from Johnson & Johnson and Bard for travel and meeting expenses. The funding sponsors had no influence on the guidelines’ content, or on the statements and recommendations. They are based purely on the best available evidence and expert opinion. All HerniaSurge members are active in the scientific community. An additional course was given to all involved members to guarantee unbiased literature searches and review.

As you can see the writers of the guidelines are sponsored by some of the biggest manufacturers of hernia meshes. This does not automatically mean that the doctors are biased when writing the guidelines (something they also contradict). Yet as an outsider, the question remains:

Would a manufacturer of meshes sponsor the guidelines, if it would advice AGAINST the use of meshes in hernia surgery?

Which method should I choose?

Our advice:

Choose a hernia operation without mesh by an experienced surgeon.

We hope that this information has given you a better idea of the different operating methods. If you are looking for a hernia operation with a rapid recovery and minimal risk in the long term, consider having one of our surgeons treat you. Keep in mind that an inguinal hernia operation without mesh is only as good as the surgeon performing it.

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