In hernia surgery such as is carried out in Irish 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.
√ Smaller scar after operation
– The preferred method in Irish 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)
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:
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.
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.
Eventhough 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.
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.
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.
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.
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.
In the past, all hernias were repaired without a mesh. This often led to a high percentage of recurrences among less experienced surgeons. To successfully execute a hernia operation without mesh, a surgeon perform the operation often. After a few studies showed that the risk of recurrent inguinal hernias was lower after the use of a plastic mesh, doctors began to specialise in these methods. The surgical methods with mesh are easier to perform and became the ‘gold standard’ of hernia surgery worldwide in no time. Nowadays surgeons in training are only taught the new operation methods with mesh.
Back then, nothing was known about the potential risk of chronic pain from the meshes. Even though we now see the potential harmful effects that the meshes have on patients, surgeons hold on to research about a lower recurrence. Without even looking at your situation, a standard laparoscopic operation is scheduled for you now if you have a hernia. We think differently and look at the personal desires of our patients before we recommend a certain operation method.
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?
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.