Mesh hernia repair: more complications than with open surgery?

One in 10 people will develop a hernia. The most common treatment involves a mesh repair. Victoria Derbyshire reported recently on the BBC that there have been between 90,000 and 100,000 hernia mesh operations in England each year since 2011-12, and that some surgeons believe the complication rate is 12-30% – which means between 68,000 and 170,000 patients could have been adversely affected in the past six years. Mesh has been used for hernia repairs since the 1990s, so the total number who have experienced complications since its introduction is thought to be much higher. 

A Royal College of Surgeons spokesperson replied:  “It is clearly tragic if even a single patient suffers complications from any type of surgery, not just hernia operations. Unfortunately the nature of surgery in general, not just mesh surgery, carries with it an inherent risk of complications which surgeons will always seek to assess, and will discuss with patients according to their individual clinical circumstances before surgery takes place.

“It is important to make a distinction between groin hernia, the most commonly carried out repair and other forms of abdominal wall repair where a hernia has arisen, for example, in an incision or scar after a previous operation. These are more difficult and the complications rates are much higher.

“A recent study found that both mesh and non-mesh hernia repairs were effective for patients and are not associated with different rates of chronic pain. The Victoria Derbyshire programme is right to point out how a minority of hernia mesh operations are associated with complications. However, it is also important to stress that such complications range dramatically from minor and correctable irritations to the more serious complications highlighted in its programme. Complications can also occur with non-mesh hernia repairs, and by not operating on a hernia at all. It is extremely important that patients are given the full picture by surgeons, regulators, and the media.

“There have already been a number of scientific studies looking at the use of different types of mesh in hernia and we should continue to review the evidence and patients’ experiences to make sure the right advice is given and the right action is taken. Along with the regulatory authorities, we will continue to listen to patients’ experiences. Patients suffering complications or pain need help, not silence. There must also be an ongoing review of the data to make sure that previous studies have not missed any serious, widespread issue. It remains vital that surgeons continue to make patients aware of all the possible side effects associated with performing a hernia repair.”

What are your views? Do you believe that mesh hernia repair is associated with a higher complication rate than the more traditional open hernia repair?

Comments (4) Add yours ↓
  1. Charles Imber Consultant Surgeon

    There is now no doubt that mesh hernia repairs can result in extremely tragic complications for patients, especially if the wrong surgical technique is utilised with potentially with the wrong type of mesh by an inexperienced surgeon. Conversely there is very convincing evidence from rigorously conducted clinical studies that the long term outcome of hernia repair can be improved dramatically with the correct “tension free” mesh technique.

    This is a complex area and my advice to patients is to be well informed and to choose a surgical team with a large experience, and a solid track record. They should be happy to discuss with you both the medical evidence for the technique they are suggesting, and also their own outcome data as a unit, or as an independent surgeon. At the initial meeting with the specialist, and again prior to the operation there has to be time for a detailed discussion of all the potential risks so you are able to give informed consent prior to proceeding.

    October 8, 2018 Reply
  2. Mr Roland Morley Consultant Urologist

    Agree with above comments. However , the evidence available suggests the use of mesh wherever used is safe and reliable. However, patients need to be be fully informed, with local outcome data, and full discussion of the alternatives including doing nothing

    October 9, 2018 Reply
  3. Peter Rimington Consultant Urologist

    There is now a two year moratorium on the use of any tape for male or female incontinence. These tapes are not hugely different from the mesh we use for hernia repairs. And as is suggested above there are many types of hernia, many types of repair techniques and many types of mesh or biological substitutes available for hernia repair. Much like the hype over steam treatment for BPH, this type of broad blanket coverage of “complications” form surgery is unhelpful to the public and in this case alarming.
    One would hope with all the regulation of practice that there are now no surgeons who will pick up a new product or technique from a journal article and without further ado, just “have a go”!
    In any surgical procedure, full knowledge of the patient and their expectations, full knowledge of the anatomy, full knowledge of the possible complications and how to avoid them should be brought to bear to provide the best possible outcome which should result in an improved quality of life.

    October 10, 2018 Reply
  4. Krishna Patil Consultant Urologist

    Hernias are of dirrerent shape, sizes and complexities. Like any surgical procedures they should be left to the specialist of the craft. There is place for the mesh in certain hernias that should be decided by the speciliast and patient should be fully informed about its pros & Cons. If the patient’s own tissues are strong enough for repair that is the best way to repair without any foreign material. If the native tissues are not good enough then using mesh of appropriate type by experienced surgeon after full discussion with the patient is appropriate. Chosen wisely patient’s will be benifitted and surgeons will be satisfied with their outcomes. A Win- Win situation

    October 14, 2018 Reply

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