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?