Mesh vs. No MeshShomaf Nakhjo, DO Advanced Minimally Invasive Surgery

The human body consistently demonstrates a preference for its own natural tissues, and this principle holds true in the context of hernia surgery. The abdominal wall, a complex structure composed of layers of muscle and fascia designed to flex and bear tension for bodily movement, becomes strained when subjected to anything disrupting its natural mobility.

Historically, non-mesh hernia repairs have been considered the gold standard for over a century, offering exceptional results in the hands of skilled surgeons who specialize in natural tissue techniques. However, not all practitioners were adept at these methods, resulting in variable recurrence rates. The introduction of synthetic mesh in the mid-20th century seemed promising, as it reduced overall recurrence rates when used by surgeons who didn't specialize in hernia repair. However, it came with unforeseen consequences, as its long-term effects remained unexplored.

Today, the debate over the benefits and risks of using mesh in hernia repair remains contentious. Ongoing research is delving into the intricate interactions between mesh and the human body. Despite the extensive literature on the topic, the information can be contradictory due to commercial interests conflicting with scientific inquiry.

After 120 years of natural-tissue repair and 30 years of established mesh repairs, it's evident that all techniques yield roughly equivalent hernia recurrence rates when performed by non-specialist surgeons. Mesh has reduced recurrence rates to approximately 5% for these practitioners. However, specialized hernia centers like ours that focus on natural-tissue inguinal hernia repair have consistently achieved even better outcomes with recurrence rates of less than 1%.

Mesh usage can be associated with significant complications:

1. Infection: Addressing infection can require long-term antibiotics and possibly complicated removal of mesh if antibiotics fail.
2. Foreign body reaction: The body attempts to eliminate the foreign mesh.
3. Mesh movement: Mesh can become loose, migrate, fold, or entrap nerves.
4. Mesh shrinkage: As scar tissue shrinks, it contracts the mesh, forming a hardened, nerve-embedded mass.
5. Mesh material: Mesh fibers can trap nerves and harden over time, leading to adhesion to surrounding tissues, nerves, and organs.

These complications can result in chronic pain, sexual issues, severe infections, hernia recurrence, and complex mesh removal surgeries. Natural tissue hernia repair carries none of these risks, as the scar tissue left behind poses no danger.

While mesh has a role in hernia surgery when the patient's own tissues are insufficient to support repair, its use should be driven by surgical necessity. A thorough assessment of the patient's tissue and a comprehensive evaluation of the risks and benefits of mesh usage should guide this decision. Mesh should never be chosen for convenience, cost-effectiveness, or due to a lack of expertise in natural-tissue techniques. To learn more, call Advanced Minimally Invasive Surgery at (973) 383-2222 to schedule a consultation.