As knowledge about the problems with the hernia mesh becomes more widespread, an increasing number of patients facing hernia surgery are doing their own due diligence and asking their surgeons about different solutions. The fact is that there are alternatives to the hernia mesh. Why aren't these alternatives more widely known?
The hernia mesh was first developed in the early 1960s by Dr. Irving L. Lichtenstein (1920-2000). Before that time, hernia surgery was a fairly complicated procedure requiring hospitalization and extended recovery time. Under general anesthesia, an incision was made into the patient's abdomen and the surgeon would re-join the torn ends together with sutures.
Complete recovery could take as long as ten weeks, during which time the patient was unable to engage in most physical activities. Lichtenstein believed that general anesthesia and such extended recovery times were unnecessary. During the 1950s, he did experiments on animals, and eventually on human subjects. His research led to the development of the polypropylene mesh that subsequently became the “gold standard” in hernia treatment.
Twenty-five years ago, the medical community believed that the rate of chronic pain among patients receiving a hernia mesh was no more than 10%, due to the introduction of lightweight material and laparoscopic surgical techniques. However, recent research has found that while patients suffer less pain during the immediate post-operative period, 25% of patients undergoing laparoscopic hernia repair with the mesh suffer chronic pain two years after the procedure. Aside from that, the recurrence rate with the hernia mesh can be as much as 15%.
While this has been attributed to surgeon error, Dr. Hari K. Ondiveeran, presenting at the 2016 meeting of the International Hernia Collaboration, acknowledged that much of it is due to the mesh eroding into surrounding tissues. This is not unlike the problem patients experienced with the pelvic mesh, a similar product.
Other complications result from reactions to the polypropylene material, which create oxidative stress and can trigger an immune response from white blood cells. According to Dr. Ondiveeran, “This may explain some of the chronic fatigue syndrome and other features patients have anecdotally reported, such as rashes, joint pain and just not feeling well.”
So – what are the alternatives?
One of them, developed during the Second World War, is known as the Shouldice Technique (named for the Canadian hospital where it was first used). Performed under local anesthesia, this operation employs steel wires, has an extremely low recurrence rate, requires minimal recovery time – and is very inexpensive.
This begs the question of why, if this technique is more effective, less harmful and so economical, why isn't it being done more? Part of it is the difficulty; relatively few surgeons have training in this surgical method. However, a patient's body weight also comes into the equation. Patients who are severely overweight are not good candidates for the Shouldice Technique.
Another alternative is the “component separation technique” (CST). This surgery takes longer (about two hours), and uses the patient's own tissues to repair the injury. However, while this is effective for large abdominal wall hernias, it is not considered suitable for groin or inguinal hernias.
The bottom line, however, is that regardless of factors such as recovery time, complexity and cost, there is no price tag on one's long-term health. Patients facing hernia surgery owe it to themselves to learn as much as possible about alternatives to the hernia mesh before signing a consent form.