Well, Here’s Another Fine Mesh We’ve Gotten Into! Part 1

Laurel & Hardy “Another Nice Mess!”

I suppose I’m dating myself by massaging a quote from Oliver Hardy of the Laurel & Hardy duo from the 1930’s.  When it comes to hernia surgery, the use of mesh is almost universal, and it occasionally will create quite a “mess”.  But for the most part, mesh is a very useful resource for durable repair of a variety of hernias.

If one were to rely solely on information you might gather from watching daytime TV, you would quickly conclude that anyone who used mesh to fix a hernia must be crazy, given all the plaintiff attorney ads encouraging any patient who has had a hernia fixed with mesh to call in and find out how much a lawsuit might be worth. And yet, of the more than a million hernia repairs annually in the US, I would estimate that mesh is used in over 90%.  And in most cases, these patients do very well, with a repair that’s likely to be more durable than if mesh had not been used.

First Use of Mesh

Mesh for hernias dates back to the 1950s, with the introduction of Marlex mesh, a woven polypropylene product.  Other types of mesh had been tried unsuccessfully even as early as the 1890’s, but they were made from materials like cotton or silk, and there were just too many complications. The use of any type of mesh came to be perceived as a “foreign body” that was inherently a bad idea.  And so it took some decades before the use of polypropylene mesh was widely considered to be not only an acceptable option but perhaps the “standard of care” in hernia repairs.

Benefits of Mesh

So why would we want to use mesh in the first place?  The primary reason is to reduce the possibility of a recurrence.  Without the use of mesh, one must rely on suturing the native tissues in such a way as to close the defect, or area of weakness.  There are probably 50 variations described in the surgical literature, and most of them are known by the name of the surgeon who initially reported it.  The most familiar names for suture only repairs are the Halsted, the McVay, the Bassini, and the Shouldice.  It’s a general truth that, the more options available for how to approach a surgical problem, the greater the likelihood that none of them is ideal.  Surgical lure is rife with stories of patients having a suture only hernia repair under anesthesia, and upon awakening, an audible “pop-pop-pop” heralds the immediate breaking of the sutures just placed for the repair, with the hernia bulge stubbornly rejecting the surgeon’s efforts.

That’s not to say that there is no good “suture only” repair, however, we’re always looking for an option that will tilt the odds in our favor for a repair that will never break down. And the prudent use of mesh often fits the bill. Furthermore, as the use of laparoscopy and robotics has increased for hernia repairs, the use of some type of mesh for the repair is almost absolutely required.

In Part 2, I’ll give some background about why so many plaintiff’s attorneys are advertising about the evils of mesh.

Here is a link to the information on our website about hernias.