Hernias are a common health problem, with more than one million hernia repairs performed each year in the United States. Approximately 800,000 are done to fix hernias in the groin, and the rest are for other types of hernias in the abdomen.
A hernia occurs when there is a weakness, or opening, in the muscle and connective tissue that surround the belly area. Patients may feel a slight bulge, discomfort, or pressure as organs push out through this weakness.
However, many patients may have this opening/weakness even if organs aren’t actively pushing through. Over time, this bulge or area of weakness can grow in size. Occasionally, intestine can become trapped in the hernia, which requires emergency medical attention.
Not only are there different kinds of hernias, different methods and surgical approaches are currently used to repair them. Today, a "mesh" product is commonly used in hernia repairs.
Hernia mesh has been around for over 50 years, and earlier versions of it have long been regarded as the "gold standard" to use in repairs. However, some websites today make claims that mesh is unsafe, and that repairing hernias without mesh is better.
Here, Andrew T. Bates, MD, director of the Stony Brook Comprehensive Hernia Center, answers frequently asked questions about hernias and the mesh used to repair them.
Q: Must a hernia be repaired?
A: All hernias have the potential for trapping abdominal contents, such as intestine, which is why we typically recommend repair in patients who are acceptable surgical candidates.
Not all hernias, though, are the same, and so we often employ a different approach based on the location of the hernia, such as groin or abdominal wall.
In the case of groin (inguinal) hernias, surgeons in the recent past advocated for "watchful waiting" for hernias that were not particularly bothersome.
However, based on newer research, we now know that a large percentage of these hernias will later become bothersome and require repair, possibly emergent, and therefore we advocate for repair.
Q: Does hernia repair require mesh?
A: Not necessarily, but usually. In the right patients, some groin hernias can be repaired without mesh and still have acceptable success rates. Additionally, some small hernias at the belly button can be repaired with suture alone. Most repairs, though, do utilize prosthetic mesh to achieve a successful repair.
When patient care is seamless as done here, outcomes improve.
Q: What exactly is mesh?
A: The term "mesh" is used to describe a flat sheet of prosthetic material that is used to cover, or "patch," a hernia.
Q: Are there different kinds of mesh? How are they different?
A: There is a sizable industry devoted to a large array of hernia meshes. Some are made of various plastics; some are made of biologic materials. Some are permanent and some are designed to degrade over time.
The most common type of mesh is made of a plastic material and closely resembles a window screen in appearance. Some meshes are also made with protective coatings that allow them to be placed in the abdomen near the abdominal organs.
Q: What are the advantages of using mesh in hernia repair?
A: Decades ago, hernia repairs were performed by simply suturing the hernia closed. For some types of hernias, this repair resulted in 25-50% of hernias later returning. Mesh changed that. By using mesh, the chance of hernia recurrence dropped to the low single-digits.
Q: Does mesh cause problems in hernia repair?
A: In most cases, using mesh is the acceptable standard of care. However, there can certainly be complications related to the mesh.
Q: What specific problems are associated with mesh?
A: Mesh is a foreign body that your body incorporates to help strengthen the repair. However, being a foreign body, it can also become infected if it becomes contaminated either at the time of surgery or later. This may require mesh removal.
Mesh placed inside the abdomen can also lead to scar tissue, or adhesion, formation that can predispose patients to bowel obstruction down the road.
However, all patients who have had surgery in the abdomen also form these adhesions, so this is not a problem specific to the mesh itself.
Most brands and models of mesh have excellent safety profiles.
Q: Why are mesh companies being sued now?
A: There are many sizes and shapes of mesh, all with different strengths and flexibility. Some lightweight meshes were removed from the market after cases of breakage were reported, but most brands and models of mesh have excellent safety profiles.
There were also other surgeries that used mesh, such as vaginal sling surgery, which regrettably had a high complication rate but is a completely different surgery altogether. In the vast majority of cases, complications are the result of surgical technique and not the mesh used.
Q: When mesh is required, is traditional open surgery or minimally invasive laparoscopic surgery better?
A: This is impossible to answer because every patient is different and every hernia is different. What is right for one patient may not be best for another.
For this reason, an individualized approach is key. What our research has shown is that surgeon experience with a particular technique is the most important factor, whether it is laparoscopic or open.
Q: What do the latest major scientific studies say about mesh? Is there a consensus?
A: In most hernias, mesh is the standard of care. This is what the science clearly indicates, and it is backed up by well-designed clinical trials as well as retrospective studies.
Q: What is the advantage of having a hernia repair with mesh done at Stony Brook?
A: The advantage is two-fold: academic and comprehensive. By having your repair at an academic institution like Stony Brook Medicine, you take advantage of a surgery faculty that utilizes the newest techniques and, in many cases, is driving the field forward.
Our surgeons present their work at national societies, and have published countless articles about their research projects in respected surgical journals. As academic surgeons, we are committed to making surgery better.
"Comprehensive" means that all of your needs are addressed under one roof, delivered by a collaborative team dedicated to excellent patient outcomes.
Our center includes open, laparoscopic, and robotic surgery specialists. We work closely with plastic surgeons for those patients that may require complex repair.
We have also integrated pain management specialists into our treatment protocols for those patients suffering from debilitating hernia-related pain. When patient care is seamless as done here at Stony Brook, outcomes improve.
|The Stony Brook Comprehensive Hernia Center — distinguished by Stony Brook Medicine's multidisciplinary approach to patient care — offers a wide range of options to diagnose and treat most types of hernias. Our experienced hernia experts work together as a team to design the best treatment plan possible so patients can get back quickly to their normal lives and daily activities. Patients can see our hernia specialists at our Suffolk County offices in Centereach, East Setauket, Smithtown, and Commack.|