In the United States, over 190,000 people had surgery to repair an incisional hernia in 2012. In at least half of those patients, hernia mesh was stitched into their abdomen to reinforce the abdominal wall.
Some types of hernia mesh have higher risks than others. In May 2016, Ethicon pulled Physiomesh off the market after two large studies in Germany and Denmark found higher rates of hernia recurrence and re-operation.
Because the long-term risks of hernia mesh are unknown, researchers decided to analyze outcomes for 3,242 patients in Denmark who had elective surgery to repair an incisional hernia between 2007 and 2010.
The good news is that hernia mesh appeared to help prevent hernias from recurring and needing another operation. Recurrence occurred in 17% of non-mesh repairs vs. 10-12% of patients who received hernia mesh implants.
Unfortunately, those benefits were offset by increasing rates of devastating mesh-related complications like bowel obstruction, bowel perforation, bleeding, and late abscess — especially in patients with larger-sized mesh.
After 5 years of follow-up, complications were at least 4X more likely in patients who received hernia mesh compared to patients who did not.
Only 0.8% of patients who did not receive hernia mesh developed a long-term complication. In comparison, mesh-related complications occurred after 3.7% of laparoscopic repairs and 5.6% of open repairs.
According to the authors of the study:
Mesh implantation prevented the need for subsequent re-operation in relatively few patients, suggesting that the benefits associated with the use of mesh are partially offset by long-term complications associated with its use.”
The authors cautioned that the study results may have been skewed by selection bias. Large hernias were more likely to be repaired with mesh, and small hernias with little chance of long-term side effects were more likely to be repaired without mesh.
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Source: Dunja Kokotovic, Thue Bisgaard, Frederik Helgstrand. Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair. JAMA, 2016.