Is hernia mesh necessary? What everyone needs to know about abdominal mesh for groin hernia.

Before I write blog posts for AlivenHealthy, I always do keyword research to try to find the best search terms that will help readers find my posts in search engines when they need them. Doing keyword research for health-related issues is always interesting because it can tell me a lot about the trends. For example, while researching keywords for this post, I first researched the words “hernia surgery”. According to the results, few people do a Google search for “hernia surgery”. On the other hand, a LOT of people search for the words, “No Mesh Hernia Surgery”. Why is that?

I have a theory…

When I was about 5 years old, I thought it would be fun to lift weights like my dad did. Unfortunately, in doing so, I ended up with an inguinal hernia. It took some time for my parents to realize that I had the hernia and then, when they took me to the doctor, he refused to diagnose me. I had chronic urinary tract infections for a year before he finally admitted that I needed surgery. This was back in the early 1980’s and, once diagnosed, the surgery was quick and simple. They used general anesthesia, made an incision in my lower abdomen, sewed up the abdominal muscles with stitches, and then sent me back to recovery. Thirty-five years later, after several years of running marathons, training for a black belt in Taekwondo, multiple pregnancies, a C-section surgery, and lifting furniture for 22 different relocations across the country, the incision is still holding strong. I had this traditional surgical procedure back in the 1980’s and my body healed without issue. But today, most doctors don’t even offer traditional hernia surgery to their patients. Instead, doctors offer hernia surgery that uses a mesh “fabric” to close the hole in the abdomen. Many patients don’t realize that they have a choice about whether to get mesh or not until after they’ve had the mesh put into place and it starts to cause problems.

Then, patients (LOTS of patients, apparently) will, based on my keyword research, start searching on Google for “No Mesh Hernia Surgery”.

But I’m hoping this article will be found and read by people who may have just realized that they need hernia repair or people who think that they might have a hernia, but aren’t sure. I’d like to educate the people who haven’t already had the mesh installed in their bodies in the hopes that they’ll realize that they have options, and that the hernia mesh isn’t necessarily the best one.

I’d never even heard about hernia mesh until I traveled to Merida, Mexico in the Yucatan about 5 years ago for an extended trip abroad. One weekend, my family and I did an outbound trip to the ruins in Uxmal. This is one of the bigger tourist destinations in the Yucatan, so there were lots of people walking around at the ruins surveying the big pyramid and the various other structures. While we were there, I had to walk all the way back to the entrance to use the lady’s room and on my way back to the family from the restrooms, I saw a man standing at the pyramids taking photos with his mobile phone and holding his groin at the same time. He was not just scratching or arranging something. The man had his hand on his groin in a very public and unabashed way.

When I got back to my husband I said, “Did you see the guy who was holding his crotch?”

“Yep…What do you think that’s all about?” He asked me.

“I don’t know.”

We decided that we should avoid the man with his hand on his crotch and continued with the day.

When afternoon came and it was time to go back to Merida, we got in a combi van in the parking lot. Sometimes you have to wait for combis to fill before they’ll leave, but our van was almost full because there were three of us traveling together. The driver left to go see if he could find at least one other person to fill his van. When the driver returned, he brought the guy who’d been holding his crotch with him.

The driver opened the side door and the man asked my husband to move to one of the seats in the back so that he could stretch out his leg. “I have a hernia.” He said. My husband readily moved to the back and the man started telling me about how he wanted to have hernia repair surgery done, but he couldn’t seem to find a doctor who was willing to do the procedure without the mesh. I felt bad that I’d avoided him all day. His story helped me and my loved ones later. It was a blessing that he’d crawled into the van with us that day.

He told me that he’d already flown to the U.S. from Brazil once to try to find a doctor who would perform a no mesh hernia surgery, but he couldn’t find one. He told me (and research later confirmed) that the hernia mesh caused a variety of problems and side effects including:

• Bowel obstructions
• Severe infections
• Adhesions
• Leg pain or testicular pain
• Rashes
• Testicular removal
• Digestive issues like chronic constipation (a sign of bowel obstruction), diarrhea, or nausea
• Fistula
• Seroma
• Dental issues
• Severe headaches
• Fever
• Autoimmune disorders
• Neurological changes
• Renal failure
• Liver abnormalities
• Inflammation
• Joint problems
• Abnormal sweating
• Mesh migration or “meshoma” –the contracture or bunching-up of the mesh inside the body to become a hard and tumor-like  [1] [9] [5]

The mesh used in hernia repair surgery may be made out of a variety different substances, so the exact causes of the problems vary. But many of the hernia mesh products contain polypropylene, a plastic product that’s used to make things like kitchen utensils, athletic clothing, rugs, and car batteries [2]. It was never meant to be used as a permanent structure inside the body [3]. Despite the fact that it’s been prohibited for use inside the body, many manufacturers continue to put polypropylene in hernia mesh. One study I read says that hernia mesh causes “intense scarring”, which is “desirable for hernia repair” (according to the study, that is). But intense scarring can cause adhesions and other issues with the positioning of internal organs inside the body [5][7]. I was taught that most surgical procedures aim to keep scarring to a minimum because scarring and adhesions, especially scarring that occurs in the abdomen, can cause visceral organ damage [8]. Keeping scarring to a minimum is usually a goal of surgery—that is, unless the pharmaceutical companies can convince doctors, and their patients to believe that sometimes, scarring is desirable. Here’s a quick quote about scarring that I found at MedicineNet.com:

“Abdominal surgery is the most frequent cause of abdominal adhesions. Almost everyone who undergoes abdominal surgery develops adhesions; however, the risk is greater after operations on the lower abdomen and pelvis, including bowel and gynecological surgery.”

Adhesions can cause some serious and life threatening issues as well as extreme pain. So scarring, which leads to adhesions, is something to consider as you take in all the information about hernia repair. Whenever you’re faced with having to have surgery, think about all the gimmicks that might be profitable for pharmaceutical companies—all the high-tech stuff that might make your procedure more profitable. Then, imagine you’re being “sold” on the procedure like you might be sold a “lemon” at the used car lot. Ask yourself if you’re being sold a “lemon” in terms of your health care and then seek out what you really want because it’s out there. YOU CAN FIND IT.

When this man at Uxmal disembarked from the combi in Merida, he was still searching for a surgeon somewhere in the world who would do a hernia surgery without the mesh. I gave him my small town doctor’s name and number and I hope he called her. She’s the one who referred my dad to the doctor in North Platte, NE who did his no mesh hernia repair.

When I found out that my dad had to have hernia surgery, I warned him that he needed to seek out a doctor who would do the procedure sans the mesh and that it might be a difficult find. He decided to go ahead and do the consultation with the doctor in North Platte, Dr. Curtis at Great Plains Regional Medical Center, but I’d located a hospital in Canada, the Shouldice Hospital in Ontario, that does no mesh hernia repair, so he had options. Dad really didn’t want to have to travel all the way from Nebraska to Canada for the procedure, but it was nice to know that there was a place that he could go if he couldn’t track down a doctor in our area who would be willing to do a traditional hernia surgery. Sometimes, it can be helpful to have an ace in your back pocket. When the surgeon says, “No one will do a no mesh hernia surgery for you.” You can say, “Yes they will and I’ll walk out of here right now, if you aren’t one of them.”

My dad went to a consultation with a doctor in North Platte, NE about his hernia and put his foot down in regard to the mesh. The physician’s assistant was resistant to the idea of a no mesh hernia surgery, but when the doctor finally came in, he was willing to entertain it. He was a doctor who’d been trained outside of the United States so he was more open-minded about the possibilities. He’d obviously been trained in the Shouldice Method of Hernia Repair while he was in residency. Many U.S. doctors aren’t even trained to be able to do a traditional, suture-only hernia surgery because Big Pharma makes more money when surgeons use mesh. Not training doctors makes it easier Big Pharma to sell more of their product (the mesh). They don’t feel competent enough to do a no mesh surgery because they’ve never done it. And they believe that the sutures won’t hold (not because it's true, but because this is what they’ve been taught). My dad was at a relatively small hospital in a city with only 25,000 residents. Smaller hospitals host a different political climate because many of their doctors travel back and forth from a “home base” at bigger hospitals to rural hospitals. This can be problematic, but it can also foster diversity. Keep this in mind if you’re in need of hernia repair and you’re in search of someone nearby in the U.S. who would do the procedure without the mesh. If you’re in a big city and you can’t find a doctor, try contacting hospitals in nearby cities, perhaps even smaller cities with smaller, less high-tech hospitals. Ask for a surgeon who performs hernia surgery and then ask those doctors if they’d consider doing a no mesh hernia surgery. You may have to make several phone calls and face rejection. Be prepared for that. Many of them will tell you that they’ll “consider” it, but that they won’t promise anything until they do an in-person consultation with you. That’s just legalese. They’re afraid you’ll sue them if they promise you a no mesh surgery and then they don’t deliver because they think your incision will be too large or unstable for some reason. My advice is to go to the consultation if you find a doctor who will “consider it”, but make sure they know the distance you’ll be traveling for the appointment so that they don’t waste your time if they aren’t really going to consider it.

Many of the citations I’ve made for this post leave a lot of room for interpretation and speculation. I need to explain this before I continue. A WebMD article that I cite in my reference section is actually Pro-Mesh, but the article uses linguistic tricks to arrive a positive assessment of hernia mesh. Another article, a scientific case study, says that mesh should be used for large herniations, but the study is about a woman whose mesh “migrated” into her lower large intestine over the course of 14 years. She had to live with it there. It couldn’t be removed without threatening her life. Still, the study ends by extolling the virtues of using mesh for large hernias. But WAIT. I had a Cesarean section 16 years ago. A C-section is a HUGE incision made in the abdominal wall. I had an infant removed from my belly. And I’ve never had a problem with this incision, which was closed with suturing. My mother had a C-section 40 years ago. She also, has NEVER HAD PROBLEMS with this incision. As an extremely active woman who does things like Taekwondo and Parkour, regular heavy lifting, and construction projects, I know that I’ve taxed my large incision to the max. And I had a hernia surgery as a little girl too. The two incisions overlap, in fact. But still, I’ve never had a problem with “hernia recurrence”. And if I did, I would run from any doctor who tried to force me to do have a surgery to put hernia mesh in place.

These days, a no mesh hernia surgery can be done with only local anesthetic and a sedative, which is much less risky than the general anesthesia I received as a little girl. The use of general anesthesia is a major risk factor in all surgical procedures. If you can have the surgery done without it, do so. And don’t be afraid to ask your surgeon about using just local anesthetic and sedation rather than general anesthesia. U.S. patients have the notion that doctors know everything and that they’ll think of everything…especially big stuff like using local anesthesia rather than general anesthesia. Not so. And be glad if you find a doctor who’s willing to admit that they left a stone unturned, especially if they’re willing to listen to you when you make note of it. That’s a rare find.

Doctors, after all, are in a sticky situation here in the United States. The ones who think creatively about their patients and treatments tend to be targeted in a negative way by Big Pharma. The ones who follow the straight-and-narrow as laid out and propagated by the American Medical Association (AMA) are targeted by patients when treatments like hernia mesh get them into trouble. Most doctors simply don’t know that their treatments are hurting patients. They’re doing what they’ve been taught and trusting agencies like the FDA and the AMA to make sure that the treatments they offer are beneficial and not harmful. It’s misguided, but well-intentioned. Too bad the road to hell (at least in the US) is paved with good intentions.

Manufacturers of hernia mesh have funded studies (a conflict of interest) to show that the mesh lowers hernia recurrence [4] (by creating a flawed study designed to get these specific results). The studies, of course, were funded to serve the manufacturer’s corporate interests (bigger profits). Doctors read these studies though and then earnestly believe that it’s in their patients’ best interests to use the mesh. And let me add another layer to the medical research paradigm: many of the doctors listed as “researchers” on these hernia mesh studies did not participate in the research at all. Rather, pharmaceutical reps from companies that developed the hernia mesh products go to doctors and ask for them to put their names on these studies. As a doctor, having your name on research can boost business as well as status. They read the study and then sign up to have their names put on the byline. Consumers see the word “research” and they imagine a doctor in a white lab coat doing the study in the name of unbiased-science and they buy into whatever the study says.

But if you search long enough, you’ll start finding stories about real people who were sold on hernia mesh [9]. The research may say one thing, but real people are having a different experience. And it’s important that patients know and understand the hernia mesh issue so they can make the best decision for themselves.

In this study, reviewed by WebMD in regard to hernia mesh, the problem of infection and hernia mesh is mentioned, but it’s importance is somewhat diminished using a linguistic trick:

“The other, less invasive procedure, uses stitches alone. Because of the smaller incision, the odds of infection are lower, but there is a greater risk of recurrence, Hodgett noted.”

The words “less invasive” and “minimally invasive” are buzzwords that are often used as a selling point for patients waiting in line for surgery (see this story about my mom and aneurysm coiling for an example of how the buzzwords are used hypocritically). But hernia mesh repair is an exception according to the quote. Even though the risk of infection is higher and even though the hernia mesh repair surgery requires a bigger incision than the Shouldice Method of just using sutures---even though the hernia mesh surgery requires a longer recovery, AND patients risk a higher rate of infection (this article didn’t note any of the other common side effects of hernia mesh) the risk of recurrence seems to take precedence. Using the word “BUT” in a sentence like this is like making a mental U-Turn. A lot of people follow the “BUT” without thinking about it. But they should think about it. Without the “BUT”, the sentence reads as such:

The other, less invasive procedure uses stitches alone. Because of the smaller incision, the odds of infection are lower.

The “other, less invasive procedure” in this case is the Shouldice Method or any of the other suture-only methods used to repair hernias (McVay Repair, Desarda Repair, and Bassini Repair are all examples of this). And remember, individuals like me, who had the Shouldice Method to repair their hernias, have had a 99.5% success rate. Only 0.5% of patients have their hernias recur. AND plain old sutures cause very few of the horrible side effects of hernia mesh that are listed above.

A higher risk of infection is nothing to sneeze at (pun intended) when you’re having surgery, especially abdominal surgery, after all [6]. Remember, there are plenty of new resistant strains of bacteria and fungi that skulk around hospitals these days like Methicillin Resistant Staphylococcus Aureus (MRSA), for example. When you opt for a hernia repair with the mesh, you’re opting for a higher rate of infection, autoimmune issues, mesh migration, extreme chronic pain, and the risk of having a diminished quality of life [7][9].



Related Posts:

References:

[1] Hollis Law Firm (n.d.) Hernia Mesh Lawsuits 2017: Individual Lawsuits. Available online: https://hollislawfirm.com/case/hernia-mesh-lawsuit/?gclid=CNGe1e7mq9ECFUyAaQodZGQA4A January 5, 2017. [2] PlasticsMakeItPossible.com (2008). What is polypropylene plastic? Available online: https://www.plasticsmakeitpossible.com/about-plastics/types-of-plastics/professor-plastic-one-of-the-plastics-superheroes-polypropylene/ January 5, 2017. [3] Hollis Law Firm (n.d.) Polypropylene Safety Data Sheet. Available online: https://hollislawfirm.com/wp-content/uploads/2015/03/Polypropylene-MSDS.pdf January 5, 2017. [4] WebMD (2005-2017). Mesh for Hernia Repair Reduces Recurrences: Study. Available online: http://www.webmd.com/digestive-disorders/news/20140219/mesh-for-hernia-repair-reduces-recurrence-study-suggests#1 January 5, 2017. [5] Divyangkumar, G., Szember, M., Zhang, X., Bale, A., Dharmesh, K., Brelvi, Z. (2011). Chronic abdominal pain secondary to mesh erosion into cecum following incisional hernia repair: a case report and literature review. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959323/ January 5, 2017. [6] Diongi, R., Rovera, F., Diongi, G., Imperatori, A., Ferrari, A., Diongi, P., Dominioni, L. (2001). Risk factors in surgery. Available online: https://www.ncbi.nlm.nih.gov/pubmed/11936382 January 5, 2017. [7] PatientInfo.com (n.d.). Common Postoperative Complications. Available online: http://patient.info/doctor/common-postoperative-complications January 5, 2017. [8] MedicineNet.com (n.d.). Abdominal Adhesions (Scar Tissue in the Abdomen). Available online: http://www.medicinenet.com/abdominal_adhesions_scar_tissue/page2.htm January 5, 2017. [9] Drugs.com (2012). Hernia Surgery and medical Mesh, have you had problems with medical mesh? Available online: https://www.drugs.com/answers/hernia-surgery-medical-mesh-you-problems-medical-613895.html January 5, 2017.