Hernia Mesh

A hernia occurs when fatty tissue or an organ protrudes through a weak spot in connective tissue or muscle. Most hernias happen in the abdominal and pelvic areas. Surgeons use hernia mesh to repair weak areas in muscle walls to keep organs and tissue from sticking out.

Surgeons perform over a million hernia surgeries in the United States every year, and about 800,000 of these are for groin hernias, or inguinal hernias, according to the U.S. Food and Drug Administration. By the year 2000, doctors repaired about 90% of inguinal hernias with mesh.

Hernia mesh is the gold standard of hernia repair because it’s thought to have a lower recurrence rate, but studies have shown some brands of hernia mesh may have higher failure and complication rates.

Hernia meshes come in several types classified by the materials they are made of and how they function in the body. These include: Non-absorbable and synthetic, coated or composite, combined and biological materials.

The most common type of mesh is a non-absorbable, synthetic mesh made from a plastic called polypropylene. Some synthetic meshes are coated with a barrier such as collagen or omega-3 fatty acids that are supposed to reduce the body’s inflammatory response to the mesh.

Manufacturers have marketed hundreds of hernia mesh models in the United States since the first hernia mesh was used in the 1950s.

More than a dozen major hernia mesh makers market products in the United States. Each produces different sizes of its various brands.

Companies voluntarily recalled or withdrew products from the market because of packaging errors, higher than normal failure rates or the risk of serious complications such as adhesions, pain and hernia recurrence.

Manufacturers of recalled mesh include Atrium Medical, Bard Davol, Ethicon/Johnson & Johnson and Covidien/Medtronic.

While hernia mesh is the gold standard of care for repairing hernias, no hernia mesh is without potential complications. The ideal hernia mesh resists infection, doesn’t cause an inflammatory response, maintains long-term strength, is flexible and quickly incorporates into the body’s native tissue. Unfortunately, the perfect type of mesh hasn’t been invented yet.

The experience of the surgeon performing the surgery and the surgical technique may also influence the complication rate. If you are undergoing hernia repair with mesh, speak to your doctor about the risks and benefits of different mesh types and surgical techniques.

Sometimes, the risks of hernia mesh may outweigh the benefits.

For example, one 2016 study in JAMA found patients who had incisional hernia repair with mesh had a lower rate of hernia recurrence after five years compared to patients who didn’t use mesh. But study authors said “benefits attributable to mesh were offset in part by mesh-related complications” such as “bowel obstruction, bowel perforation, bleeding and late abscess.”

In general, most people do well with hernia mesh surgery. According to the FDA, most complications have been linked to recalled meshes.

“Rates of mesh-related complications vary by hernia type. A majority of patients report excellent long-term quality of life, although a relatively large percentage of patients experience severe or disabling symptoms at long-term follow-up,” according to authors of a 2021 study of over 6,000 patients published in the Journal of the American College of Surgery.

The most common hernia mesh complications reported to the FDA are pain, infection, recurrence, adhesion and bowel obstruction. Other possible problems include the mesh shrinking or the implant moving around inside the body. Two of the most serious complications reported to the FDA are bowel perforation and obstruction.

Pain can occur in and around the hernia surgical site because of mesh erosion, inflammatory reactions to mesh, nerve entrapment or the mesh moving around or puncturing organs. If pain doesn’t go away after three to six months, it’s considered chronic pain and may last for years.

All surgeries carry a risk of infection, but hernia mesh surgery carries an extra risk because the implant itself can become infected. Hernia mesh infections happen when bacteria stick to or colonize the mesh implant. Because bacteria forms a protective biofilm around it, mesh infection is difficult to treat with antibiotics.

When the mesh sticks to intestines or migrates, it can block the bowel. People with obstructed bowels can’t pass gas or stool. Obstructions may also stop blood flow to the intestines.

Like bowel perforation, FDA says bowel obstruction mostly occurred with recalled hernia mesh.

When hernia mesh fails, it needs to be replaced. This may occur because of the design of the mesh or a defect in the product. It can occur weeks to years after the original surgery.

Thousands of hernia mesh lawsuits have accused manufacturers of producing devices that caused serious complications. The lawsuits currently target three major mesh makers in three separate multidistrict litigations, or MDLs. These are large court actions that combine similar lawsuits in a single federal court.

In 2011, Bard Davol essentially ended one of the largest hernia mesh MDLs when it agreed to pay $184 million to settle 2,600 claims that involved the company’s Kugel Patch.

Meanwhile, additional cases are pending in state courts. These include Physiomesh cases in New Jersey and other people suing Covidien over its Parietex mesh.