Mesh-Free Hernia Repair
By Fred Amir
Primary Care Physician
Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. Journal of American Medical Association, 2006 Jan 18; 295(3):285-92.
Does delaying repair of an asymptomatic hernia have a penalty? American Journal of Surgery. 2008 Jan;195(1):89-93.
The First Surgeon
A study published in 2004 in the New England Journal of Medicine concluded, “The open technique is superior to the laparoscopic technique for mesh repair of primary hernias.” (New England Journal of Medicine, 2004; 350:1819-1827) The recurrence and complication rate were also found to be higher among those with laparoscopic repair.
The truss that I found most versatile and useful was the one made by Truform.OTC.
According to Timothy S. Kuwada, MD, Assistant Clinical Professor, Department of Surgery, University of North Carolina, Chapel Hill; Director, Bariatric Fellowship Training, Carolinas Medical Center, Charlotte, North Carolina, “With the increased utilization of hernia prosthetics, the incidence of mesh-related complications has also risen. Although rare, mesh infections and enterocutaneous fistulas are a devastating complication that can have significant effects on long-term quality of life. Furthermore, a growing body of literature suggests that mesh can increase chronic pain and discomfort in the form of a foreign body sensation, excessive rigidity, and collateral nerve and tissue inflammation. Multiple high volume (> 1000 cases) studies have demonstrated a relatively high incidence of chronic pain after inguinal hernia repair. In an effort to improve post-herniorrhaphy [hernia repair] quality of life, prosthetic manufacturers are increasingly focused on developing meshes that have a more favorable graft-host profile.
Dr. Roth discussed the influence of mesh on quality of life and chronic pain after hernia repair. He began by reviewing the growing trend of prosthetic hernia repairs. According to Dr. Roth, the adoption of the Lichtenstein technique, as well as laparoscopic approaches to inguinal hernias, has led to a significant increase in mesh repairs for these hernias. For example, in 2003 there were over 750,000 inguinal hernia repairs in the United States with over 90% of these procedures utilizing mesh. Similarly, in 2004 it is estimated that there were 300,000 incisional hernia repairs with more than 50% employing mesh.” Report on Hernia Repair from SAGES 2008, Contents of Highlights of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2008 Annual Scientific Session and Postgraduate Course.
And the following article published in Clinical Microbiology and Infection, titled, “Mesh-related infections after hernia repair surgery,” elaborates more on mesh complications.
“Clinicians have been challenged in the past few years by an increasing variety of novel non-infectious and infectious complications following the widespread use of meshes after open or laparoscopic repair of hernias. The possibility of a mesh-related infection occurring weeks or even years after hernia repair, should be considered in any patient with fever of unknown origin, or symptoms and/or signs of inflammation of the abdominal wall following hernia repair. The reported incidence of mesh-related infection following hernia repair has been 1%–8% in different series, and this incidence is influenced by underlying co-morbidities, the type of mesh, the surgical technique and the strategy used to prevent infections. An approach that combines medical and surgical management is necessary for cases of mesh infection. The antimicrobial treatment regimen chosen initially should include coverage of Staphylococcus spp. and, particularly, Staphylococcus aureus.” Clinical Microbiology and Infection, Volume 11, Issue 1, pages 3–8, January 2005.
The United States Food and Drug Administration video on Kugel mesh recall
The Proceed Surgical Mesh was hit with an FDA recall on December 21st, 2005 after a troublesome pattern surfaced with regards to a soft mesh layer of the patch delaminating from the polypropylene layer, leaving it exposed. It was determined that this exposure to the polypropylene could lead to an increased risk of adhesions and bowl fistulization. Symptoms associated with these injuries may include chronic abdominal pain, prolonged fever, or tenderness at the implant site.
Recurrence & Pain
“Recurrence after inguinal hernia repair at ten years by open darn, open mesh and tep [i.e. laparoscopy] — No advantage with mesh” The Surgeon. 2009 Apr; 7(2):71-4.
“Is Postoperative Chronic Pain Syndrome Higher with Mesh Repair of Inguinal Hernia?" The American surgeon. 2010 Oct; 76(10):1115-8
Online Discussion Groups on Hernia
Hernia mesh patch recall
Laparoscopic hernia repair complications
Dr. Ulrike Muschaweck
Minimal Repair technique of sportsmen's groin: an innovative open-suture repair to treat chronic inguinal pain. Muschaweck U, Berger L. Hernia. 2010 Feb;14(1):27-33.
Dr. Ulrike Muschaweck’s website
The USA’s soccer team captain goes to Germany for hernia repair
Prof. Dr. Mohan Desarda
Study of 200 patients and detailed explanation of Prof. Dr. Desarda’s theory and method published in BMC Surgery. This article explains in detail Prof. Dr. Desarda’s theory and technique.
Study of 860 patients treated with the Desarda repair and follow up results published in Hernia.
More articles by Prof. Dr. Desarda
Prof. Dr. Desarda’s Website
Dr. Zafar Parvez
1900 Red Rock Drive Gallup, NM, 87301
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Worried Sick: A Prescription for Health in an Overtreated America by Nortin Hadler, MD.