Like finding a radio station on a road trip, locking in the ideal height and resistance during a bike ride, or getting the filter just right for the ‘gram, control is a constant adjustment of give and take that impacts virtually every aspect of our lives.
We are taught from a very young age that we can influence outcomes of almost any situation, but what happens when control is no longer in our hands? For example, when a doctor diagnoses you with a condition like a hernia that will require surgery to fix.
To get better we must give up certain levels of control to the surgeon. This requires an incredible amount of trust, which is why we spend countless hours searching for symptoms, treatments, and reading patient reviews so we can determine the best possible path forward for our situation.
When you combine several well-publicized unfortunate outcomes, lawsuits, a flood of borderline predatory advertisements questioning mesh safety, and the explosive polarizing social media environment where mesh is often blamed for causing complications, it’s easy to see why many patients simply do not trust hernia mesh.
A survey of 500 hernia patients revealed that 36% felt “No hernia mesh is safe,” 16% where “unsure, and needed to speak with a doctor,” while 48% trust the standard of care by believing “Hernia mesh is safe.”1
Naturally if the standard of care is hard to trust, the right approach must be a “no mesh” tissue repair. While this logic makes sense, however it’s vital to understand that a no mesh hernia repair is only a viable option for select patients who meet the following criteria:
Rather than feel trapped by the perceived limited options of no mesh or mesh, consider the following to help you find the right hernia repair approach for you.
Used to repair hernias prior to the moon landing, synthetic mesh made of polypropylene has been widely considered by many as the gold standard due to low cost and favorable material properties. While polypropylene is a foreign body that is bioinert, meaning it’s believed to not cause a reaction to surrounding tissue, data is now emerging that suggests otherwise in certain situations.
Thousands of patients experience no complications from sutures or hernia mesh made of polypropylene, so why does it work in one person and cause complications in another? The answer may come from within, meaning will depend on our individual foreign body response. When any foreign material enters our body, an inflammatory cellular response is triggered that has two outcomes; integrate with the surrounding area or encapsulate, meaning wall off which is a natural protective mechanism that creates scar tissue. For many this process ends after a few weeks without any major issues. Data is starting to show that complications occur during periods of prolonged foreign body responses where the protective mechanisms are overwhelmed and may require corrective surgical intervention such as an explant procedure to remove the material.
One major misconception patients have is the no mesh hernia repair approach eliminates all the mesh associated complications related to prolonged foreign body response. Viewed as the gold standard no mesh tissue repair, The Shouldice repair can utilize similar amounts of foreign body that are found in some of the available synthetic hernia meshes. A recent study examining the outcomes of a novel hernia repair technique found “the MIS ReBAR technique has less retained foreign body (0.13 grams) as compared to the “no mesh tissue” Shouldice repair (0.20 grams) and the synthetic mesh Open or MIS repair (0.97 grams),”3.
While getting better is the top priority, no one looks forward to having surgery regardless of how routine the procedure. A no mesh hernia repair may seem like the right treatment today, but please consider “tomorrow’s” recurrence, which most likely will require a more complex hernia repair. Literature has shown that a no mesh suture repair has a 45% chance of recurrence at 36 months, compared to 20% with a mesh repair.4
Amplified by social media, blaming mesh for complications has become common practice among patients. What often loses context in these discussions or takes place in the DMs, are the other factors that contributed to the adverse event. In addition to mesh related complications, consider the following factors that may play a role in recurrence:
Just like we are all different, the same goes for hernias. The treatment is relatively routine, however there are a variety of interconnected factors that can add complexity which is why it’s important to find the right surgeon. Look for a healthcare provider who offers:
Data suggests that patients who get to play an active role in the decision-making process have lower anxiety than patients that do not.7
After going through the process with your doctor and they recommend a hernia repair with mesh and something in your gut is still making you apprehensive; there is a compromise that’s growing in popularity because of encouraging clinical outcomes and patient demand for more natural alternatives.
Whether you are more concerned with recurrence or prolonged foreign body response, what if there was a way to have both addressed in the same hernia repair procedure? A study of 619 patients demonstrates a recurrence rate of 1.2% by leveraging the surgeon’s existing tissue repair techniques augmented with a permanent reinforced biologic, named appropriately the ReBAR technique.3
Whatever option you decide, please do not delay seeking care because of hernia mesh related fear as that could cause a medical emergency you can’t control anymore.
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