Serious, long-term complications outweigh benefits of using hernia mesh
SAN DIEGO, Calif., April 6, 2017 — A recent study in JAMA exposes the long-term risks of using hernia mesh in at least one type of hernia repair surgery.
The study found the benefits of using mesh in abdominal wall hernia repair were eventually outweighed by the risks of complications related to the mesh. Complications observed in the study were serious and usually required additional surgery to treat.
Researchers say the findings could call into question current standards of using hernia mesh in open or laparoscopic abdominal wall hernia repair.
Hernia repairs are one of the most common surgical procedures in the U.S. — over 1 million are performed each year. Hernia recurrence is one of the biggest problems faced by patients who get a hernia repaired. Hernia mesh is thought to reduce this risk, but there are few large, multi-center studies to back up this claim.
The JAMA study, published online Oct. 18, 2016, found that while hernia mesh did reduce hernia recurrence rates by a little more than 5%, the risks of developing mesh complications down the road tended to outweigh that benefit.
These complications included bowel perforation, bowel obstruction, chronic surgical site infection, fistulas, abscesses, fluid buildup at the surgical site, non-healing wounds and the collection of blood within the tissues. Most of these complications required the need for additional surgery.
The study was one of the largest and longest ever conducted on hernia repair outcomes and collected 5-year follow-up data from 100% of patients.
Researchers used data from the Danish Hernia Database and found 3,242 patients who had undergone abdominal wall hernia repair between 2007 and 2010.
The patients were divided into 3 groups based on the type of surgery they had:
- Open hernia repair without mesh (11.3%)
- Open hernia repair with mesh (34.5%)
- Laparoscopic hernia repair with mesh (54.2%)
Researchers were able to follow up with patients using data from the Danish National Patient Registry to determine the risk of long-term complications.
In patients who underwent open hernia repair without mesh, the risk of needing to repair a recurrent hernia was higher compared to patients who underwent either laparoscopic or open hernia repair (17.1% versus 12.3% and 10.6%, respectively).
But the increasing number of mesh-related complications for both open and laparoscopic repairs seemed to outweigh the benefits provided by the mesh. At 5 years’ followup, the frequency of mesh-related complications was 5.6% for open mesh repair and 3.7% for laparoscopic mesh repair.
The long-term repair-related complication rate for open non-mesh repair was just 0.8%.
In an opinion published in JAMA alongside the study, Dr. Kamal Itani said one of the most noteworthy findings was the small difference in hernia recurrence rates between open mesh repair and open non-mesh repair.
The study found the difference to be about 5%, which was more than offset by the 5.6% rate of major mesh complications.
“These data suggested that the risk-benefit ratio of mesh is not as clear as previously thought. This calls into question the current practice of liberal use of mesh, even for repair of small hernias, when mesh is the norm for all incisional hernia repairs of any size,” Dr. Itani wrote.
There are a number of hernia mesh brands on the market today and some that have been removed because of their risks for complications.
Patients who experience these painful mesh complications are beginning to file lawsuits against their manufacturers. Atrium Medical’s C-Qur Hernia Mesh, Ethicon’s Physiomesh and C.R. Bard’s Sepramesh IP are just a few of the brands now under fire for their potential risks.
If you were implanted with a hernia mesh and developed complications that required a second surgery, you may be entitled to financial compensation.
JAMA. “Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair.” Dunja Kokotovic et al. (Oct. 18, 2016). Retrieved from http://jamanetwork.com/journals/jama/article-abstract/2565771
JAMA. Editorial. “New Findings in Ventral Incisional Hernia Repair.” Kamal M.F. Itani, MD. (Oct. 18, 20116). Retrieved from http://jamanetwork.com/journals/jama/article-abstract/2569750