“To Revise or To Not Revise…”

Rob Jenner: Jenner Law, PC
June 21, 2019
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The Pros & Cons of Surgical Mesh Revision Surgery: When is Revision Surgery Right for Me?

Choosing whether or not to have mesh revision surgery after a urinary incontinence mesh implant fails is a big decision, and one that should be made with the help of your doctor.

Surgical mesh implant devices have a high rate of failure. Depending on the type and size of the mesh implant required, as well as the surgical technique used, the recurrence rate is anywhere from 8% to 30%, and that rate is even higher for recurrences, according to studies.

Surgical mesh implant surgeries to fix stress urinary incontinence are a commonly performed general surgery in the United States.

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There is always a risk of the mesh implant failing. Unfortunately, many problematic meshes were approved by the U.S. Food and Drug Administration (FDA) and put millions of people at risk for complications.

Most of these problem meshes were recalled several years later, but it was too late for those people who were implanted with faulty meshes.

Even people who underwent surgery without the use of a problem mesh are at risk for recurrence and other complications down the road. A long-term study on hernia mesh published online by JAMA in 2016 showed the risks of mesh may outweigh the benefits for some patients who underwent surgery for pelvic organ prolapse or urinary incontinence repair.

The study authors noted that mesh implantation prevented the need for subsequent reoperation in relatively few patients, meaning most patients who underwent mesh surgery repair eventually had some sort of complication leading to recurrence. The authors also noted that the benefits associated with mesh are sometimes offset by long-term complications, such as bowel obstruction, bowel perforation, bleeding, and abscess. These complications seemed to progress increasingly over time.

How do you know if mesh revision surgery is right for you? It depends on a number of factors, including your own quality of life and whether the benefits outweigh the risks for you. You should discuss with your doctor the pros and cons of revision surgery.

The Pros

Mesh revision surgery can increase your quality of life, including your emotional and social well-being. If your organ prolapse or urinary incontinence prevented you from going to work, meeting with friends or family, or enjoying your most treasured activities, this is a decrease in your quality of life. Having revision surgery may turn those things around for you.

A long-term study published in the Annals of the Royal College of Surgeons of England in 2015 found that surgical intervention significantly improved patients’ quality of life, even when revision was necessary.

Mesh revision surgery can prevent future complications. Even if your side effects from the mesh implant are very minor, it may worsen over time and cause more intense injuries. Surgery can also relieve any swelling or feeling of heaviness, tugging, or burning in the area of the mesh implant device.

Pelvic organ prolapse and stress urinary incontinence generally do not improve on their own, only surgery can permanently repair the failed mesh implant device. If your symptoms are severe or are affecting your quality of life, you may consider getting revision surgery.

The Cons

The condition that lead to the mesh implant is likely to come back. Just like your first recurrence, a second or third recurrence is also possible and more likely the more it happens. The odds of a pelvic organ prolapse or urinary incontinence recurring increase with each recurrence.

There are risks inherent in any surgery. These risks include:

  • A bad reaction to the anesthesia
  • Infection and bleeding
  • Nerve damage, numb skin, or loss of blood supply
  • Damage to nearby arteries or veins
  • Damage to the intestines, bladder, or other organs and tissues

Alternatives to Mesh Revision Surgery

Watchful waiting. There is really only one alternative to revision surgery and that is watchful waiting. If your condition is very mild, you may decide not to get revision surgery despite the likelihood of your organ prolapse and urinary incontinence recurring.

If you choose watchful waiting, your surgeon will continue to evaluate your health to make sure it doesn’t worsen or cause other related injuries that can be serious or life threatening. This is an option for those who do not experience major debilitating symptoms that impact their health or quality of life.

The Bottom line

Mesh surgeries are common and the most popular medical solution to pelvic organ prolapse, stress urinary incontinence and hernia repair. In fact, these conditions typically can only be repaired surgically. If you don’t experience symptoms or if those symptoms are ones you can live with, you may decide not to get surgery. However, not getting surgery may put you at risk for complications down the road, including rare but serious complications.

Even if you do decide to get revision surgery to repair your failed surgical mesh implant device, you’re still at risk of an infection, recurrence or major related injuries. Revision surgery can increase your quality of life and may prevent further complications down the road.

You should discuss with your doctor whether revision surgery is right for you.

Sources

Science Direct. “Recurrence after groin hernia repair-revisited,” by Sri Vengadesh Gopal and Achuthan Warrier. Published April 2013. Accessed June 2019: https://www.sciencedirect.com/science/article/pii/S1743919113000873

Kaiser Permanente. “Inguinal Hernia: Should I Have Surgery Now, or Should I Wait?” Revised November 2018. Accessed June 2019: https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=za1162

Annals. “Durability of giant hiatus hernia repair in 455 patients over 20 years,” by PA Le Page, et al. Published April 2015. Accessed June 2019: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4474010/

UCI Health. “Is surgical mesh safe for my hernia surgery?” Published June 2018. Accessed June 2019: https://www.ucihealth.org/blog/2018/06/mesh-hernia-repair

Science Daily. “Study finds mixed results for use of mesh for hernia repair.” Published October 2018. Accessed June 2019: https://www.sciencedaily.com/releases/2016/10/161018094928.htm

FDA. “Hernia Surgical Mesh Implants.” Revised February 2018. Accessed June 2019: https://www.fda.gov/medical-devices/implants-and-prosthetics/hernia-surgical-mesh-implants