Hernia Mesh Complications
The complications of a defective hernia mesh implant may range from temporary pain and a simple, self-limiting infection, to more serious adverse reaction such as organ perforation, migration, and bowel obstruction.
Some unfortunate patients even died, and it’s always important to recognize the symptoms as soon as possible. Revision surgery may correct these issues or, at least, reduce the risk of recurrence and more serious complications.
Hernia Mesh Complications include:
In this article, we will have a look at the most common Hernia Mesh Complications, how to recognize them, and the risks associated with them.
- Bowel Obstruction from Hernia Mesh
- Bowel Perforation
- Complications from Infection
Depending on the surgical procedure used to repair the hernia, the mesh can be left in contact with the intestines. To prevent adhesions to occur, several coatings have been experimented over time that prevent body tissues to come in contact with the plastic material that constitutes the mesh.
However, when this coating is absorbed by the body, as it often occurs, the intestinal tissue may grow inside porous material of the mesh. When this happens, an adhesion between the opposite walls of the intestine may occur, causing inflammation and leading to potentially deadly obstructions.
Migration is another serious complication of hernia repair surgery that occurs when a mesh plugs moves away from its original position. When a plug’s coating gel is not porous enough or the device itself is poorly manufactured, its ability to grow and attach itself to the intestinal wall is substantially reduced.
Detachment may occur, causing a reopening of the hernia as well as its migration towards nearby organs or districts of the body. Low-quality devices may also start eroding, and several fragments may migrate elsewhere to cause all kind of organ and nerve damage, obstructions, and adhesions.
It’s not infrequent that the coatings used in low-quality hernia meshes get eventually absorbed by the body leaving the mesh exposed. When the plastic polymers come in contact with regions of the body that they aren’t supposed to touch, a foreign body reaction may flare up, causing serious issues.
The most common complication is rejection, as the body tries to expel this unknown (and potentially toxic) substance. Foreign body response is often associated with the formation of a seroma around the plug – a pocket of fluids produced by the organism that tries to push the foreign object away from tissues.
Symptoms of Mesh Rejection
- Swelling and tenderness in the area of the implant
- Constant sensation of malaise
- Redness and high temperature in the area around the sutures
Bowel Obstruction from Hernia Mesh
Defective hernia meshes may change shape and start shrinking or shriveling shortly after the surgical implant. The fibrous mass formed is associated with many long-term or chronic adverse reactions. When this happens, folds and creases start forming, and the intestinal tissue slips in and starts growing between them. Eventually, if enough tissue grows up, an adhesion may form until a complete blockage of the intestinal space occurs. A bowel obstruction is a very dangerous condition.
If the intestinal loops become entrapped by the mesh, blood flow can be cut off, causing tissue to become necrotic with potentially fatal consequences. A surgeon may be forced to remove entire portions of the bowels or additional chunks of abdominal tissues to treat the obstruction, which should always be treated as an emergency.
Symptoms of Bowel Obstruction
- Nausea or vomit
- Abdominal cramps or pain
- Inability to pass stools or even gas
- Swelling or tenderness of the abdomen
- Fecal vomiting
- Abdominal distension
When a mesh starts eroding due to its low quality, a fragment may detach or an edge may become exposed, puncturing the tissues nearby – usually the bowel. Sometimes, instead, when an inflammation due to a foreign body reaction becomes too severe, the walls of the intestine may become so thin that they eventually perforate causing a fistula. In any case, a perforation is a life-threatening condition since bacteria and fecal matter can start diffusing inside the abdominal cavity, causing peritonitis, liver failure, intestinal ischemia, sepsis and eventually death.
Symptoms of Bowel Perforation
- Lack of appetite
- Abdominal rigidity
- Sudden abdominal pain
- Swelling and bloating of the abdomen
Complications from Infection
Infections are the most common cause of hernia reopening, accounting 50% of cases of recurrence. Shortly after the surgery, most patients take a course of antibiotics to prevent or treat minor infections around the suture site. However, when a more serious or chronic infection occurs inside the area where a mesh was implanted, the infection may become more complicated to treat. If the administration of intravenous antibiotic fails to treat the infection, a surgery is often required to remove the mesh and treat it.
The larger is the area of mesh introduced during the hernia repair surgery, the higher is the chance of an infection to occur. In fact, the foreign material is an ideal medium for bacteria to colonize and spread the infection, whose symptoms may not be present until years after the procedure was completed.
Symptoms of Infection
- Acute abdominal Pain
- Local redness
- Swelling and tenderness of the area around the incision
- The temperature of the abdomen is higher than normal
- Malaise, fatigue
Hernias are inherently complicated conditions to treat since even the best, most accurately performed procedure always comes with a risk of recurrence. A hernia may end up reopening, forcing surgeons to stitch the patient again to strengthen the repair. The recurrence rate of hernias varies broadly, ranging from as low as 2% to up to 25%, depending on the technique used, the quality of the mesh implanted, the individual characteristics of the patient (age, weight, gender, etc.) and the type of hernia.
However, it is known that if the quality of synthetic plug or patch used to repair the hernia was indeed poor, the chance of recurrence is significantly higher. In this case, the surgeon may also need to remove the previous defective hernia mesh as part of the procedure, especially if the low-quality device caused the complication in the first place. When a hernia reopens, the hole it may leave may be even larger than it was before and may cause serious problems in the long run.
How to identify if the Mesh is Ripped?
In some instances, a mesh may shrink too quickly after the intervention, causing the sutures to become loose. This is especially frequent when the patient overexerts himself during his or her convalescence, such as lifting a heavy weight. Detachment may occur as the device is ripped from the tacks which hold it in place, generally within a few days of weeks after the surgery.
Recurrent pain or the presence of the same symptoms that lead the patient to seek the help of a doctor the first time the hernia was diagnosed may indicate that the mesh has been ripped or detached. However, they can also indicate that some underlying problem is present, so only an explorative surgery or a more in-depth examination may provide the ultimate confirmation that the hernia mesh has been tore or damaged.
A hernia coming back may be signs that hernia mesh ripped. But these symptoms may be related to other complications, too. In some cases, surgery may be the only way to tell for certain if hernia mesh ripped or tore.
When Can Hernia Mesh Complications Occur?
Most Hernia Mesh Complications that occurred in the last few years have been associated with defective devices that should have never been released to the market in the first place. The United States Food And Drug Administration (FDA) recalled many of these faulty mesh products over time, and found that most of them were the reason behind the many adverse reaction reports filed by doctors and patients.
More in general, a complication occurs whenever a poorly manufactured hernia mesh either breaks, erodes, moves away from its position, or causes a foreign body reaction, requiring revision surgery or more urgent procedures. However, other complications can also be associated to medical malpractice or just the normal risk of recurrence that it is associated with inguinal and abdominal hernias in general.
How to Tell If the surgery Failed?
If a hernia mesh surgery failed, complications may become really serious and, in some instances, even fatal. That’s why it is always important to keep an eye out for any potential sign that indicates that something is wrong. Seeking your doctor’s help as quickly as possible can make the difference, and can be key to avoid more serious injuries.
Some of the most common symptoms of a hernia mesh failure include:
- Chronic fatigue
- Constant sensation of weight or bloating
- Flu-like symptoms such as fever, chills, or articular pain
- Recurrent pain in the abdomen or near the surgical wound (even if it’s completely healed)
- Nausea and/or Vomiting
- Inflammation, redness or soreness of the incision
- The area where the incision is located is hot, reddened, sore or inflamed
- Constipation and difficulties passing stools
- Acute or intense pain in the back or abdomen
- Concentration difficulties or confusion during everyday activities
It is important to note that some of these signs are not present immediately after the surgery, and may appear even weeks or years later. Do not ever underestimate them, especially if they are recurrent or prolonged in time.
Diagnosing and treating the Complication
Ultimately, the diagnosis and treatment of a Hernia Mesh Complication depends on the type of adverse reaction that occurs. A doctor may choose to use different medical imaging techniques such as CT scans, X-Rays, and ultrasonography, as well as several blood test to understand the underlying causes of the problem. Depending on the severity of case and the patient’s history, the physician may decide to treat the complication with just some medications. When this is not possible, surgery may be required to remove the device and repair the hernia, as well as remove nearby damaged organs such some sections of the bowel.
- International guidelines for groin hernia management. HerniaSurge Group..Hernia. 2018 Feb; 22(1):1-165. Epub 2018 Jan 12.
- Gossetti F, D’Amore L, Annesi E, Bruzzone P, Bambi L, Grimaldi MR, Ceci F, Negro P. Mesh-related visceral complications following inguinal hernia repair: an emerging topic. Hernia. 2019 Aug;23(4):699-708. doi: 10.1007/s10029-019-01905-z. Epub 2019 Feb 22.
- Baylón K, Rodríguez-Camarillo P, Elías-Zúñiga A, Díaz-Elizondo JA, Gilkerson R, Lozano K. Past, Present and Future of Surgical Meshes: A Review. Membranes (Basel). 2017;7(3):47. Published 2017 Aug 22. doi:10.3390/membranes7030047
- Schreinemacher, M. H. F. P. J. Emans, M. J. J. Gijbels, J.-W.M. Greve, Gl.L. Beets, and N.D. Bouvy, 2009. “Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model.” British Journal of Surgery 96, no. 3:305-313