Patients are much more informed about hernia mesh than they used to be, but you know the old saying: A little knowledge is a dangerous thing. Much of what they’re consuming can do more to confuse than to clarify. There’s a lot of stories out there, from botched operations and painful post-surgery complications, to defective designs and product recalls, to lawsuits and verdicts with lots of commas and zeros. That’s where we come in. When patients reach out to us with their questions, comments and concerns, we can allay their fears and set them straight.

1. I saw a report on mesh — now I’ll never get a hernia mesh repair!

Patients usually overreact after reading unbalanced reports about hernia repairs and complications attributed to mesh. Case in point: ‘Hernia mesh complications affect more than 100,000.’ Last month’s BBC report (osmag.net/eZ9EeF) pointed to a 12% to 30% complication rate. That is much higher than high-level data support. The report lumped all hernias together, but we know that the risks associated with the repair of abdominal wall hernias differ from the risks of pelvic and inguinal hernias. The report’s discussion of complications and chronic pain is incorrect or, at best, misleading. This causes anxiety for patients.

In the same report, a well-known and highly respected specialist, reported performing “3,000 mesh removals because of chronic pain — after which only 2 of the patients had not gone on to become ‘pain-free.’” That’s quite an amazing outcome, but it hasn’t been substantiated.

Buried under the mistakes and misleading discussion, the report made a valid point: Hernia surgery, as with any surgery, has risks and complications; the use of mesh adds to the risk of mesh-related complications.

2. Should I expect complications from my hernia mesh surgery?

Absolutely not. Surgeons do not offer an elective operation to their patients if complications are an expected outcome. When patients come to me, I make sure to assure them that the vast majority of hernia repairs will have excellent outcomes without complications. Complications, if they occur, are not always related to the mesh. And not using mesh does not imply there will be fewer complications. In fact, a recent modern study from Denmark compared mesh and non-mesh inguinal hernia surgery. The chronic pain complication rate was the same for both techniques. Also, each patient has his own risk profile, which increases his risk of complications. These can include nicotine use, obesity and constipation.

3. Should I sue the surgeon who ‘botched’ my mesh hernia repair?

The issue of lawsuits is a growing one. We have all seen the ads about mesh lawsuits. I try to focus patients on their medical issue, such as a complication. In such situations, they were hurt by an operation. I urge them to prioritize their health and do all that is necessary to get better. I have heard of situations where counsel has discouraged patients from having curative treatment, believing it may weaken their legal case. They are the worst. Also, in most of those situations, there was no malpractice.

4. The mesh inside me is a recall!

I assure my patients that there is no mesh recall that demands that the mesh be removed. Recalls are not made because mesh is expected to cause an injury. The recalls to date have been based on packaging issues, manufacturing issues, risks of breakage, risks of tears and hernia recurrence. Some patients also worry that I’ll implant a recalled mesh in them. That should not be a worry. Authorities pull recalled products off the market and alert surgeons to discontinue their use.

5. Do you think my doctor used the best technique to repair my hernia?

I’m a tie-breaker for some patients. They’ll seek consultation from more than one surgeon and most will offer them differing options. When they come to me, I help them analyze the risks and benefits of each of the options. I try to digest all the information and balance that with what they have read. I provide a wide variety of surgical options to my patients, including non-surgical options such as watchful waiting. Each patient may be a good candidate for a different hernia repair option. Most patients have the option to decide between 1 or 2 good choices for hernia repair.

6. Are you using the same mesh to repair my hernia that is used for transvaginal mesh repairs?

The reality is, yes. The fundamental product ingredient, polypropylene, is the same for most hernia mesh and transvaginal mesh. The 2 repairs, however, are very different. They differ in the fact that the mesh is implanted in a different place and in a different way. The anatomy is different. The technique is different. The complication rates are different. The surgeons are different. On its website, the U.S. Food and Drug Administration has made specific comments about the unique risks and benefits associated with procedures that use mesh for urogynecologic procedures to repair pelvic organ prolapse and stress urinary incontinence.

7. Is there a perfect mesh?

No, there is no perfect mesh. We are slowly moving toward better mesh designs, ingredients and options. This is my passion. I hope to design better mesh that reduces the risk of chronic pain.

8. Are there better options than mesh for my hernia repair or hernia revision?

Every patient is different. I tell that to my patients. Mesh must be used to repair some hernias. Some smaller hernias may warrant non-mesh repair, also referred to as tissue repair.

In short, patients almost always have options. Their final choice will be based on the option that has the lowest complication rate and which they find most acceptable. As surgeons, our goal is to help patients make an informed decision after educating them of the risks and benefits of each choice. OSM