Mesh Removal by DR. WILLIAM H. BROWN, III


There are two basic methods to repair a hernia. The first method uses sutures to repair the hernia through an incision. This is sometimes called a pure tissue repair. The second method of repair involves placing a piece of mesh to patch the hole. The mesh can be placed on the deep side of the hernia using a laparoscope, or the mesh can be placed to cover the outside of the hernia using an incision.


The argument for a hand-sewn repair (i.e., no mesh), is that there is no foreign body placed in the body. It is common for people to develop scar tissue around the mesh. This fibrosis causes the mesh to become stiff and hard. Then when you bend and twist, and the mesh does not bend and twist with you, the sheer stresses causes pain. Sometimes one of the nerves or spermatic cord gets stuck to the mesh, and severe pain can result. Then exercise becomes impossible because of pain, and ejaculation causes a severe burning sensation in the spermatic cord and testicle. Chronic pain after mesh hernia repairs affects 15% of patients. A significant number of those patients with pain have to have the mesh removed with another operation. Even after removing the mesh, the patient is often only about 80% better.

Most Surgeons argue for the use of mesh because of the lower recurrence rate. But their argument is flawed. If you look at the numbers, the chance for a recurrent hernia after a mesh repair is 3%. The chance for a recurrent hernia after a non-mesh repair is about 4%. But to achieve this 1% lower recurrence rate the patient runs about a 15% chance of chronic pain. Dr. Brown strongly feels that since the risk of chronic pain from the mesh is so much higher than the recurrence rate that the best hernia repair is the suture repairs. No Mesh!