Could hernia mesh be as controversial as vaginal mesh?

Claims regarding the use of mesh in hernia repair have re-entered the spotlight in recent months due to the widely reported concerns relating to its use in pelvic/vaginal procedures.

The mesh types themselves, are similar and give rise to comparable complications, such as pain, infection,  erosion, migration and shrinkage but in the case of hernia repair are also associated with recurrence and bowel obstruction.

Whilst vaginal mesh has been banned in several countries, a certain number of hernia meshes have also been withdrawn from the market due to concerns about their safety over the years. For example, the Ethicon Physiomesh^TM  was subject to worldwide recall in 2016  after unreported studies showed that there was a higher rate of recurrence or reoperation compared to other similar meshes.

The Medicines and Healthcare products Regulatory Agency in the UK does not seem concerned.  It is not conducting any studies on hernia mesh use and considers them in principle to be safe. The Mesh Oversight Group report 2017 specifically limited it’s findings to mesh used only in the “pelvic region”, and did not take hernia mesh into account.

There are well reported issues with mesh repairs, but as with all medical devices, the decision to ban or restrict their general use will be determined by whether complication rates become unacceptable.  At present,  the open flat mesh repair has become the most popular technique for hernia repair as it strengthens the abdominal wall with less suturing and tension thereby reducing the likelihood of recurrence in the short term. Longer term data on complications is less readily available.

So where does this leave us? Vaginal mesh claims certainly have a head start, but if a patient has a complication from a hernia mesh repair, the standard response will still be “this is a recognised, non-negligent complication and the mesh is safe for use”.

Until such time that there is definitive evidence of long term complications, or concerted action by the regulatory bodies, hernia mesh compensation claims are likley to be isolated to individual cases.