Long term discomfort and ‘chronic pain’ following a hernia repair. Are the figures true? Is it really mesh related?

You can hardly be unaware of all the recent media attention over “mesh”, which I agree is a major concern in the way it has been presented; but it is a pity that so much of it is not only misleading but simply wrong. There is so much disinformation, muddled thinking and sheer scaremongering that is doing a great disservice to an excellent operation. . The appropriate use of mesh has definitely changed the results of hernia repair for the better. Both the open tension-free mesh repair and the laparoscopic repair (which ha sto use mesh) are excellent operations when correctly and appropriately carried out.

To add to the confusion, the use of mesh to repair hernias has been muddled up with the use of mesh placed deep in the pelvis of women to try and treat urinary problems. The operations are completely different, with mesh used in totally different ways. This was an ill conceived gynaecolgical procedure, and the problems are related to a poorly designed operation and in many cases, poor surgical technique.

I believe that very few patients develop long term post operative pain when mesh is used appropriately for true inguinal hernias. I use the term ‘true’ inguinal hernias because I believe that a substantial number of patients are having inguinal hernia repairs when they don’t have a hernia.

Nevertheless some patients (very few in my experience and my practice) do experience prolonged discomfort near the site of the operation.

I see that reports on the internet are saying that long term pain occurs after 30% of mesh inguinal hernia repairs (!) I find that statistic incredible. What is actually going on? People use phrases such as ‘trapped’ nerves, nerves caught in mesh, or blame the mesh itself. From my personal experience, personal observations and speaking with colleagues I believe that the main cause of long term post-op pain is poor surgery. Simple poor surgical technique.

Some patients I see will say that they read that long term pain occurs in 30% of inguinal hernia repairs. I find that statistic incredible. I would have given up, had to give up, hernia surgery long ago if that was the case. In reality I would say that I see prolonged discomfort in about 0.5% of the patients I operate on, and in my experience it resolves over time.

I would have given up, I would have had to give up, hernia surgery long ago if that was the case. In reality I would say that I see prolonged discomfort in about 0.5% of the patients I operate on and there is usually a pre-existing reason. In my experience this prolonged discomfort resolves over time.

Some patients come to see me after having been operated elsewhere. When I question them carefully I often doubt whether they had a hernia before their operation. They had another cause for their groin pain. So these patients with pain, who blame the operation, never had a hernia in the first place but had another cause for groin pain. But the operation and mesh get blamed. Often they wlll say they never had a bulge or swelling before their operation, but the ultrasound scan showed one.

Ultrasound scans are notoriously unreliable, with a high incidence of ‘false positive’ reports – diagnosing hernias that aren’t there. To operate purely on the basis of an ultrasound report is asking for trouble.

In summary

Using mesh to repair inguinal hernias gives excellent results and is a good procedure

Needs to be well done

Pain is rare if it is appropriately and correctly carried out.