Hernia Mesh

Hernia mesh, or surgical mesh, is a medical device with a flat, flexible weave that supports damaged tissue around a hernia as it heals. In surgical repairs using hernia mesh, surgeons attach appropriately sized and shaped pieces in or over the hernia.

The abdominal wall, consisting of layers of fascia and muscles, protects internal organs and keeps them in place. Fatty tissues or organs can push through weak spots in the wall, causing tears. 

These tears are hernias, and most require surgery. Hernia mesh has many benefits, but patients may experience complications, sometimes requiring hernia mesh removal surgery.

Many surgeons prefer hernia repair with mesh over sutures alone because mesh typically results in stronger repairs, shortens recovery times, promotes tissue integration and significantly lessens the chance of hernia recurrence. Patients who have hernia repair surgery with hernia mesh often experience less postoperative pain.

The U.S. Food and Drug Administration also states that medical literature consistently demonstrates reduced hernia recurrences with surgeries using mesh. Research suggests that recurrence rates may be as low as 5%-10% with mesh, and one study shows that recurrence is 48% less likely with mesh than with sutures.

A patient’s individual circumstances, the hernia site and the type of repair affect recurrence rates. Technical factors cause most early (within two years of surgery) recurrences. 

Hernia mesh types vary based on mesh composition, usage and form. Because hernias appear in various areas and with different sizes and shapes, hernia mesh also has many variations. 

Surgeons can cut mesh sheets to the correct size and shape for a patient’s hernia. They may also use plugs to fill holes in affected tissues or patches that cover the area. A newer mesh featuring tentacle straps allows broader coverage and suture-free hernia repairs.

Surgeons select the type of mesh to use based on several factors, such as the hernia type and severity, the patient’s age, overall health and projected risk of recurrence. A hernia’s location can also determine the best type of mesh to use in hernia repair surgery. Proper mesh placement is critical to successful repairs.

Absorbable vs. Nonabsorbable

Absorbable mesh degrades over time, and your body absorbs it. According to the U.S. Food and Drug Administration, “As the material degrades, new tissue growth is intended to provide strength to the repair.”

Nonabsorbable mesh remains in the body. It may provide longer-lasting reinforcement to the surgical repair area.

Hybrid

Some types of hernia mesh combine layers of polymer and biological materials. This hybrid mesh provides the strength of synthetics and the advantages of animal-derived tissues, such as limited inflammation, increased tissue growth and reduced bacterial infections.

According to the FDA, many people reported adverse events from the use of hybrid mesh. The agency stated that further review of this type of mesh is warranted.

Animal-Derived vs. Synthetic

Some manufacturers use biological tissue to make hernia mesh. The skin or intestines of cows or pigs are the most commonly used. According to a January 2023 study, biologic mesh can result in a higher chance of infection and hernia recurrence compared to synthetic mesh.

Polypropylene, polyester and ePTFE are the most common synthetic materials for hernia mesh. These materials provide a high tensile strength. Some research indicates that chemical properties may change upon implantation during hernia repair surgery.

Coated or Composite

Some hernia repair techniques can place hernia mesh in contact with the intestines. This contact may cause the intestines to adhere to the mesh, potentially resulting in severe complications.

To reduce the chance of adhesion, manufacturers began coating some types of polypropylene hernia mesh. These composite meshes typically have coatings composed of cellulose, collagen or absorbable fatty acids.

Surgery is the only treatment that can permanently repair a hernia. Recurrence and other complications may result from surgical errors or patient-related circumstances, such as post-op activity and age, not necessarily because of hernia mesh.

Although surgeons don’t use hernia mesh in every instance, its use significantly decreases the odds of hernias coming back. However, the FDA has received reports of risks and complications associated with hernia mesh, including pain and infection.

How Long Does Hernia Mesh Last?

Research results on how long hernia repair lasts vary. An older study reported that recurrence rates in the first two years after surgery using hernia mesh are low, reportedly occurring in only 2.7% of mesh repairs.

However, more recent studies indicate that recurrence and other hernia mesh complications increase after five years. Researchers concluded that long-term complications offset the benefits of hernia mesh in some cases.

Although intended as a permanent solution, patients have experienced an increasingly frequent number of complications. Several recalls took place beginning in 2005, and many patients filed lawsuits in subsequent years.

Hernia mesh manufacturers recalled more than 200,000 units between 2005 and 2014. Ethicon also ordered a “market withdrawal,” taking the mesh off the market without a recall.

The FDA blamed recalled hernia mesh for cases of bowel obstruction and perforation. Many of these recalled products are no longer on the market, but some are still available.

Thousands of people have filed hernia mesh lawsuits after suffering serious complications. A federal panel combined lawsuits naming three different brands of hernia mesh into three separate multidistrict litigations. MDLs allow several similar lawsuits to move more efficiently through the legal system.

Dozens of companies make hernia mesh. Manufacturers of these medical devices include start-up TELA Bio and Johnson & Johnson, the world’s largest medical products company. Grand View Research estimates the global market was worth $293.4 million in 2020 and predicts steady growth through 2030.

Named companies in hernia mesh lawsuits include Atrium, Bard Davol, Covidien/Medtronic, Ethicon and Gore. Some manufacturers agreed to confidential settlements in 2021, but some hernia mesh cases may go to trial.

Surgical procedures and some medications offer alternatives to using hernia mesh. Sometimes doctors may also recommend watchful waiting for some hernias.

Alternative surgical techniques involve either tension or tension-free repair methods using sutures to connect damaged tissue. Surgical repairs without hernia mesh have varying results. Nonmesh repairs typically take less surgical time but may require longer recovery times.

Physicians assess each hernia independently. Based on their assessment, they’ll recommend the best treatment for you whether that’s watchful waiting, medication, an alternative type of surgery or hernia mesh.