Over the years, surgical mesh has become a standard tool in modern hernia surgery, offering benefits such as faster recovery and lower recurrence rates. However, like any medical device, it also comes with potential risks and considerations that patients should be aware of before undergoing surgery. Learn more about surgical mesh in hernia repair in this article.
What Is Hernia Mesh?
Hernia mesh is a medical implant used in hernia repair surgeries to provide support to weakened or damaged tissue. Reinforcing the affected area helps strengthen the tissue and significantly lowers the risk of hernia recurrence. In Singapore, as in other developed countries, surgeons adhere to strict medical protocols to ensure that hernia mesh procedures are safe and evidence-based.
Most hernia meshes are made from synthetic, fabric-like materials that are durable and reliable. Biologic meshes, while less common and much more expensive, are sometimes chosen for complex cases. These allow the body’s natural tissue to grow into and around the mesh, creating a strong, stable repair with a high success rate.
Different Types of Hernia Mesh Used in Singapore
Choosing the right hernia mesh is a critical step in ensuring a successful hernia repair. Each type has unique properties that make it suitable for different clinical situations.
Absorbable Mesh
Absorbable mesh is designed to gradually break down and be absorbed by the body. It provides temporary support to the weakened area while the body’s natural tissue heals and strengthens. This type of mesh is commonly used in infected or contaminated surgical fields, where permanent mesh may not be appropriate.
Typically, absorbable mesh takes 6 to 8 months to fully dissolve, though the exact timeline can vary depending on the material used and the patient’s individual healing process.
Synthetic Mesh
Synthetic mesh is made from materials such as polypropylene or polyester. It is strong, versatile and customisable, making it suitable for most types of hernia repairs.
Biologic Mesh
Biologic mesh is created from processed human or animal tissue. It is generally reserved for complex cases, such as when there is a high risk of infection or when the patient’s tissue is too weak to support synthetic mesh. This type of mesh encourages natural tissue growth, gradually integrating into the body for a more stable repair.
Non-Absorbable Mesh
Non-absorbable mesh is made from permanent synthetic materials, such as polypropylene. It is designed to remain in the body indefinitely, providing long-term reinforcement to prevent hernia recurrence. This is the most commonly used type of mesh in standard hernia repairs due to its durability and effectiveness.
Types of Hernias Treated with Surgical Mesh
Surgical mesh is employed in repairing various hernia types, with the selection of technique and mesh type dependent on the hernia’s location and severity. Commonly treated hernias include:
Inguinal Hernia
Inguinal hernia is the most common type of hernia, especially in adults. It occurs when part of the intestine pushes through a weak spot in the groin or lower abdominal wall. For this type of hernia, lightweight mesh is often recommended to provide durable support while minimising discomfort.
Umbilical Hernia
An umbilical hernia develops when a portion of the intestine protrudes through the abdominal muscles near the belly button. Mesh repair is frequently used to strengthen the area and prevent recurrence.
Incisional Hernia
This type of hernia forms at the site of a previous surgical incision, where the tissue has weakened over time. Surgical mesh helps reinforce the area and reduce the risk of the hernia returning.
Femoral Hernia
A femoral hernia occurs when tissue pushes through the femoral canal near the upper thigh. It is more common in women and often repaired using surgical mesh to provide long-term stability.
Hiatal Hernia
A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm into the chest cavity. In some cases, especially with large paraesophageal hernias, mesh may be used to reinforce the repair. However, its use is not routine, as it carries a higher risk of complications.
Techniques Used to Repair Hernias with Mesh
Surgeons use different techniques to achieve the best possible outcomes in hernia mesh repair. The choice of technique depends on the type of hernia, its location and the surgeon’s expertise, ensuring each patient receives the most effective treatment.
Lichtenstein Technique
The Lichtenstein technique is one of the most widely used methods for open hernia repair. In this approach, the surgeon places a flat mesh patch over the hernia defect and secures it with sutures. This method is highly regarded for its simplicity, reliability and proven ability to reduce the risk of recurrence.
TEP (Totally Extraperitoneal) and TAPP (Transabdominal Preperitoneal) Repairs
These techniques are laparoscopic approaches commonly used for minimally invasive hernia repair.
- TEP Repair: This method allows the surgeon to repair the hernia without entering the peritoneal cavity, which may help reduce the risk of intra-abdominal adhesions and other complications.
- TAPP Repair: In this technique, the surgeon enters the abdominal cavity but places the mesh in the preperitoneal space. TAPP is particularly useful when greater visualisation of the hernia site is required for a precise repair.
Benefits of Using Mesh in Hernia Repair
Using mesh in hernia repair provides several important benefits, making it the standard of care for many types of hernias. Key advantages of using surgical mesh include:
- Lower Recurrence Rates: Studies show that using mesh significantly reduces the likelihood of the hernia returning compared to suture-only repairs.
- Reinforcement of Weakened Tissue: The mesh acts as a supportive scaffold, reinforcing the injured area and allowing for robust tissue integration.
- Enhanced Stability: Mesh repair provides long-term stability, crucial for patients who lead active lifestyles or have physically demanding jobs in Singapore.
Risks and Complications with Hernia Mesh
While hernia mesh repair is generally safe and has a high success rate, like any surgical procedure, it carries potential risks. Patients need to be aware of the potential complications, such as:
- Infection: While rare, infections can occur and may require antibiotic treatment or, in severe cases, removal of the mesh.
- Mesh Migration: Mesh migration is a rare complication, typically occurring when the mesh is not positioned correctly during surgery. In such cases, the mesh may shift over time, potentially causing issues like erosion into nearby tissues or organs.
- Chronic Pain: Some patients may experience ongoing pain or discomfort at the site, which might require additional intervention.
- Adhesion or Obstruction: Post-surgical adhesions can sometimes form, creating obstructions or internal complications.
Most of these complications are rare and can be managed effectively when detected early. Patients are encouraged to follow post-operative care instructions closely and seek prompt medical attention if they experience severe pain, fever or unusual swelling.
Mesh or No Mesh: Which Is Better?
The decision to use hernia mesh depends on the hernia’s size and type, the patient’s health and the surgeon’s expertise. Mesh is generally recommended for large, recurrent or inguinal hernias, as well as minimally invasive surgeries and cases with a high risk of recurrence, due to its durability and lower recurrence rates.
However, mesh may not be suitable for active infections, contaminated surgical fields or certain paediatric hernias. For small, low-risk hernias, suture repair may be an alternative. Ultimately, the best option should be decided in consultation with a qualified hernia surgeon.
If you or a loved one is considering hernia repair with mesh, it is important to consult a qualified hernia specialist. In Singapore, Dr Wong Jen San, a skilled hepatobiliary and pancreatic surgeon, provides thorough assessments and personalised treatment plans to help you choose the most suitable and effective approach for hernia repair. Contact us today to schedule a consultation.