About 600,000 hernia repair surgeries are done in the United States every year, according to the Society of American Gastrointestinal Endoscopic Surgeons. Traditionally, surgeons made one long incision in the groin during a hernia operation. That technique meant pain and a longer recovery for the patient.
Now mesh made from synthetics such as polypropylene is becoming more popular for hernia repair. Non-absorbable stitches and strong mesh help patients heal more quickly and return to work sooner.
However, any material inserted into the body can cause complications, and in some cases, the mesh might need to be removed later.
Groin Sepsis
Groin sepsis can develop from infected mesh, so doctors often start the patient on antibiotics before hernia surgery as a preventive. Antibiotics are given orally or through an IV one hour before the procedure, and are discontinued after 24 hours unless an active infection was found during surgery.
A deep-seated infection can cause chronic groin sepsis, and mesh removal is necessary for resolution. Removing the mesh leaves weakness at the repair site, increasing the chance of another hernia.
Researchers from the Department of Academic Surgery at St. James's University Hospital in Leeds, England, reviewed the cases of all of their patients who had mesh removal for sepsis during an eight-year period, particularly those who had hernia recurrence and chronic groin pain.
Prosthetic mesh had been used to repair 2,139 inguinal hernias, and patients whose mesh was removed after infection were followed up. Fourteen had deep-seated wound infection, and mesh removal was necessary to resolve sepsis. They experienced no complications during mesh removal.
After a median follow-up period of 44 months, two patients had recurrences without symptoms. None of the patients reported groin pain.
Hernia recurrence is rare after mesh removal for chronic groin sepsis, suggesting that the success of a mesh repair might depend on how well the abdominal wall reacts to the prosthetic material in the mesh, rather than on the physical presence of the mesh.
Researchers concluded that when there's a deep-seated infection, immediate removal of the mesh is necessary to resolve chronic groin sepsis.
Peristomal Hernia
A peristomal hernia can develop after a colostomy or ileostomy, causing an enlargement of the opening in the abdominal muscle that collects body waste. This enlargement can cause abdominal contents to protrude along the site of the stoma, which is an artificial opening made in the abdominal wall for those procedures.
Inserting mesh around a stoma increases risk of contamination from stoma bacteria.
It's possible to place the mesh too tightly around the bowel as it exits the abdomen, preventing bowel contents from emptying properly through the stoma after the surgery. If the stoma lies against the mesh, over time the mesh can erode into the bowel wall, necessitating removal of the mesh.
Placing the mesh too loosely around the stoma might not entirely close the hernia defect, and another hernia could occur.
Tags: chronic groin, mesh removal, chronic groin sepsis, abdominal wall, another hernia, around stoma, deep-seated infection
