A leading hernia mesh doctor reports that her California office is being inundated with requests for hernia mesh removals.
Dr. Shirin Towfigh is the principal investigator among researchers reporting on the conclusion of a 4.5 year study on mesh removals, published in Hernia Magazine December 2018.
The group removed 105 meshes mostly from men (58%). While men had hernia mesh removed from the pelvis, women had it removed from the abdomen. The average age was 53 years.
Pain was the most common reason for abdominal and pelvic pain removal with a pain score ranging from 5 to 10.
Ninety percent of mesh removed was polypropylene-based, followed by a composite of PP and ePTFE (6%). Polypropylene is an inexpensive polymer commonly found in indoor-outdoor carpets and on Tic-Tac boxes.
Polyester made up 4% of removed meshes then plain ePTFE (3%), biological mesh such as porcine, bovine or human dermis (2%), and a hybrid mesh such as Cook Medical Zenapro (1%).
It is known that nearly all hernia mesh, once infected, will continue to be infected until it is removed. It is very difficult to cure. The infection can develop into a biofilm which is an ecosystem of bacteria.
The mutations can become antibiotic resistant and are able to survive at levels 100 to 1,000 times higher once biofilm is formed.
There are currently hundreds of thousands of U.S. patients with an infected hernia mesh. At the same time, there is very little literature about mesh removal. Most focus on mesh infections, which almost always require a removal.
Meshoma was first termed by Dr. Parviz Amid and describes the problem of folding or balling up of mesh. That contributes to chronic pain, hernia recurrence, and/or nerve entrapment.
Meshoma was found in 38% of Dr. Towfigh’s patients. Most who had a meshoma presented with pain (95%) and / or hernia recurrence (17%).
In the pelvis, some had associated nerve entrapment requiring neurectomy, or surgical removal of a nerve.
Researchers recommend, when evaluating for patients with post-surgical pain, hernia recurrence, and or neuralgia or pain along a nerve, a diagnosis of meshoma should be ruled out as the primary cause.
In her practice at Beverly Hills Hernia Center, Dr. Towfigh generally sees 13% of the practice dedicated to mesh removal. In 2017, that number increased to 22%. She says it’s unclear if this trend will continue and whether there is a national increasing trend in patients requiring mesh removal. ###