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Surgical mesh is sometimes recommended

Addressing Patients’ Concerns About Surgical Mesh in Hernia Repair

It is estimated that more than 1 million abdominal and groin hernia repairs are performed in the United States each year. Surgical mesh — the prosthetic material frequently used to cover and reinforce the herniated area during surgery — has been around more than 50 years, and has long been regarded as the “gold standard” for ensuring that a hernia repair will hold.

“When used and placed correctly with the da Vinci® robotic platform, surgical mesh helps reduce the risk of hernia recurrence with minimal risk of complications,” says Frederick Sabido, MD, FACS, a general surgeon specializing in robotic-assisted hernia repairs, gallbladder removal and anti-reflux surgery at miVIP Surgery Centers in New York. “We also have a bioresorbable mesh, which is used in ventral hernias to eliminate complications related to mesh. This mesh is completely resorbed by the body after 18 months.”

Despite good safety ratings, recently there has been more public attention on the potential complications of surgical mesh, as patients experiencing negative side effects have filed lawsuits. As a result, more patients are asking questions about the pros and cons of mesh.

Surgical Mesh in Hernia Repair: the Good vs. the Bad

In a recent article about mesh in hernia repairs, Andrew T. Bates, MD, director of the Stony Brook Comprehensive Hernia Center, states “Decades ago, hernia repairs were performed by simply suturing the hernia closed. For some types of hernias, [suture] repair resulted in 25-50% of hernias later returning.” Dr. Bates added that once surgical mesh was introduced as a method for reinforcing hernia repairs, the chance of hernia recurrence dropped to the “low single-digits” – good news that is supported by at least one recent study.

While mesh is considered the acceptable standard of care in hernia repair and many patients do fine with it, the bad news is that many others experience complications. No matter how safe the material, surgical mesh is a foreign object implanted in the body that has the potential to cause problems, including infection, breakage or erosion, inflammation related to the material, and formation of scar tissue, or adhesions.

As reported by the media, other types of surgery (i.e., urogynecologic surgery) have led to cases of mesh migration, though this complication is only rarely seen with hernia repair. However, new hernia patients may raise concerns about mesh migration.

Addressing Patients’ Questions and Concerns About Mesh

With more mesh lawsuits making news headlines, more patients are asking questions about mesh, and requesting “mesh-free hernia repair.”

In a January 2019 article in General Surgery News, B. Todd Heniford, MD, chief of gastrointestinal and minimally invasive surgery at Carolinas Medical Center, said “This is a change that’s been happening over the last few years and has picked up speed recently … every single patient will ask me about mesh.

The GSN article proposes that surgeons take time to listen to patients’ concerns and address their questions. Referencing the GSN article and others, we compiled a list of tips from various physicians to help others tackle the mesh topic with their patients.

5 Tips to Help Address Patients’ Concerns About Mesh

  1. Discuss what kinds of mesh may be appropriate for the patient, and document your reasons for using a particular mesh—synthetic, biologic/dissolving (bioresorbable), or a hybrid. “I now dictate it in my operative note about my mesh choice and why I am using what I am using,” says Dr. Heniford. When meeting with patients, Marcelo W. Hinojosa, MD, a UCI Health surgeon specializing in gastrointestinal and bariatric surgery, says he discusses the risks and benefits — and the reasoning behind using mesh — to help them make informed decisions.

  2. Give patients a “Mesh Education Sheet” and also refer them to the FDA website.

  3. Provide information on alternatives to mesh, such as mesh-free or dissolving mesh. Discuss all treatment options with your patients, and be honest about the pros and cons. For example, patients may not understand that adhesions are possible after any hernia surgery, whether surgery was performed with mesh or without—this is not a problem specific to mesh. “I think these discussions improve patient health care and allow them to make better decisions, and to have more appropriate expectations of long-term goals,” says Archana Ramaswamy, MD, MBA, an associate professor of surgery at the University of Minnesota.

  4. Disclose that chronic pain or discomfort has been experienced by some patients whose surgery involved mesh, but this side effect is not experienced by every patient. Conversations about chronic pain associated with mesh are already active on social media, so consider addressing this potential complication up front. “Patients want data, like we do,” says Shirin Towfigh, MD, a hernia and laparoscopic surgeon at Beverly Hills Hernia Center. “They want to know the risks and benefits, and they’re [being vocal]. Our job is to educate them and provide as much objectivity as possible, to reduce the amount of emotion that’s attached to this issue.”

  5. Outline special risk factors, such as obesity, for hernia recurrence and complications to help manage expectations. “Although obesity is a risk factor for hernia recurrence or complications, I have strong data that supports using a bioresorbable mesh in patients with a BMI over 35 and as high as 55, using the da Vinci transabdominal robotic platform,” says Dr. Sabido. “This approach results in a recurrence rate of only 2.4% at 24 months in ventral hernia repair with the bioresorbable mesh.”

The Future of Hernia Repair & Patient Communications

Evidence strongly supports the continued use of safety-approved mesh in hernia repair, as studies demonstrate reduced hernia recurrence and no difference in pain compared with mesh-free repairs. Yet, many surgeons agree that it is important not to dismiss a patient’s concerns about mesh. It is equally important not to over-sell the idea that there is no need for mesh in hernia repair. Striking this balance may be tricky, but worth the effort.

“Surgeons need to be honest with patients [about] their outcomes [with] no-mesh hernia surgery. Otherwise, they risk preying upon a vulnerable patient population and falsely providing momentum to an anti-mesh movement,” says Dr.Towfigh.

This is curated content that has been edited for miVIP Surgery Centers readers. Additional information and insights can be found in the source articles listed below.

Sources:

Talking to Patients About Mesh: In Age of Social Media and Lawsuits, Surgeons Offer Advice on How to Communicate With Concerned Patients. Christina Frangou, General Surgery News.

Prophylactic Mesh Reduces Hernias, but Not Without Trade-offs: Study in Patients at High Risk for Incisional Hernias. Christina Frangou, General Surgery News.

FAQs about Mesh in Hernia Repairs — What Patients Need to Know. Andrew T. Bates, MD. Stony Brook Medicine.

FROM THE JOURNALS: Guidelines offer recommendations for hernia repair in obese patients. Jeff Craven. MDedge.

What is surgical Mesh? Karen Poulon, RN. Owlcation.

PUBLISHED 1 Mar, 2019

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