How We Repair Hernias: Hernia Meshes

 

Mr Kirkby-Bott repairs hernias using a mesh: a synthetic piece of material used as a scaffold around which the body creates a new area of connective tissue.

Mesh is continually shown to reduce the risk of hernias recurring after repair. This is why 99% of surgeons use them routinely now.

Mesh technology and design evolve at a very fast pace – faster than your mobile phone evolves!

The latest cutting edge material and design is the Medtronic Progrip used in our open inguinal repairs. It has good coverage and a unique way of reducing tension along your repair to get primary wound healing that produces more comfortable scar tissue and a pliant, comfortable repair.

Frequently Asked Questions About Hernia Meshes

Answered by Consultant James Kirkby-Bott

Q: What exactly is a mesh and what are the benefits of using a mesh?

A: Meshes differ in their sizes, shapes and materials, and are designed to

      • Minimise the impact of infection
      • Minimise the risk of recurrence
      • Minimise the risk of chronic pain

These are the three risks of hernia surgery we are trying to combat.

“The ProGrip mesh in particular comes in both polyester & polypropylene material with a layer of resorbable polylactic acid

A close up of ProGrip mesh showing the resorbable microgrips.

microgrips that integrate into the tissue, providing an alternative to traditional mesh fixation complications. It provides a true tension free repair without the risk of nerve entrapment through traditional fixation methods.”

Q: How is it fixed in place and can it migrate away from where it is supposed to be?

A: This depends on the mesh. Progrip is designed to be used without any other fixation, but I do tend to put in 2-3 loose dissolving sutures at the critical anchor points to be certain it won’t move.

In laparoscopic repairs we often do not fix the mesh as the fixation is a contributor to pain and chronic discomfort. However, this makes recurrence more likely and all the recurrences we have seen have been using a laparoscopic technique and no fixation of the mesh. I have recently started using a new glue to fix these meshes to minimise risk of chronic discomfort and recurrence.

Mesh does move – all the materials shrink in size by an area of around 20%. It is rare for mesh to migrate, but not unheard of.

Q: Is it permanent or does it dissolve?

A: Most meshes don’t dissolve, and meshes that do dissolve have higher hernia recurrence rates of around 10%. There is a new kind of mesh that does not fit into either group – this is the mesh that we use.

It is composed of 2 materials: A non-dissolving sheet that allows a scaffold for good embedding of new connective tissue, and a dissolving layer of little fasteners that embed into the posterior wall of the inguinal canal spreading any tension in the repair evenly over the 12×8 cm area of the mesh.

If these fasteners cause discomfort in the muscle, they dissolve at 6 months so they cannot cause chronic pain or discomfort. This mesh is called ‘Progrip’.

Q: Can you feel the mesh/can it cause pain?

A: I am not sure you can feel the mesh itself, but you can feel the new scar tissue and inflammation around the mesh from your repair. This persists for just over 12 months. You can perhaps feel an uneven edge if it catches on tissue, but this is rare.

Chronic pain tends to come from the fixation used rather than the mesh itself. A mesh placed and fixed without tension is the most comfortable – this is why I use the ‘Progrip’ mesh and, in laparoscopic surgery, a moulded mesh that moves less.

Q: Do you have to do anything to maintain the mesh?

A: No, there is nothing you can do to influence the mesh. You can, however, influence the wound healing. It is wound healing rather than fixation that causes the most long term discomfort. You do have some control over this and I describe this on our website.

To find out more about Medtronic and their hernia repair products, Click Here.

Other mesh used by Mr Kirkby-Bott

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