Hernia mesh can shrink, harden and degrade and complications are becoming more common, says leading surgeon
PUBLISHED: 07:30 29 August 2018 | UPDATED: 14:05 09 October 2018
A surgeon has hit out at claims that hernia mesh does not cause life altering pain after a British clinic boasted it had not seen a single problem in 30 years.
The polypropylene material used for hernias is the same, albeit of different fibre size and weight at times, as that used for women’s pelvic mesh implants which were suspended across the UK in July after a senior Tory peer said she was appalled at the tragic risks.
The plastic can twist, harden, shrink, cut, erode or degrade once implanted, which has been confirmed in nearly 500 mesh explants.
But the British Hernia Centre (BHC) claims the material and their implanting method to fix hernias is safe and the problems only affect women’s pelvic mesh with issues originating mainly in America.
Canadian surgeon Robert Bendavid said the claims are “preposterous” and the UK has been more effective than America in raising the issues.
Meanwhile, American surgeon Kevin Petersen says he has received calls from former patients of the British Hernia Centre suffering pain.
Dr Bendavid, who pioneers a non mesh hernia repair called the Shouldice Method, said: “Knowing the march of events of mesh hardening, stiffening, erosion, degradation, it is difficult to understand why surgeons use it so freely and without reservation, when an alternative is available and is just as effective.
“It only demands knowledge of basic anatomy.
“In the last two years there have seen several studies with nearly a million patients to prove the point.
“Studies from the Mayo Clinic and the University of Toronto being the largest. In the latter of 216,000 patients with a 16 year follow-up, the mesh repairs were seen to have five times the recurrence rate of the Shouldice repair by experts of the Shouldice Hospital.
“The Shouldice Hospital was unaware of the study which was carried out independently by the Institute for Clinical Evaluative Sciences (ICES), and independent and outstanding statistical team of the University of Tornto.
“The BHC statement is dubious and defies statistical happenstance as well as logic.
“It relies on ignorance of the public. The complication of hernia mesh pain is becoming more common and is forcing us to consider expansion of our mesh removal service.”
Sling The Mesh campaign, with more than 6,500 members, has a growing number of people join suffering life altering pain from hernia mesh.
In America there are 100,000 cases in courts associated with women’s mesh issues, while 50,000 court cases involve hernia mesh repairs, Dr Bendavid said.
However, a BHC spokesman strongly denied it was a problem and said: “We need to make it perfectly clear that the mesh we use and the open techniques we employ are in no way implicated or involved in these matters.
“It needs to be understood that in hernia repair, using our technique, the mesh should not come into contact with anything significant other than the muscle and tendon tissue that has herniated within the abdominal wall structure.
“The internal organs, contained within the peritoneal cavity, are not even touched in the normal course of this procedure. This applies to both genders.
“It is important to distinguish between the two types of surgery and to recognise that the claimed problems do not apply at all with hernia repair.
“The British Hernia Centre bases its opinion on our experience of many tens of thousands of cases over three decades and not a single case suffering these complications.”
Dr Bendavid said their claims might be more believable if supported by an editorial in a surgical journal or the Royal College of Surgeons, but above all by verifiable statistics from the BHC.
“The BHC techniques means the mesh is in contact with organs, the bladder, the distal portion of the fallopian tubes in women, the femoral or iliac arteries, veins and all nerves nearby, as well as creating a foreign body response,” he said.
“In time, the very peritoneum that protects the internal organs at first, becomes adherent to the mesh and eventually to internal organs.
“In the long run the method used by the BHC namely, the preperitoneal space, is the very space where one finds the genito-femoral nerve, and invariably the femoral branch of the genito-femoral nerve, which is often implicated in chronic post-operative pain.
“No mesh technique is devoid of the possibility and likelihood on time, of complications. Our longest recorded case lasted 24 years before mesh removal.
“Importantly for men the mesh is in contact with the vas deferens whose muscular coating is non existent in the pre-peritoneal space.
“Many men suffer mesh shrinking and eroding into their vas deferens causing excrutiating pain and loss of sex life, that it is referred to in the European Hernia Society’s International guidelines as dysejaculation (3.1-4 per cent) and sexual pain (10.9 per cent) in men.”
• In the UK treatments used in NHS hospitals are supposed to be based on NICE guidelines. There are no NICE guidelines for hernia mesh. When asked why, the NICE press office said it was because nobody had asked them to produce any.
• British Hernia Centre statement
• Sling The Mesh Hernia Voices page
• David Urbach in his follow-up of 216,000 cases over 14 years proved that non mesh suture repairs of the Shouldice Hospital gave five times better results than all the techniques known and practiced elsewhere in Canada.