Page 52 - herina surgery and possible lawsuits

There is little evidence that recurrence is related to the type of mesh used, although it
has been proposed that light-weight meshes have a higher risk due to their increased

flexibility and movement. [85]

• Two-thirds of recurrences occur after 3 years (median, 26 months). [82]

• This suggests that a technical error is unlikely to be the only cause of recurrence and
defective collagen synthesis may be equally important.
• All meshes cause a foreign body reaction which has an effect on the ratio of Type I and

III collagen synthesized.[85]
• Altered ratios of collagen affect both tensile strength and mechanical stability and may

increase the risk of recurrence. It is not clear if the type of mesh used has any effect
on this. [85]

Pain

Meshes are associated with a reduced risk of chronic pain compared to suture repair. It is
thought to be related to the ability to use tension-free technique rather than the mesh itself.
However, pam remains a serious complication of mesh repair and can occur up to 40% of

hernia surgeries [99]. With regards to acute postoperative pain, there is little difference m the
type of mesh used. Chronic pam following hernia repair has gamed increased recognition and
may be because of foreign body reaction of mesh or nerve(s) injury.[16, 91]. Explants

removed for chrome pam are found to have nerve fibres and fascicles around the foreign
body granuloma within the mesh. Neuroma were found at the interface of mesh and host
tissue suggestmg mechanical destruction of nerves by mesh. It follows that meshes with small

pores and greater foreign body reaction, will cause higher rates of chrome pain.[80, 100] Pam
described in separate chapter.

Mesh degradation

Degradation of meshes is rare and mamly seen in polyester meshes and may be due to
hydrolysis, resulting m brittleness and loss of mechanical strength. [82] Calcification can also
occur but has only been documented in meshes with small pores. [101]

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