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Hernia Mesh Facts

Information About Hernia-Mesh Complications

What Is a Hernia?

A hernia appears as a lump under your skin. What’s actually happening is that an internal organ, muscle, or tissue is bulging out of its normal position through a hole or weakness in the muscle or tissue surrounding it. Most hernias occur somewhere along the abdominal wall, but they are possible in other places like a forearm.

There are many technical terms for where the hernia occurs on the body. They are:

  • Inguinal hernia: In the inner groin. Usually when a piece of the intestines pushes through a weak spot in the lower abdominal wall. About 70% of hernias are inguinal.
  • Femoral hernia: In the outer groin/upper thigh.
  • Umbilical hernia: At the bellybutton. Though this hernia sounds exclusive to pregnancy, it’s not. This is when part of the intestine protrudes through the umbilical opening in the abdominal wall, which does not always close in adults.
  • Ventral hernia: Elsewhere on the abdominal wall.
  • Bilateral hernia: When an inguinal hernia is on both sides of the body, opposite each other. Usually on both sides of the pubic bone or in both groins.
  • Hiatal hernia: Between the upper stomach and diaphragm. This occurs when a piece of your stomach pushes up through your diaphragm in the hiatus (the small opening where your esophagus passes through). Most of the time, this type of hernia causes no problem; however, a large hiatal hernia allows food and acid to splash back up, causing heartburn. Medications can relieve the symptoms, but the only cure for a large hernia is surgery.
  • Incisional hernia: At a previous incision/scar site, which has "tension" in the scar and weakness in the surrounding area.
  • Muscle hernia: Also called "myofascial defects," these occur when a muscle’s belly protrudes through its "fascia" or top layer of connective tissue holding the muscle together. They are more common in the lower extremity (legs) but possible in the upper extremity (arms).

What Causes Hernias?

Though hernias can be caused congenital openings in the tissue or muscle, they are usually caused by strain. Intense or repetitive activity tends to strain an area, and if the muscle is weak, the tissues or organs can be forced through.

For example,

  • Pregnancy
  • Chronic coughing or sneezing
  • Previous abdominal injury or surgery
  • Constipation
  • Sudden gain in weight
  • Lifting heavy weights

are factors that strain your abdomen, making you more likely to suffer a hernia. Hernias can build over time or develop very quickly. Often, the only indication is a small bump. Though you can try to strengthen the surrounding muscles with exercise, this sometimes makes a hernia worse and should only be attempted with proper medical guidance.

Treatment for Hernias

A hernia is not necessarily dangerous by itself, and doctors will often do "watchful waiting" (that is, monitoring) on the hernia. As long as the hernia is not getting larger or causing other problems, you probably don’t need surgery. If, however, the hernia gets larger or causes severe pain, surgery is the only fix. Untreated hernias do not go away on their own. There are two ways doctors can go in and repair the hernia:

  • Laparoscopic surgery: Also called minimally invasive surgery (MIS) or keyhole surgery, this procedure is done through several small incisions, just large enough to fit the surgical tools through. Hernia mesh is sometimes used, sometimes not, to cover the hernia site.
  • Open repair: This is a when the surgeon cuts open the area near the hernia and goes in to repair it. The protruding tissue is tucked back in and the muscle or connective tissue hole is stitched closed, with or without hernia mesh.

Surgery without a mesh is called herniorrhaphy. Surgery with a hernia mesh is hernioplasty. Mesh was first used in the 1940s, but became prevalent in the 1980s. Today, an estimated 90% of hernia repair surgeries in the United States use mesh.

What’s in a Hernia Mesh?

A hernia mesh is a patch of thin, woven fibers meant to cover and strengthen the body’s muscle wall, supporting the contents inside. There are holes in the weave of the mesh, meant to allow the body’s muscle to integrate into the mesh.

Meshes are made out of natural materials (like pig intestine) as well as synthetic materials.

  • Animal-derived mesh: Animal-derived mesh is an example of absorbable mesh, which the body breaks down over time. According to the FDA, "As the material degrades, new tissue growth is intended to provide strength to the repair."
  • Synthetic mesh: A permanent or non-absorbable mesh, usually made out of plastics like polypropylene, polyester and ePTFE. Different brands and types have different "blends."
  • Composite mesh: Many hernia meshes are made of synthetic polypropylene. "Composite meshes" are devices (usually made of polypropylene) that have a barrier coating on the mesh. This coating is also referred to as a "prosthesis" or "film" surrounding the mesh. This coating is intentionally absorbable, but these composite meshes often cause serious problems when put in contact with the intestines.

Hernia meshes come in a few sizes: plugs, patches, and sheets. Plugs go inside the muscle wall into the actual hole. Patches go over the muscle wall, covering and reinforcing the weak spot. Sheets can be cut to custom shapes to fit the particular hernia.

During surgery, the mesh is either stapled, stitched, or glued over, under, or inside the herniated area. Sometimes the tear in the muscle wall is sutured shut first.

What Can Go Wrong After a Hernia Mesh Implant?

Lots of things. Many mesh manufacturers, including Ethicon, Bard Davol, and Atrium Medical have been forced to issue recalls. Here are some common adverse events associated with hernia mesh, which may require additional surgery to fix:

  • Adhesions where the internal organs (usually the bowels or intestine) grow into or attach to the mesh. Usually, when this happens, portions of the organs will have to be removed along with the mesh.
  • Bowel obstructions because of adhesions. This means a patient will have trouble defecating, constipation, and diarrhea.
  • Infection of the mesh itself or the surrounding tissue. This usually requires removal.
  • Pain could be caused by any of the above problems. Chronic pain is pain lasting longer than three months, and should not be present after a hernia repair surgery.
  • Fever in response to the body’s rejection of the mesh or internal infection.
  • Seroma is a fluid buildup surrounding the mesh.
  • Immune system reactions like swelling, joint pain, sweating, fever, nausea, headache, or vomiting.
  • Fistulas are abnormal connection "tunnels" between internal organs, or, in this case, an internal organ and the hernia mesh.
  • Kidney or liver failure has been noted in patients with composite meshes, due to the extra strain the "absorbable" coating puts on the body’s waste system.
  • Meshoma, when the mesh itself migrates, bunches up, or hardens into a tumor-like lump.

What’s Wrong with Composite Mesh?

As the field of hernia surgery has advanced, laparoscopic mesh placement has become more prevalent. While laparoscopic surgery generally reduces complications and shortens recovery time; the use of mesh in these surgeries is associated with a higher risk of adhesions.

Mesh manufacturers marketed this "special coating" as reducing the risk of adhesions in patients, good for either laparoscopic or open surgery. The coating is supposed to be absorbed by the body naturally while the polypropylene stays put. However, the coating takes six months or more to break down, while the body starts to heal immediately. This means the body cannot property integrate the mesh into the wound during the critical post-op healing period.

Also, during laparoscopic surgery, the hernia mesh often comes into contact with internal organs, deeper in the bowels. This can be disastrous if the mesh scrapes, adheres, or integrates into the organs.

In a nutshell, composite meshes do not properly integrate with the body. The "barrier film" on the mesh, instead of protecting patient, actually makes it more dangerous.

If you’ve suffered any of the above symptoms or had to get revision surgery, there is help available. Call Rhine Law Firm, P.C., at (866) 772-9960 to speak to a defective medical device attorney. We are currently pursuing litigation against several brand name manufacturers of hernia mesh. Your consultation is free, confidential, and no-obligation. We will let you know if we can help you receive just compensation from these companies.

There is a time limit on how long you have to file, so please call us today. The sooner we can get started gathering information on your case, the better your outcome will be.

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