What causes nausea and upset stomach after incisional hernia repair with mesh?

Causes of Nausea and Upset Stomach After Incisional Hernia with Mesh Repair

Nausea and upset stomach following incisional hernia repair with mesh are most commonly caused by mesh-related complications, particularly early mesh infection or inflammatory response to the prosthetic material, which may require prompt evaluation to prevent serious morbidity and mortality.

Primary Causes

1. Mesh-Related Complications

• Mesh infection: Occurs in approximately 1.9-5% of cases 1

  • Early signs include nausea, upset stomach, and localized inflammation
  • Can develop immediately post-surgery or present months later (average onset 15 months) 2
  • Common pathogens include Staphylococcus spp., Enterococcus spp., and Gram-negative bacteria 1

• Inflammatory response to mesh material:

  • Different mesh types trigger varying degrees of inflammatory response
  • Polypropylene mesh (most commonly used) can cause significant tissue reaction 1
  • Material-specific reactions: biomaterial mesh has higher rates of adverse reactions (57% vs 7% for other materials) 3

2. Surgical Complications

• Bowel manipulation during surgery:

  • Temporary ileus (slowed bowel function) causing nausea and upset stomach
  • More common with extensive adhesiolysis during repair

• Enterotomy or inadvertent bowel injury:

  • Can occur during dissection, especially in complex incisional hernias
  • Associated with higher risk of mesh infection (OR 5.17) 1
  • May lead to peritonitis causing nausea and abdominal discomfort

• Intestinal obstruction:

  • Partial obstruction from adhesions to mesh
  • Intestinal complications reported in 7% of mesh-related adverse events 3

3. Patient-Specific Risk Factors

• Obesity:

  • Significant association between BMI and post-operative complications (p<0.001) 4
  • Higher risk of seroma formation and wound infection

• Diabetes mellitus:

  • Significantly associated with post-operative complications (p=0.005) 4
  • Impairs wound healing and increases infection risk

• Medication effects:

  • Post-operative analgesics, particularly opioids
  • Anesthesia-related nausea

Diagnostic Approach

When evaluating nausea and upset stomach after incisional hernia repair:

1. Assess timing of symptoms:

   • Immediate post-operative: likely related to anesthesia, ileus, or medication
   • Delayed onset (days to weeks): consider infection or inflammatory response
   • Late onset (months): suspect chronic mesh infection or adhesions

2. Physical examination:

   • Look for localized tenderness, erythema, or drainage at the surgical site
   • Check for fever, tachycardia, or other signs of systemic infection

3. Laboratory evaluation:

   • CBC to assess for leukocytosis
   • Culture of any wound drainage

4. Imaging studies:

   • CT scan to evaluate for fluid collections, abscess, or mesh displacement
   • Ultrasound to identify seromas or hematomas

Management Algorithm

1. For early post-operative nausea (1-3 days):

   • Conservative management with antiemetics
   • Ensure adequate pain control
   • Early ambulation to promote bowel function

2. For persistent symptoms (>3 days) or worsening symptoms:

   • Evaluate for surgical site infection
   • Consider imaging to rule out collections or obstruction
   • Early and adequate local source control with antibiotics 1

3. For confirmed mesh infection:

   • If infection persists >3 months, complete surgical removal of mesh is often necessary 1, 2
   • Mesh removal carries significant morbidity (54% post-operative complications) and mortality (12%) 2

Prevention Strategies

• Preoperative optimization:

  • Weight management (target BMI <40 kg/m²)
  • Diabetes control (target HbA1C <7%) 5
  • Smoking cessation

• Surgical technique:

  • Minimize operative time
  • Avoid enterotomy
  • Consider mesh type based on patient risk factors
  • Ensure adequate mesh overlap (3 cm) of defect 5

• Postoperative care:

  • Early mobilization
  • Appropriate wound care
  • Monitoring for early signs of infection

Important Caveats

• Nausea and upset stomach may be the earliest signs of mesh infection before more obvious signs develop
• Delayed diagnosis of mesh infection can lead to serious complications including enterocutaneous fistula and sepsis
• Mesh infection is more likely in emergency repairs with concurrent bowel resection (38% wound infection rate) 6
• The type of mesh material significantly impacts complication rates - consider this when evaluating symptoms 3

Early recognition and treatment of mesh-related complications are essential to prevent progression to chronic infection requiring mesh removal, which carries significant morbidity and mortality risks.