From the Guidelines
The overall complication rate associated with mesh use in hernia repair is approximately 1-8% for mesh infection, with a crude mesh infection rate of 5% as reported in a systematic search published in 2011 1.
Complications and Risk Factors
Complications can be categorized as mesh-related or non-mesh-related issues. Common mesh-related complications include:
- Seroma formation (fluid collection)
- Chronic pain
- Mesh infection
- Mesh migration
- Mesh shrinkage The risk of complications varies based on patient factors, such as smoking status, with a relative risk (RR) of 1.36 for mesh infection 1, and American Society of Anesthesiologists (ASA) score ≥ 3, with a RR of 1.40 for mesh infection 1.
Mesh Type and Complication Rate
Synthetic meshes are easy to handle and well tolerated; however, they can be potentially associated with infection when bacteria adhere to the synthetic material leading to chronic infection 1. Biological meshes can confer protective factors such as resistance to infection and high biocompatibility when implanted 1.
Surgical Technique and Complication Rate
Proper surgical technique, appropriate mesh selection, and perioperative antibiotic prophylaxis can significantly reduce complication rates. Most complications occur within the first year after surgery, though some like chronic pain and mesh migration may develop years later.
Recent Guidelines and Recommendations
The 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias suggests that mesh hernioplasty is crucial to prevent recurrence and that it is safe for repairing acutely incarcerated hernias, even in case of intestinal resection 1.
From the Research
Overall Complication Rate Associated with Mesh Use in Hernia Repair
- The overall complication rate associated with mesh use in hernia repair varies depending on the type of hernia, mesh material, and surgical technique 2, 3, 4, 5, 6.
- A study published in JAMA found that the cumulative incidence of mesh-related complications at 5 years of follow-up was 5.6% for patients who underwent open mesh hernia repair and 3.7% for patients who underwent laparoscopic mesh repair 2.
- Another study published in the Journal of the American College of Surgeons reported that rates of mesh infection varied by hernia type, with lower rates after umbilical (0.0%) and inguinal (0.4%) repair, and highest after incisional repair (1.3%) 3.
- A meta-analysis published in PloS one found that the mesh-associated complication rate was 1.9% for patients who underwent laparoscopic mesh-augmented hiatoplasty 4.
- A systematic review and meta-analysis published in Surgery found that biologic meshes resulted in increased hernia recurrences and surgical site infections compared to synthetic meshes 5.
- A study published in Surgical infections found that mesh infection after hernia repair is associated with significant morbidity and costs, including hospital re-admission, re-operations, and recurrences 6.
Mesh-Related Complications
- Mesh-related complications can include infection, explantation, and recurrence 2, 3, 4, 5, 6.
- The risk of mesh-related complications can be influenced by factors such as mesh material, surgical technique, and patient characteristics 2, 3, 4, 5, 6.
- Strategies to prevent mesh infection and identify patients most likely to experience infectious complications are needed to reduce the risk of mesh-related complications 6.
Quality of Life and Outcomes
- Patients who undergo hernia repair with mesh can experience improved quality of life and reduced symptoms 3.
- However, a significant percentage of patients can experience severe or disabling symptoms at long-term follow-up 3.
- The use of mesh in hernia repair can reduce the risk of recurrence, but may also increase the risk of mesh-related complications 2, 3, 4, 5, 6.