What are the most common complications of mesh-based hernia repair?

From the Guidelines

The most common complications for mesh-based hernia repair include chronic pain, infection, mesh migration, adhesions, seroma formation, and recurrence of the hernia, with chronic pain affecting approximately 10-30% of patients and infection occurring in about 1-8% of cases 1.

Common Complications

• Chronic pain: resulting from nerve entrapment or inflammatory reactions to the mesh, affecting approximately 10-30% of patients
• Infection: occurring in about 1-8% of cases, may require antibiotics or mesh removal in severe situations
• Mesh migration: happens when the implant shifts from its original position, potentially causing organ perforation or fistula formation
• Adhesions: can develop between the mesh and surrounding tissues, leading to bowel obstruction
• Seroma formation: fluid collections that typically resolve spontaneously but occasionally require drainage
• Recurrence of the hernia: rates with mesh are lower than non-mesh repairs (1-10% versus 15-30%), but still occur due to technical factors or mesh failure

Risk Factors

• Patient factors: obesity, smoking, and chronic immunosuppression can increase the risk of complications
• Surgical technique: proper technique and mesh selection can minimize risks
• Mesh properties: physical properties of the mesh itself can contribute to complications

Management

• Proper surgical technique and mesh selection can minimize risks
• Careful patient selection and management of risk factors can reduce complications
• Early detection and treatment of complications can improve outcomes According to a recent multicentre prospective observational study by De Simone et al. 1, early postoperative wound infection occurred in 21 patients (29.57%), and high ASA score, smoking, diabetes, chronic immunosuppression, previous hernia repair, and dirty surgical field were associated with wound complications. Another study by Han et al. 1 found that the use of human acellular dermal matrix (ADM) repair resulted in a very low rate of infection (1.6%) and recurrences (15.9%) in a follow-up of 43 months. The use of biological meshes, such as cross-linked mesh prosthetics, may offer a low-morbidity alternative to prosthetic mesh products in contaminated fields, with good results also in immune-compromised patients 1.

From the Research

Common Complications of Mesh-Based Hernia Repair

• Chronic pain: a severe complication of mesh-based inguinal hernia repair, affecting 11% of patients, with more than a quarter experiencing moderate to severe pain 2
• Mesh migration: an infrequent occurrence, but can lead to complications such as chronic abdominal pain, as seen in a case report of mesh migration into the cecum 3
• Mesh-related complications: can include mesh infection, mesh explantation, and adhesion-related chronic abdominal and pelvic pain 4, 5, 6
• Adhesion-related chronic abdominal and pelvic pain: a common cause of chronic pain after surgery, with limited treatment options and a need for further research on non-surgical analgesic treatments 5

Mesh-Related Complications by Hernia Type

• Inguinal hernia repair: lower rates of mesh infection (0.4%) and mesh explantation (0.4%) 6
• Umbilical hernia repair: low rates of mesh infection (0.0%) and mesh explantation (0.0%) 6
• Incisional hernia repair: higher rates of mesh infection (1.3%) and mesh explantation (3.0%) 6

Patient-Reported Outcomes

• Quality of life: improved in most patients after mesh-based hernia repair, but a significant percentage (2.9-4.4%) report severe or disabling symptoms at long-term follow-up 6
• Patient experience: themes emerged from interviews with patients who experienced mesh-related complications, including indicators of mesh-related complications, knowledge of potential surgical complications, and psychosocial impact of hernia repair and mesh-related complications 4