What to Consider Before Hernia Repair
Learn the history and facts about mesh hernia repair for a more informed decision.
Despite litigation ads, hernia mesh repairs have a historically excellent track record. To understand why hernia mesh has developed a questionable reputation, it’s best to go back to the beginning.
The year was 1965, and young Americans injured on the battlefields of Vietnam needed to be patched up and shipped to State-side hospitals quickly. The Army, therefore, needed a go-to mesh patch.
During the Vietnam War, the U.S. Army used four different mesh patches, ultimately settling on a product called “Marlex,” which is a polypropylene woven mesh patented in 1959 as an industrial filter. This is basically monofilament fishing line that is woven together in a tight weave that has some give but does not break. At the time, soldiers who received the Marlex mesh generally did not get infected – despite the infection-prone field hospital conditions – but as they recovered, they were told that the mesh would eventually get infected and need repair in the US. Much to the military’s surprise, however, many of these soldiers have now gone fifty years or more with the initial mesh maintaining its structural integrity and still in place without infection or irritation.
Patients with hernias generally have failing fascia—a thin sheath of fibrous tissue enclosing a muscle or other organ. Hernias were historically repaired by laying down stretchy fetal fascia to replace the ailing fascia in patients. Consequently, areas of thin fascia stretched out and further hernias developed. Surgeons with experience in Vietnam during the war introduced Marlex mesh into mainstream medicine as a replacement for fetal fascia; Marlex was then used routinely in operations for hernias, whether in open repair or laparoscopic repair. The dramatic decrease in hernia recurrence that followed (from roughly 25% to 2%) was directly attributable to the use of mesh to buttress the weakened fascia of the abdominal wall.
With the expiration of the patent on Marlex in the late ‘90s, there was a dramatic increase in the number of mesh product competitors. Currently, the U.S. has about 120 FDA-Approved mesh products, some of which have very little clinical experience – certainly not decades worth. Along the way, some specific meshes have had less-than-stellar results.
Hernia Mesh Problems
It happens that one of the most litigated meshes ever invented, the Kugel patch, was developed in Auburn, WA. Dr. Kugel was particularly interested in hernia repairs and, like others, wanted to develop a better mesh. His mesh was two layers of Marlex with a wire rim attached that allowed for a different approach to the hernia repair. He was an effective salesman and sold his hernia patch approach quite widely, especially in the Seattle region. The University of Washington picked it up, taught the residents, and it later went worldwide and was bought out by Bard.
Unfortunately, some medical inventions are not successful in the long term. While the mesh of the Kugel patch was fine itself, the wire at the rim can break and stick into patients causing pain and/or infections as the wire erodes into bowel and bladder, etc. In the end, once that wire becomes a problem, the Kugel patch needs to be removed. Since there are thousands of people in the Puget Sound area with the Kugel patch in place due to its initial popularity, we will continue seeing mesh litigation ads in the region.
Proven Hernia Mesh Solutions
Dr. Wright has had inguinal hernias repaired on both sides himself and had his repaired with a single layer of polypropylene mesh (the old Marlex) because of the decades of experience with that mesh and the absence of significant problems. His practice has been to use proven, long-term, nonexperimental mesh in all of his patients throughout his career.
Dr. Wright trained in the era before mesh was in routine use and is very comfortable in performing inguinal hernia repairs without mesh, but because of the significant drop in the likelihood or re-operation, his practice is to do mesh repairs unless the patient feels very uncomfortable with that option.
Please contact our staff if you’re interested in our mesh repair policies, or if you’d like to schedule an examination.
Cascade Hernia & Surgical Solutions—We’re in network.
At Cascade Hernia & Surgical Solutions at Meridian Surgery Center, we listen to you to understand your concerns—and solve your nagging health problem—when it’s convenient for you.
We offer minimally invasive surgical solutions for GERD, hernia, gallbladder, melanoma, and more at a lower overall cost in a private setting. We’re in network with most major insurance plans.
Think you have a hernia? Make an appointment for a consultation today. Call (253) 840-1999. Often, you can get an appointment on the next weekday. Learn more at www.cascadehernia.com. Stay connected with Cascade Hernia & Surgical Solutions: Follow us on Facebook.
# # #