Is Mesh safe for hernia repair?

The use of mesh in hernia repair has become controversial over the last decade or so. What is the truth about the concerns around mesh repair of hernia? Is mesh safe? This short video seeks to address this from the perspective of research evidence.

Chronic pain after mesh versus non-mesh repair of inguinal hernias: A systematic review and a network meta-analysis of randomized controlled trials
Stina Öberg 1, Kristoffer Andresen 2, Tobias W Klausen 3, Jacob Rosenberg 2
Surgery 2018 May;163(5):1151-1159. doi: 10.1016/j.surg.2017.12.017.
Epub 2018 Mar 13. PMID: 29506882 DOI: 10.1016/j.surg.2017.12.017

Abstract
Background: Chronic pain affects 10%-12% of patients after inguinal hernia repairs. Some have suggested that less foreign material may theoretically prevent pain. If the prevalence of chronic pain is less after nonmesh repairs, selected hernias might be repaired without mesh. Our aim was to clarify if nonmesh repairs are superior to mesh repairs regarding chronic pain.

Methods: For this systematic review, searches were conducted in five databases. The main outcome was chronic pain reported a minimum of six months after mesh and nonmesh repair in adult patients with a primary inguinal hernia. Only randomized controlled trials (RCTs) were included.

Results: A total of 23 RCTs with 5,444 patients were included. The median follow up was 1.4 years (range 0.5-10). Twenty-one studies reported crude chronic pain rates, and when considering moderate and severe pain, the prevalences of pain after nonmesh repairs and mesh repairs were similar: median 3.5% (0%-16.2%) versus median 2.9% (0%-27.6%), respectively. Both the meta-analyses and the network meta-analysis indicated no difference in chronic pain rates when comparing nonmesh repairs with open- and laparoscopic mesh repairs.

Conclusion: Mesh may be used without fear of causing a greater rate of chronic pain.