Mesh Controversy
Recently there has been some discussion into the validity of mesh. This was due to the use of
mesh in repair of the pelvic floor (not inguinal hernias). Mesh placed incorrectly can cause
problems.
Mesh is indicated in inguinal hernia repairs and has been used successfully for over 30
years. The NZ General Surgical Association recently released a statement affirming the
above.
New Zealand Association General Surgeons position statement Mesh hernia repair
There has been much controversy in the media recently regarding transvaginal mesh prolapse
repair and its potential associated risks of infection, erosion and chronic pain.
- Unfortunately, the media have portrayed the outcomes of this one gynaecological
procedure to include all surgical use of mesh for hernia repair. It has caused
unnecessary widespread patient stress and anxiety throughout New Zealand. The use of
mesh in General Surgery to repair hernias of the groin or the abdominal wall is well
established internationally and is considered the procedure of choice.
- For ventral hernias with fascial defects greater than 2cm in diameter mesh must be used
to reinforce the tissue repair.
- If not the hernia recurrence rate without mesh is unacceptably high. For groin hernia
repair most surgeons worldwide use mesh for the repair. The use of mesh for abdominal
and groin hernia repair is safe. Chronic pain may occur after hernia repair in less than
10% of patients. However, it is important to remember that chronic pain after groin
hernia repair is higher for patients having non-mesh repair compared to mesh repair.
- Mesh infection after abdominal hernia repair is uncommon, less than 1 %.
- For laparoscopic inguinal hernia repair it is even lower.
The use of surgical mesh is an important part of the curriculum for general surgical training
and NZ general surgeons have extensive experience in the use of mesh for hernia repair.
The good results of mesh hernia repair in general surgery should not be bought into disrepute
by categorising all mesh repairs as the same.
Steven Kelly, General Surgeon, Christchurch on behalf of the Executive, New Zealand
Association of General Surgeons (NZAGS)
