Should You Use Degradable Mesh for Hernia Surgery? Expert Insights on Benefits and Risks

Is it recommended to use biodegradable mesh for hernia surgery?

My mother (59 years old) has been diagnosed with a hernia (a lump in the lower right abdomen near the groin).
She has had two cesarean sections and often lifts heavy objects, but she does not have any issues with hypertension, diabetes, or high cholesterol.
Her fasting blood sugar is 101 mg/dL.
I heard about a newer type of biodegradable mesh made from animal tissue, which promotes muscle growth and eventually breaks down and is excreted by the body.
Is it necessary to use this type of biodegradable mesh for a first-time hernia? Will it help reduce postoperative pain? Thank you!

Lan, 50~59 year old female. Ask Date: 2020/07/20

Dr. Chen Jiaming reply Surgery

Hernia surgery is a very common procedure in Taiwan, with approximately 30,000 surgeries performed each year.
The technique has evolved from traditional tissue repair methods to the current mainstream approach of tension-free repair using synthetic mesh.
A wide variety of synthetic meshes are continuously being developed; however, the recurrence rate of basic hernias, postoperative pain, and the skill of the surgeon performing the procedure are still significantly correlated.
Even with the synthetic mesh covered by national health insurance, excellent treatment outcomes (postoperative pain) can be achieved in the hands of a skilled surgeon.
Whether to opt for special synthetic mesh at the patient's or family's expense depends on the communication between the patient, family, and physician, and is not necessarily related to whether it is the first surgery (if managed well, it may very well be the only surgery needed in a lifetime).

Reply Date: 2020/07/20

More Info

When considering the use of degradable mesh for hernia surgery, it’s essential to weigh the benefits and risks associated with this option, especially in the context of your mother’s specific situation. Hernias, particularly inguinal hernias, are common, especially in individuals who have undergone previous abdominal surgeries or who engage in heavy lifting, as is the case with your mother.

Understanding Degradable Mesh
Degradable mesh, often made from biological materials derived from animal tissues, is designed to provide temporary support to the hernia site while allowing the body to heal naturally. The idea is that over time, the mesh will degrade and be absorbed by the body, ideally leaving behind a strengthened tissue structure. This contrasts with traditional synthetic meshes, which remain permanently in the body.

Benefits of Degradable Mesh
1. Biocompatibility: Since degradable mesh is made from biological materials, it tends to have a lower risk of rejection or adverse reactions compared to synthetic meshes.

2. Natural Healing: The mesh supports the tissue as it heals, potentially leading to a more natural integration with the body’s own tissues.

3. Reduced Long-term Complications: There is some evidence suggesting that using degradable mesh may reduce the risk of chronic pain and other complications associated with permanent synthetic meshes.

4. Less Foreign Material: As the mesh degrades, there is less foreign material left in the body, which may reduce the risk of complications related to long-term foreign body presence.

Risks and Considerations
1. Incomplete Support: One of the primary concerns with degradable mesh is that it may not provide sufficient long-term support for the repaired area, especially in cases where the hernia is large or the patient is at high risk for recurrence.

2. Variable Degradation Rates: The rate at which the mesh degrades can vary significantly among individuals, which may affect the healing process and the strength of the repair.

3. Potential for Recurrence: There is a possibility that the hernia could recur if the mesh degrades too quickly or does not provide adequate support during the healing phase.

4. Pain Management: While some studies suggest that degradable mesh may lead to less postoperative pain, this is not universally guaranteed. Pain management can depend on various factors, including the surgical technique used and the individual’s pain threshold.

Recommendations
Given your mother’s age and medical history, it is crucial to have a thorough discussion with her surgeon about the best surgical approach for her hernia repair. Here are some points to consider:
- Surgical Technique: The choice of mesh (degradable vs. synthetic) should be aligned with the surgical technique (open vs. laparoscopic) and the specific characteristics of the hernia.

- Individual Factors: Factors such as her overall health, activity level, and the size of the hernia should guide the decision-making process.

- Postoperative Care: Regardless of the type of mesh used, proper postoperative care and monitoring are essential to ensure a successful recovery and to address any complications that may arise.

- Pain Management: Discuss pain management strategies with the surgical team, as effective pain control can significantly impact recovery and quality of life post-surgery.

In conclusion, while degradable mesh presents an innovative option for hernia repair, it is essential to evaluate its suitability based on your mother’s specific condition and the surgeon’s expertise. Engaging in a detailed conversation with her healthcare provider will help determine the best course of action tailored to her needs.

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