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Debate Over Core Causes of Chronic Pain After Hernia Repair


In case you are unfamiliar, a hernia is a condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it, often involving the intestine at a weak point in the abdominal wall. They are unsightly, unpleasant and painful, and can put a serious damper on your lifestyle – regardless of what it is.

Thankfully, in recent years, a new technique has emerged that make fix hernias relatively quick and easy by using a synthetic mesh to repair the gap. And while this procedure does save time and money for all parties involved, some surgeons aren’t convinced it is the best approach to take.

Dr. Michael Kavic, MD, a hernia surgeon and editor-in-chief of the Journal of the Society of Laparoscopic Surgeons, recently gave a presentation during a Minimally Invasive Surgery conference and call the occurrence of chronic pain after a mesh hernia repair a “potential time bomb for the surgical community and medical device suppliers.

“The surgical community, as well as the industry that garners huge profits from the use of synthetic materials, must address this troubling issue,” said Dr. Kavic, professor emeritus of surgery at Northeast Ohio Medical University and a leader in the field of hernia surgery. “The evidence is mounting that mesh, which was generally thought—and promoted—to be inert, now appears not to be so.”

As it would be expected, some surgeons do not share Dr. Kavic’s opinion.

“The number of people with chronic debilitating pain is around [4%] to 6% so I don’t think this qualifies as an epidemic,” said Dr. Guy Voeller, MD, a professor of surgery at the University of Tennessee Health Science Center, in Memphis. “While it may not be an epidemic, it is certainly an important issue and I agree with Dr. Kavic in that respect. I think we were always focused on recurrence rates prior to mesh introduction. I don’t think that we really looked at pain. It doesn’t mean it didn’t occur prior to mesh introduction and it doesn’t mean that mesh-based repairs are the cause.”

The use of synthetic mesh became popular as it seemed to solve the problem of hernias high recurrence rate, however, what it didn’t foresee or take into account was the chronic postoperative pain that occurs.

“I don’t think this is a matter of Chicken Little saying the sky is falling. The science is pretty good to show there’s a problem with chronic pain and the reason for the chronic pain is the mesh itself and the behavior of it. This could be far-reaching in its consequences.”

But how far-reaching? Medical malpractice lawsuits? Going after the corporations and manufacturers? The hospital being sued? The potential real for all of these until a set of unified guidelines is determined. Sadly, we cannot answer when that might happen.