Hernia Mesh Removal

Doctors remove hernia mesh for a few reasons, but mostly because the mesh shifts, wrinkles, erodes into organs or causes other serious or painful complications. Hernia mesh pain is the most compelling reason for removal surgery. Hernias can also recur, requiring the original mesh to come out.

“The types of injuries that we see following [hernia mesh surgery] are infections and fistulas and things like that,” Daniel Nigh, a product liability attorney involved with hernia mesh litigation, told Drugwatch. “Any time we see those types of injuries, almost without exception, they require another surgical intervention to repair the problem that was caused by the original implant.”

Doctors use mesh — a net-like implant that bolsters weak tissue and supports organs — in more than 90% of hernia repairs. Mesh’s prevalence has led to an increased number of removal procedures, even though removal rates are static. If post-surgery tests detect infections, prevailing medical advice is to remove the mesh sooner rather than relying on other longer-term strategies to treat the infection.

A comprehensive study of mesh removal showed the reasons for removal differed by location: pelvic mesh (91% for pain) vs. abdominal mesh (43% for infection). A 2023 study showed that the longer the time between a patient’s original hernia mesh procedure and their revision surgery, the more likely they are to see a reduction in pain. But, the study said, physicians should not avoid removal surgery based on a long duration of bothersome symptoms when there is a connection between the symptoms and the location of the mesh.

Hernia mesh removal surgery addresses complications from the placement of hernia mesh. It is almost always a complicated surgery because implanted mesh integrates with abdominal tissues. The more the mesh integrates, the more complex the removal.

Surgeons may need to remove all or part of the mesh in addition to tacks that keep it in place. Then, if possible, they rebuild parts of the abdominal wall to prevent future hernias. When a patient has damaged tissue, the surgeons may need to implant new mesh to prevent hernia recurrence.

Doctors use several surgical methods to remove mesh: laparoscopic, robotic or traditional surgery. The type of surgery depends on the location of the mesh, the type of mesh that doctors used in the original hernia repair surgery and the patient’s complications, condition and overall health.

Laparoscopic or Minimally Invasive Surgery

Laparoscopic surgery, or minimally invasive surgery, requires three small incisions in the abdomen. The surgeon inflates the abdomen with gas and inserts a camera through the belly button. Next, surgical instruments are inserted through the other incisions, allowing the doctor to cut the mesh out and avoid damage to other structures.

Pros and Cons of Laparoscopic Surgery

A 2024 study published in Surgical Endoscopy found that intraperitoneal onlay mesh (IPOM) repairs for ventral hernias have a low rate of long-term complications. Out of 325 patients, only two required reoperation due to mesh-related complications (0.62%). The study concluded that this procedure is a safe and effective option for surgeons to repair small to medium-sized hernias.

Additionally, 16 patients required reoperation for reasons unrelated to the mesh, such as hernia recurrence or other intraabdominal issues. 

A 2023 study of 503 people from Wuxi Rehabilitation Hospital in China reported that when a patient has a laparoscopic inguinal hernia procedure from a doctor who has passed the learning curve on the technique, surgery times are shorter and bleeding and pain outcomes are better.

Robotic Surgery

Robotic surgery, or robotic-assisted surgery, is another minimally invasive surgery that enjoys a high success rate. Surgeons use a console, called the da Vinci Surgical System, to make precise cuts and to cauterize, grasp and retrieve the mesh.

Surgeon Anthony Gielow, who performs hernia operations for Orlando Health, said robotic surgery is often “far easier” than traditional or laparoscopic hernia surgery for some doctors because of the procedure’s complexity. Some doctors prefer robotic surgery for people who are obese or who have complicated conditions.

Pros and Cons of Robotic Surgery

A 2021 study documented 29 hernia mesh removals by robotic surgery from 2016 to 2020 and determined the technique “an advantageous platform” for mesh repair in complex cases. More than 65% of people didn’t need a second mesh implant, while 17.2% did. Only one person in the study reported a recurrence of a hernia.

The most common complication was seroma formation (a buildup of fluid in a tissue pocket), experienced by two people. However, robotic procedures, while increasingly common, have a particular set of complications, including technical difficulties and computer system errors.

Traditional or Open Surgery

Traditional hernia repair, also called open surgery, is the most invasive of the three techniques. A surgeon makes a 5-6 cm incision, then finds the spermatic cord, the ilioinguinal nerve, the hernia sac and hernia. Although two nonmesh procedures exist, most doctors opt for mesh repairs, which have lower rates of hernia recurrence, a low risk of injury and shorter hospital stays.

As recently as 2021, about 70% of inguinal hernia repairs were open surgery. That rate has decreased as laparoscopic and robotic techniques have gained more acceptance and techniques have advanced. A doctor may perform open surgery on a patient who is older or who has health circumstances that prevent the patient from having either of the other two procedures.

Pros and Cons of Traditional (Open) Surgery

Open surgery requires larger incisions and more cuts in muscles and tissues. That’s why people experience more post-op discomfort and require a longer time to get back to normal activities. Doctors may combine open mesh removal with laparoscopic techniques to limit tissue and organ damage.

Patients can expect pain for one or two days. Sometimes people have post-surgery bruising in their groin. If you experience swelling, call your doctor.

The biggest benefit of having mesh removed is fixing the symptoms that brought you to surgery in the first place: pain, infection or another life-altering complication. If you have severe chronic pain, the benefits of surgery may outweigh the risks. However, there are no guarantees that your pain will go away after mesh removal.

A hernia mesh removal procedure comes with risks. Ongoing pain, infection, excess bleeding, numbness and hernia recurrence are among the possible outcomes. Studies show some people who had robotic surgery had broken or burned instrument pieces left inside them.

For hernia patients who first had mesh implanted more than 70 months prior to a mesh removal procedure, revision surgery delivers better results for reducing pain, according to a 2023 study published in the journal Hernia. Before undergoing a mesh removal procedure, talk to your doctor about the benefits and risks of surgery.

People who undergo hernia mesh removal surgery often experience financial and emotional loss and seek compensation from mesh makers by filing a lawsuit. They may lose time from work before and after the procedure, and sometimes their pain is so great that they file for short- or long-term disability. Medical bills can pile up.

Further, pain and other complications commonly lead to emotional distress: Life might not feel the same, and it may not be clear if it ever will.

As of October 2024, there were 26,410 hernia mesh lawsuits pending in federal multidistrict litigations against Atrium, Bard Davol, Covidien and Johnson & Johnson’s Ethicon unit. Bard Davol paid out $184 million in 2011 to patients who suffered complications from its Kugel Patch. J&J settled 161 cases in June 2023, although financial details are not yet public.

Bard won one bellwether hernia mesh trial in 2022 but lost two others. The second verdict awarded $4.8 million to the plaintiff. Attorneys in all 50 states are taking cases for hernia mesh removal claims. They recommend people tell their surgeons to preserve the mesh after removal surgery.