Hernia Mesh Infection

Hernia mesh infections, deep infections that occur around the mesh implant, can cause serious symptoms that may occur within weeks to years after surgery. According to research published in Clinical Microbiology and Infection, “Mesh infections can manifest with chronic, persistent or recurrent symptoms and signs.”

If you experience any of these signs of infection, contact your doctor immediately.

Though pain after hernia mesh surgery is relatively common, experiencing it in combination with flu-like symptoms may be cause for concern.

“Chronic pain occurs in 3-10% of inguinal hernias,” Dr. Mazen Al-Mansour, a hernia mesh surgeon and assistant professor at the University of Florida College of Medicine, told Drugwatch. “Other less common complications such as mesh infection or intestinal fistula are about 1%.”

How Long After Surgery Can Symptoms Appear?

According to a 2023 study in BJS Open, hernia surgical site infections can occur any time within 90 days after surgery, based on assessments that comply with the Centers for Disease Control criteria.

An earlier 2016 study in the Chinese Medical Journal found the median time between hernia surgery for inguinal or incisional hernia repair and mesh infection was 17 months.

Most hernia mesh infections are caused by bacteria. Common culprits include Staphylococcus (staph) and Enterobacteriaceae. Risk factors include mesh design, type of surgery and preexisting health conditions.

Mesh Design

Mesh choice is crucial for resistance to infection, according to a 2024 study in Trauma Surgery & Acute Care Open.

While infection can occur with any type of mesh, some mesh designs carry higher rates of infection. For example, mesh made from materials such as extended polytetrafluoroethylene (ePTFE) and polyethylene terephthalate (polyester) are more likely to become infected.

Meshes with smaller pore sizes are more susceptible to infection. Bacteria can stick to the small pores, making it difficult for immune cells to reach and eliminate them.

“Some types of mesh are more susceptible to biofilm formation than others. It is suggested that lightweight mesh with larger pore size may work as they may be less susceptible to infection than heavyweight mesh with larger pore sizes,” the study’s authors wrote.

Type of Surgery

The type of hernia surgery a patient undergoes matters in determining the risk of infection. The same 2024 study shows that laparoscopic approaches are typically safer, with infection rates averaging 3.6%, compared to open procedures, which pose a higher risk of infection ranging from 6% to 10%.

In a ventral hernia, when mesh is placed in the retrorectus position (behind the main abdominal muscle), the researchers found that the risk of infection is greatly reduced from 26% to 2%. However, in cases of emergency surgery or contamination of the surgical field, the risk of infection can be higher.

Preexisting Health Problems

A person’s risk for mesh infection increases if they have preexisting health conditions. These include diabetes, abnormal wound or skin issues, immunosuppression, COPD and obesity.

People who smoke and have recurrent hernias are also at greater risk of developing infection.

Recalled Mesh

According to the U.S. Food and Drug Administration, many of the reported hernia mesh complications, including pain and infection, were associated with the recalled mesh.

The FDA monitors the safety of hernia mesh through various sources, but it acknowledges that passive surveillance has limitations. The agency has received over 55,000 reports of complications such as pain, infection and hernia recurrence.
FDA literature reviews show varying rates of complications, including mesh ranging from 0% to 1.4%, with no significant difference between different types of mesh.

Lifestyle changes before hernia surgery are among the most recommended ways of preventing hernia infection.

“The risk [of infection] is minimized by encouraging preoperative weight loss, smoking cessation and ensuring blood glucose is well-controlled, as well as sterile surgical technique and the use of antibiotics during the surgical procedure,” Dr. Al-Mansour said.

A 2024 study published in the medical journal Cureus identified obesity, diabetes and comorbidities as strongly associated with complications including infection. Gender and smoking showed weaker correlations.

However, body mass index showed a significant relationship, with obesity posing a substantial risk. The researchers concluded that these findings underscore the importance of appropriate counseling, optimized care during and after surgery and preventative measures to improve surgical outcomes in hernia repair.

Doctors typically treat infections with antibiotics. Doctors may prescribe oral antibiotics for mild cases, while more serious cases may require hospitalization with intravenous antibiotics. In the most severe cases, surgery may be necessary.

“If the infection is deeper in the abdominal wall, this may require surgery to drain it or placement of drains by the interventional radiology,” Al-Mansour said. “In some cases, mesh removal is necessary.”

People who are unstable because of infection may be unable to undergo surgery immediately. In these cases, doctors will drain the infection before removing the mesh.

Thousands of hernia patients who suffered from infection filed lawsuits against several mesh manufacturers, including Atrium, Bard Davol, Covidien and Ethicon.

Manufacturers of hernia mesh implants allegedly designed faulty products and failed to warn patients of the risk of infection and other complications, leading to revision surgeries.

As of December 2024, mesh manufacturers faced 26,246 hernia mesh lawsuits in Georgia, New Hampshire and Ohio federal courts, and many more are pending in state courts.