A hernia mesh is a surgical device used to reinforce a weakened area of tissue, most commonly in the abdominal wall, preventing internal organs from protruding. This prosthetic material remains in the body indefinitely, providing a scaffold for new tissue growth and reducing the chance of the hernia returning. While the mesh is generally secured in place, a common concern is whether this implanted material can shift from its initial placement. The mesh can sometimes become dislodged or move, leading to potential complications.
How Hernia Mesh is Secured
Surgeons utilize several methods to ensure the mesh stays in its intended position immediately following the procedure. The goal of these fixation techniques is to temporarily anchor the mesh until the body achieves long-term stability through biological integration. Traditional methods include using absorbable or non-absorbable sutures to sew the mesh to the surrounding healthy tissue.
Another common approach involves specialized tacks or screw-type fasteners, which are either permanent or designed to dissolve over time. More modern techniques often employ surgical glues, such as fibrin or cyanoacrylate adhesives, to seal the mesh to the abdominal wall. Ultimately, long-term stability relies on the body’s natural healing process, known as fibrosis. This process involves scar tissue forming around and through the mesh pores, permanently incorporating it into the body wall.
Factors Leading to Mesh Displacement
Mesh movement is categorized into two types: displacement, a minor slip from the original site, and true migration, movement far from the original placement. Inadequate initial fixation is a primary mechanical cause of movement, often occurring shortly after the operation if the anchors fail to hold the device firmly. External forces, such as excessive straining from heavy lifting, severe coughing, or aggressive physical activity before the mesh has fully integrated, can also separate the mesh from the tissue.
Less immediate movement, referred to as secondary migration, can develop months or even years after the surgery. This late-onset migration is frequently linked to a foreign body reaction, where the body’s inflammatory response causes gradual tissue erosion around the mesh. Over time, this erosion allows the mesh to slowly move through anatomical planes. Material properties, such as mesh shrinkage or erosion, can also contribute to the breakdown of the mesh-tissue interface, leading to dislodgement.
Symptoms and Complications of Mesh Migration
When a hernia mesh moves, the patient may experience a range of symptoms, including new or worsening chronic pain in the groin, abdomen, or leg, often resulting from nerve entrapment. The dislodged mesh may roll up, creating a palpable lump or bulge near the surgical site, sometimes referred to as a meshoma. Other signs of a problem include flu-like symptoms, persistent swelling, or a sensation of rigidity in the abdominal area.
The most concerning complications arise when the mesh migrates into adjacent internal structures. This can lead to severe issues like bowel obstruction, presenting as an inability to pass gas or stool, nausea, and vomiting. In rare instances, the mesh can erode into organs such as the bladder or bowel, potentially causing perforation or the formation of an abnormal connection, known as a fistula. Addressing significant mesh migration often requires a second surgical procedure for revision or removal.