A Pathology of Mesh and Time

Abstract

Irreversible damage of the nerves and vas musculature due to mesh migration is one of the mechanisms for sexual pain and dysejaculation. Attempts at all cost to preserve elements of the spermatic cord may not be justified in cases of severe pain, especially sexual pain (and/or dysejaculation) and intraoperative finding of cord involvement by the mesh. Vasectomy with mesh removal may well be indicated and be considered not a radical procedure but a conservative measure given the severity of the pain!

Quantitative somatosensory assessments in patients with persistent pain following groin hernia repair: A systematic review with a meta-analytical approach

“…Iatrogenic nerve damage and the gradual onset of neuropathic pain may be brought on by surgical dissection or transection of the nerve or by fixation of the mesh (sutures, tacks). Additionally, the mesh implant is prone to dehiscence, dislocation, induration, invasion of nearby structures, or shrinkage, processes that may result in a 20–90% reduction in mesh area [ 4 , 5 ].…”

“…The IASP (the International Association for the Study of Pain [ICD-11]) criteria for chronic post-surgical or posttraumatic pain are “a chronic pain that develops or increases in intensity after a surgical procedure or a tissue injury and persists beyond the healing process, i.e., at least three months after the surgery or tissue trauma” [ 4 ]. More elaborate criteria have previously been proposed [ 5 ]. The condition can significantly impair the physical and psychosocial functions of the individual, and a conservative estimate is that 2% of patients undergoing groin hernia repair will be affected by PPSP [ 6 , 7 ].…”

Transversalis fascia suture reinforcement may facilitate the performance of electrospun P(LLA-CL) nanoscale fibrinogen mesh in inguinal hernia repair: a prospective single-center cohort study

“…Biological meshes have evolved in response to a growing need for safe alternatives to permanent synthetic meshes which have the complications of chronic pain, infection, erosion and fistula formation 5 , 6 , 16 – 18 . Biologic meshes serve as a regenerative framework that attract early cellular and vascular infiltration, support site-specific tissue remodeling and new collagen deposition into the host’s tissue, resulting in the reconstruction of a new and mature autologous fascia 7 , 8 .…”

“…The use of synthetic mesh may induce foreign body reaction and inflammatory response in the host body, culminating in the formation of a scar plate, which brings side effects such as chronic groin pain and stiffness 3 , 4 . As the mesh implants are permanent, these adverse effects may exist life-long 5 , 6 .…”

Feasibility of a novel tacking method of securing mesh in transabdominal preperitoneal inguinal hernia repair: Secure tacking against recurrence

“…The onset of chronic postoperative inguinal pain is multifactorial and includes patient-related factors and technical factors (12)(13)(14). Among the technical factors are the repair technique, nerve handling, and type of prosthetic material and its fixation (15)(16)(17)(18). Chronic pain is the main challenge of modern inguinal hernia surgery in both the laparoscopic and anterior approaches.…”