Mesh issues

There are many questions that can be raised with the use of mesh. Most of the mesh that are used are made from either polyester or polypropylene. They are safe and tested to be used in patients and undergo such vigorous investigations by the companies that manufacture them. Professor Sheen has vast experience in the use of mesh, and he does understand that as it is a foreign body which, is used as a scaffold and reinforce abdominal wall reconstructions as well as in the groin, mesh can also cause problems.

Like any foreign body, mesh can cause pain, become infected, become fractured, dislodged and be ‘walled-off’ with very thick scar tissue creating a ‘meshoma’.

Occasionally after careful assessment, mesh does require to be removed, especially if infected.

Mesh related pain

Previously inserted mesh can also give rise to pain in the groin, this can be as a result of mesh irritation, mesh infection, a meshoma (contraction/ thickening of the mesh) development and possible mesh ‘entanglement’ of the nerves. Mesh irritation of the vas deferens in men, which may present with orchitis (testicular pain) as well as pain on ejaculation, can occur with either open or keyhole techniques and is initially treated with pain killers as removal of the mesh here does not guarantee resolution of all the symptoms experienced. Guidance with regard to testicular pain and symptoms will be provided in conjunction with a Consultant Urologist.

In most cases Chronic Groin Pain (CGP) will most likely be due to a combination of mesh related factors along with nerve irritation or damage. Both magnetic resonance imaging and sometimes CAT scanning may help elucidate any mesh related causes of CGP. 

Mesh related Infection

Signs of mesh infection generally include a poor healing wound, where a small area continues to discharge what is described as exudate, as well as infected material or pus. Further imaging is required and if it shows that an infected tract leads down to the mesh, then the mesh will need to be removed. Other ways mesh infection can present is a with prolonged seroma, which is a persistent fluid collection on top of the mesh, or under the skin and this can become infected or be a sign of a small focus of infected mesh.

Removing mesh is a complicated and high-risk operation however, the resultant effect is a resolution of the patient symptoms as well as healing of the wound.

All mesh infections with subsequent extrications need to be considered and treated with great care and caution. Unfortunately, there is never a guarantee that all the patients’ symptoms will resolve. Therefore, careful counselling is advised at all points in the patients care.