Mesh pain risk from hernia high, surgeon says

A leading Canadian hernia surgeon says the risk of complications from surgical mesh is too high and its use in New Zealand should be restricted.

Surgical mesh made with polypropylene is used routinely in New Zealand hernia procedures to strengthen weakened abdominal walls. About 5000 procedures take place each year.

However, hundreds of Kiwis have suffered severe injuries after being implanted with the product.

Robert Bendavid, a past president and a founding father of the American Hernia Society, said the incidence of chronic pain following all types of hernia repairs had increased substantially since the use of surgical mesh from the mid-1990s.

The surgeon has performed thousands of non-mesh hernia repairs at the only hospital in the world dedicated to such procedures, the Shouldice Hernia Hospital in Ontario, Canada.

He said the most reliable studies put the post-hernia surgery complication rate at 12 per cent, but some found the risks were ‘‘unacceptably high’’ at up to 20 per cent.

Bendavid took issue with Christchurch surgeon Steven Kelly’s defence of mesh in a letter to the New Zealand Medical Journal published in November.

Kelly had said media had been scaremongering over the issue: ‘‘The public needs to be informed that mesh for abdominal wall hernia repair is safe and effective,’’ he wrote.

Bendavid’s response was published in a letter in the December issue of the journal.

He said that despite the risks, mesh was used in most hernia procedures as surgeons had been manipulated by the medical device industry and were not trained in non-mesh techniques.

Much of the research used to gain regulatory approval for mesh products was paid for by mesh manufacturers, he said.

‘‘If the various meshes were as safe as the industry claims them to be, why are there hundreds of thousands of patients involved in class actions, resulting in billions of dollars in fines?’’

Regulatory authorities, including the Untied States Food and Drug Administration (FDA), had failed to ensure adequate safety checks or even monitoring of the devices, he said.

‘‘Neither the industry, nor the FDA nor any world organisation that I am aware of, is keeping track of such complications.’’

Attempts by the industry to fix problems with mesh by introducing lighter products and new coatings had failed to address the risks:

‘‘In fact nothing new has been introduced since it is, and always will be, polypropylene once its added coats have been digested away.’’

Bendavid said polypropylene used to make the mesh products was a foreign body which could erode into tissues and nerves.

Despite his views, Bendavid did not want surgical mesh banned for hernia repairs, but restricted for use in up to 2 per cent of cases.

Governments should make it mandatory for surgeons to follow up hernia patients treated with mesh for at least four years and ideally for up to 10 years afterwards as studies showed complications could appear years after the procedure, he said.

A mandatory registry to record all mesh procedures should be a minimum requirement of governments, to enable follow up of patients with complications, he said.

After a two-year inquiry into mesh products, New Zealand’s health select committee proposed the development of a national mesh registry in 2016.

Minister of Health David Clark, who had promised to immediately begin work on the registry if elected, last month said the Ministry of Health had committed in October to looking at a cost-benefit analysis for a pelvic surgical mesh registry.