Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Hernia Surgeon · Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
In short
- Mesh is removed when it is infected, when it has folded or moved, or when it is the clear cause of lasting pain.
- Removal is a bigger operation than the first repair, because the mesh has grown into tissue and must be freed from it.
- Taking the mesh out often leaves the hernia needing repair again, so the plan covers both removal and how to close the gap.
Mesh removal is a real operation that is sometimes the right answer. It is also one that gets discussed more often than it gets done, and for good reason.
Deciding on it is mostly a question of evidence: is this mesh the cause of the problem, and will taking it out fix that problem.
Why mesh is hard to take out
A mesh is not a plate sitting loose under the skin. Within weeks, tissue grows through the pores and the mesh becomes part of the wall. That is how it works.
It also means the mesh has to be cut away from whatever has grown into it. That may be muscle. In the groin it may be the cord. If the mesh was placed inside the belly, it may be loops of bowel.
So removal is usually a longer operation than the original repair, with more risk attached. That is the honest trade-off, not a reason to refuse it.
The clear reasons to remove it
Some situations do not need much debate.
A mesh infection that will not settle with antibiotics and drainage usually needs the mesh out. Germs sit on the mesh itself, where antibiotics reach poorly. A mesh that has folded, rolled or moved off the gap is not doing its job, and it can press on tissue. A mesh wearing into bowel or bladder has to be dealt with.
In each of those the mesh itself is demonstrably the problem, usually with a scan to show it.
Reasons mesh is removed, and what removal is expected to achieve
| Reason | How clear the case is | What removal usually achieves |
|---|---|---|
| Mesh infection that will not settle | Clear | Clears the infection |
| Mesh folded, rolled or displaced | Clear on a scan | Settles pain from the fold, repair redone |
| Mesh eroding into bowel or bladder | Clear | Removal with repair of the affected organ |
| Lasting pain traced to the mesh | Needs a work-up first | Helps some people, not all |
| Worry about mesh in general | Not an indication by itself | Not expected to help |
Considering mesh removal? Bring the first operation notes and any scan, as both change the plan.
Lasting pain, the harder reason
This is where most of the difficulty sits, and where careful assessment earns its place.
Pain months or years after a repair has several possible sources: a nerve caught or irritated, a fold or edge of mesh, scar tissue, a recurrence of the hernia, or a problem that has nothing to do with the repair at all, such as a hip or back cause.
Those are not the same thing, and they are not all treated by taking mesh out. The work-up starts with an examination to map where the pain really is. Then a scan. Sometimes a nerve block, which both tests the source and treats it.
Removal helps some people with mesh-related pain. It does not help everyone, and it can leave pain unchanged while adding a second recovery. Anyone offering it should say so.
What happens to the hernia afterwards
This part is easy to overlook. The mesh was there to hold a gap closed.
Take it out and the gap is often still there, so the hernia can come back. The plan therefore has to answer two questions at once: how the mesh comes out, and how the wall is held afterwards.
Sometimes the wall can be closed with stitches alone. Sometimes a different repair is used, in a different layer. If the area is infected, a new mesh may be left to a later operation rather than put in the same day.
What to bring to the discussion
Two documents change the conversation more than anything else.
The notes from the first operation, which say what mesh was used and where it was placed. And a recent scan, usually a CT, which shows where the mesh is now and whether the hernia has returned.
Without those, any plan is guesswork. With them, the discussion can be specific about what is likely to be gained.
If you are worried about mesh but have no symptoms
Worry about mesh is common and understandable, and it is worth talking through.
But a mesh that is doing its job, with no pain, no infection and nothing on a scan, is not removed on the basis of worry. The operation to take it out carries more risk than leaving a working repair alone.
If that is your situation, a consultation to go through what was done and what it means is the useful step.
Frequently asked questions
When does a hernia mesh need to be removed?
When it is infected and will not settle, when it has folded or moved, when it is eroding into an organ, or when pain is clearly traced to it.
Is mesh removal a big operation?
It is usually larger than the original repair, because tissue grows into the mesh and it has to be dissected free.
Will the hernia come back if the mesh is removed?
It can, because the gap is often still there. The plan has to cover how the wall is held once the mesh is out.
Does removing mesh cure chronic groin pain?
It helps some people, but not everyone. A work-up first establishes whether the mesh is actually the source.
Related pages
The main page on this site is hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Bring your reports. Second opinions are welcome.