Is Abdominal Mesh Overused?

New Orleans, LAA recent hernia mesh lawsuit was filed at the end of September in Louisiana by a plaintiff who underwent surgical repair for a hernia a year ago this month, only to experience surgical mesh side effects that necessitated revision surgery just six months later. The Bard Ventralex ST Hernia Mesh, manufactured by C.R. Bard (Bard) and Davol Inc. (Davol), is alleged to have left plaintiff Richard Stipelcovich in “excruciating” abdominal pain.

Abdominal mesh has been often in the news over allegations of surgical mesh complications and other surgical mesh side effects. In May of last year, Johnson & Johnson’s Ethicon unit withdrew its Ethicon Physiomesh from the market due to numerous reports of complications. It should be noted that the exit of Physiomesh was not, technically a recall. That said, it has been reported that Ethicon has no intention of returning Physiomesh to the market any time soon, if at all.

In his surgical mesh side effects lawsuit filed against C.R. Bard and Davol, Stipelcovich alleges the Ventralex mesh inserted into his abdomen for his hernia repair in October, 2016 has numerous defects that carries the potential to abrade tissue and cause painful and permanent consequences. Ultimately, Stipelcovich asserts the Bard Ventralex Hernia Mesh failed to repair his hernia, according to his hernia patch lawsuit.

“Before Plaintiff suffered the injuries complained of herein, Defendants were on notice of numerous bodily injuries caused by [Bard Ventralex], and based thereon, Defendants knew or should have known that the Product caused an unreasonably high rate of infection, extrusion, perforation, chronic pain and/or abscess in people implanted with the Product,” the complaint said.

Stipelcovich and his doctor would not have used Bard Ventralex hernia mesh to repair the plaintiff’s incarcerated umbilical hernia had information and warnings been properly disclosed, according to the complaint.

In Canada, the investigative unit of the CTV Television Network reports that of the 100,000 hernia repairs performed in Canada every year, more than 90 percent utilize abdominal mesh. Complications from abdominal mesh products in general are high, according to CTV’s W5 (09/30/17). And while there are many in the medical community who expound the virtues of surgical mesh, others question its widespread use. In other words, surgical mesh should remain an option that is only employed when it makes sense for the patient.

Dr. John Morrison, who practices in Chatham, Ontario, is sought after for his skills at surgical mesh removal.

“I’ve seen hernia mesh erode into the adjacent tissues, the tissue that’s beside it,” Morrison told W5. He has also seen mesh erode into the spermatic cord, the rectum in female patients with pelvic mesh, “and actually hang out through the anal canal and the patient come (sic) to me thinking they had hemorrhoids. That was from one of these pelvic meshes.” Morrison is quick to point out he is not against surgical mesh, suggesting that surgical mesh should remain an option for some patients.

What he does decry is its widespread use. “I am against the absolute use of mesh in every case. I would much prefer a surgeon to say ‘hey, do we actually need to use mesh in this position? Does this patient require mesh?’” Morrison told W5 that he advocates giving patients a choice between mesh, and older techniques where a patient’s own tissues are used for the repair.

Dr. Vladimir Iakovlev, director of Cytopathology at St. Michael’s Hospital in Toronto, has examined over 500 mesh specimens removed from patients experiencing complications.

Iakovlev says the mesh is implanted flat but in the body can fold, and shrink – sometimes up to 50 per cent of their original size, he told W5.

He has seen nerves, blood vessels and scar tissue having grown into the mesh fibers – “like a rebar in concrete,” he said, adding that it makes the mesh difficult to remove.

Iakovlev also said that almost all mesh products move. “Some mesh move just microns, very little, some mesh move all the way through the bowel,” he said, in comments to CTV, adding the polypropylene mesh degrades and becomes brittle over time in the body.

It’s important to note that what Iakovlev sees remains a rare occurrence, happening in only a fraction of mesh patients. But it’s enough to worry him, he says.

The Shouldice Hospital in Thornhill, a part of Metropolitan Toronto, is a world-renowned private hospital that specializes in hernia repair and attracts patients from across North America and beyond. Billed as the global leader in hernia repair, Shouldice does not use abdominal mesh in any of their hernia repairs, preferring instead the exclusive use of a patient’s own tissue.

In Louisiana, the hernia patch lawsuit filed late last month is Richard Stipelcovich v. C.R. Bard and Davol, Inc., Case No. 2:17-cv-09656, filed September 26th, 2017 in the US District Court, Eastern District of Louisiana.