Overview
What is Mesh ?
There are many types of mesh products available, but surgeons typically use a sterile, woven material made from a synthetic plastic-like material, such as polypropylene. The mesh can be in the form of a patch that goes under or over the weakness, or it can be in the form of a plug that goes inside the hole. Mesh is very sturdy and strong, yet extremely thin. It is also soft and flexible to allow it to easily conform to body's movement, position, and size. Mesh is used in both tension-free and laparoscopic tension-free hernia repairs.
Aftercare
Immediately after surgery, the patient will be observed in a recovery area for several hours, for monitoring of body temperature, pulse, blood pressure, and heart function, as well as observation of the surgical wound for undue bleeding or swelling. Patients will usually be discharged on the day of the surgery; only more complex hernias such as those with incarcerated or strangulated intestines will require overnight hospitalization. Some patients may have prolonged suture-site pain, which may be treated with pain medication or anti-inflammatory drugs. Antibiotics may be prescribed to help prevent postoperative infection.
Once the patient is home, the hernia repair site must be kept clean, and any sign of swelling or redness reported to the surgeon. Patients should also report a fever or any abdominal pain. Outer sutures may have to be removed by the surgeon in a follow-up visit about a week after surgery. Activities may be limited to non-strenuous movement for up to two weeks, depending on the type of surgery performed. To allow proper healing of muscle tissue, hernia repair patients should avoid heavy lifting for at least six to eight weeks after surgery, or longer as advised.
Risks
Long-term complications seldom occur after incisional hernia repair. Short-term risks are greater with obese patients or those who have had multiple earlier operations or the prior placement of mesh patches. The risk of complications has been shown to be about 13%. The risk of recurrence and repeat surgery is as high as 52%, particularly with open procedures or those using staples rather than sutures for wound closure. Some of the factors that cause incisional hernias to occur in the first place, such as obesity and nutritional disorders, will persist in certain patients and encourage the development of a second incisional hernia and repeat surgery. Each subsequent time, the surgery will become more difficult and the risk of complications greater. Postoperative infection is higher with open procedures than with laparoscopic procedures.Postoperative complications may include:
- Fluid buildup at the site of mesh placement, sometimes requiring aspiration (draining off)
- Postoperative bleeding, though seldom enough to require repeat surgery
- Prolonged suture pain, treated with pain medication or anti-inflammatory drugs
- Intestinal injury
- Nerve injury
- Fever, usually related to surgical wound infection
- Intra-abdominal (within the abdominal wall) abscess
- Urinary retention
- Respiratory distress
The Use Of Mesh In Hernia Repair
The patient’s hernia region is then examined. The process should be explained to the patient as palpation of the adjacent scrotal region can cause embarrassment (this is part of risk management in Australia where soaring indemnity payments has become an issue).
The site is first inspected standing up at rest and then whilst coughing and straining. The hernia is usually apparent. During this process all possible sites for hernias should be inspected, including the opposite side for an inguinal or femoral hernia. It is surprising how often an additional femoral hernia or inguinal hernia can be detected in this manner. This avoids referring patients with an incomplete diagnosis. The hernia then may be palpated whilst standing. Then the hernia is palpated whilst the patient coughs and strains – looking for a cough impulse. Care must be taken not to hurt the patient by attempting to forcefully reduce an irreducible hernia.
The patient then lies down and is examined again.
The scrotal and testes region should also be examined whilst the patient is standing and then recumbent. Some conditions are only detected whilst the patient is standing. This includes a saphena varix, varicocele or communicating hydrocoele.
The scrotal contents and the testes and other structures are palpated carefully to exclude other conditions. The findings should be recorded – especially any abnormality. The patient should be advised, for example about the presence of a varicocele, so that following surgery it is not thought to be a complication of surgery (risk management).
Further general assessment firstly of the directly related areas and then other regions is required before giving comprehensive advice.
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Abdomino-Perineal Resection 
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