Over the past 6 years, approximately 570,000 hernia sufferers have undergone hernia mesh implant surgery. However, leading surgeons believe the complication rate of this procedure lies between 12% and 30%. Consequently, it has been estimated that 68,000 to 170,000 outpatients could face future complications.[i]
Hernia mesh surgery has been used since the 1990s. Since 2011/12, between 90,000 and 100,000 operations have taken place annually.
During the procedure, a clinician pushes herniated tissue back through the wall of tissue or muscle from which it originated. The flat surface is then covered with a piece of surgical mesh.
Patients with complications have reported chronic pain, an inability to walk and mental health issues.
Currently, NHS Trusts in England do not have a consistent policy in place for the provision of treatment or follow-up with hernia patients. This may have had the effect of inflating the mesh implant complication rate, which has been branded a potential ‘scandal’ by Labour MP, Owen Smith, who chairs the All Party Parliamentary Group on Surgical Mesh Implants.
The Medicines and Healthcare products Regulatory Agency (MHRA) has been criticised for not ensuring that medical devices are safe. It told the BBC that it had not obtained any evidence which would lead it to alter its ‘stance on surgical mesh for hernia repairs or other surgical procedures for which they are used. The decision to use mesh should be made between patient and clinician, recognising the benefits and risks’.
In support, the Royal College of Surgeons (RCS) has stated that mesh implants are ‘the most effective way’ to treat hernias.
Recently the use of vaginal mesh was halted on the NHS in England. Hernia mesh complications are similar to vaginal mesh complications. On this basis, Dr Suzy Elnheil, a consultant urogynaecologist, estimates that the cost of treating hernia patients with post-surgical complications will be a minimum of £25,000 per patient. Treatment would involve:
- Mesh removal;
- A further operation to treat the hernia; and
- Follow-up care.
If this is not a restricted product liability issue (faulty mesh), then occupational hernia claim reserves may have to increase in cases where the claimant has undergone this procedure to account for continuing pain caused by post-operative complications.
Claimants may also claim for private healthcare costs of alternative therapies, which are not available on the NHS. Dr Ulrike Muschaweck, a leading hernia surgeon in the private sector, uses a suture technique, otherwise known as ‘Minimal Repair’, to treat patients with ‘sportsmen’s groin’, which young surgeons are rarely taught. This eradicates pain by reducing pressure on the genitofemoral nerve in the groin and avoids any enlargement of the defect causing the hernia. Dr Muschaweck claims that 2,998 of 3,000 mesh removal patients, who have undergone suture treatment, went on to become ‘pain-free’.
In 2010, Muschaweck co-authored a paper, which reported on suture treatment success in athletes.[ii] Out of 129 patients, 126 significantly reduced their physical activity prior to treatment as a result of groin pain. However, 4 weeks after ‘Minimal Repair’, 96.1% of the participants had resumed sports training and 75.8% had returned to full pre-injury sports activity levels. The study concluded that:
‘... the outcome after operation under the Minimal Repair technique is very fast, without exposing the patient to possible risks related to mesh insertion or laparoscopic procedures’.
In the same year, Muschaweck published another co-authored paper, which listed advantages of ‘Minimal Repair’, including:
- No insertion of prosthetic mesh;
- No general anaesthesia required;
- Less traumatisation; and
- Lower risk of severe complications with equal or even faster convalescence.[iii]
[ii] Muschaweck, U. & Berger, L. Minimal Repair technique of sportsmen’s groin: an innovative open-suture repair to treat chronic inguinal pain. Hernia 14, 27–33 (2010). https://www.ncbi.nlm.nih.gov/pubmed/20063110 (Accessed 27 September 2018).
[iii] Muschaweck, U. & Berger, L. M. Sportsmen’s Groin—Diagnostic Approach and Treatment With the Minimal Repair Technique. Sports Health 2, 216–221 (2010). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445105/ (Accessed 27 September 2018).