Arjun Shankar, Medical Director at The Lister Hospital discusses hernia surgery options with the Daily Mail:
After two failed attempts to repair a hernia, Ila Murarji had everything crossed that this time surgery would work. The 56-year-old first developed a hernia nine years ago.
They are a common problem – affecting up to one in ten people – and occur where an internal part of the body (normally the bowel or fatty tissue under the skin) pushes through a weakness in the muscle wall.
This appears as a lump or swelling, usually on the abdomen or groin. In Mrs Murarji’s case, the hernia was near her belly button, an umbilical hernia, and was probably caused by the strain of two pregnancies on her stomach muscles (her daughter and son are now 25 and 30 respectively).
There are several other types of hernia – inguinal and femoral, which are in different parts of the groin, and incisional hernia, which occurs at the site of a previous operation.
While most hernias cause no symptoms, many require surgery. This is because serious bowel problems, such as blockages, can occur and these can be life-threatening.
More than 80,000 such operations are carried out each year in England alone.
The surgery involves placing a mesh, a loosely woven ‘net’, in the weak area of muscle to strengthen it, a bit like a puncture repair kit.
The mesh is implanted either under a local or general anaesthetic. In the past stitches were used to repair the hernia, pulling the muscle together, explains Colin Elton, a consultant surgeon at London’s Royal Free Hospitals NHS Foundation Trust.
But stitches are more easily strained than a mesh – which spreads the load from the surrounding weak muscles – so the wound is less likely to heal fully, and the chance the hernia will come back is higher, he says.
However, what many people don’t know is that there are different types of mesh, each with its own advantages and drawbacks.
The vast majority of hernia repairs are done with a synthetic mesh made of soft plastic. They’re popular because they are hard-wearing (they remain permanently in the body), inexpensive and have less than a 3 per cent risk of infection, says Mr Elton.
‘In the vast majority of cases, a synthetic mesh is perfectly adequate,’ he adds.
The alternative is a biological mesh – made from pig or cow skin – which will integrate fully into the body after about six months.
However, they too, have drawbacks – they aren’t immune to infection nor are they as strong as synthetic mesh so don’t last as well, raising the chance of the hernia recurring, says Arjun Shankar, a consultant general surgeon at London’s Royal Free and University College Hospitals.
And biological mesh is not cheap. ‘The most expensive one I have used to reconstruct the abdominal wall cost £16,000,’ adds Mr Elton.
Choosing the right mesh is vital, says Mr Shankar. ‘Plastic mesh is fine for most patients, but if a patient is high risk – if they have other complaints such as diabetes or heart disease, are obese or at greater risk of infection, for example, if they suffered previous infections from surgery – a biological mesh may be better,’ he says.
What many people don’t know is that there are different types of mesh
Around 2 per cent of groin hernia operations fail, but the figure is higher for incisional hernia repairs, where up to 20 per cent fail, says Mr Elton.
Typically, the problem is that the mesh has become infected. Some older types of plastic mesh can also stick to the intestine, which can cause scar tissue to form leading to blockages of the bowel. There is also a greater risk of mesh failing if the patient is obese or through general muscle weakness.
Repeated repairs can also weaken the area, making it less likely to heal properly – as was the case for Mrs Murarji.
She underwent her first hernia repair in 2006, but it failed a year later for no obvious reason.
A second operation in 2011 also failed after she developed an infection. Both procedures were carried out privately using a synthetic mesh.
Two months after her third hernia op in 2013, also carried out privately, she started feeling unwell – tests revealed she had an infection.
‘I had fluid building-up inside my abdomen and flu-like symptoms,’ recalls Mrs Murarji, a former chiropractic assistant, who lives with her accountant husband Ashwin and their son in South London. She thought the problem would pass. But within four weeks she was admitted to hospital for intravenous antibiotics and it took four days for her temperature to come down.
For Mrs Murarji the only choice after the infection was to have a biological mesh. She underwent her fourth hernia repair, again privately, last April at The Lister Hospital, London.
The operation was more complicated because the abdominal wall needed repairing.
‘I was really nervous beforehand as I had been so ill,’ she says. ‘They cut me open from hip to hip to do the repair and I no longer have a tummy button. But it worked and I have been making steady progress ever since.’
While Mrs Murarji is delighted her fourth hernia repair using biological mesh was a success, she hopes other patients don’t have to undergo the same ordeal.
‘I am taking things much easier than before the surgery and can’t do any heavy lifting or gardening as the biological meshes are not as strong and the doctors have said if it happens again, there may be nothing they can do,’ she says.