Hernia Mesh – What Should You Ask?

By now, most people have heard that there are thousands of product liability lawsuits filed against the makers of permanent polypropylene (PP) mesh implants for both hernias and pelvic repair.

Some of the biggest names in Big Pharma are among them – Johnson & Johnson and its Ethicon division, Boston Scientific, C.R. Bard, American Medical Systems, Coloplast, Caldera, Cook Medical, and Neomedic.

Two hernia meshes in particular and the focus of a growing number of cases being filed to take to trial or settled.

Atrium C-Qur and Ethicon’s Physiomesh, are the focus of two courts consolidating cases into MDLs or multidistrict litigation, and other brands and names will likely follow.  Since most are made out of polypropylene, they all carry the same risks of infection and pain.

Despite the lawsuits, mesh is still it is being offered as a first line treatment for a hernia repair.

So what do you ask if you are told you need Hernia Mesh?

Here are some suggested questions to ask your doctor if you are offered a hernia repair using mesh.  

• Your first question might be – Can you do a non-mesh repair and if you can, am I a candidate?   Unfortunately someone who has had previous repair attempts that were unsuccessful, who smokes or who is obese, may have weak connective tissue. In some cases the doctor feels using a mesh as a reinforcement is the last resort. Is that the case with you?  
• Does your doctor only do mesh-reinforced hernia repairs? Can he do a Desarda or Shouldice repair with no mesh?  If you have a portion of your external oblique membrane taken for support, how long will your recover be? How many non-mesh repairs has he done? You want to choose a provider who understands alternatives to the traditional mesh repair.
• What is the mesh you use made of? Answer: polypropylene (PP), biologic or composite or coated. Even biologic (pig, cow or cadaver) or coated generally merge with a PP base. If your doctor says its “Marlex” or Prolene” or Gynemesh, it’s all polypropylene!  Make sure you do not allow them to confuse you.  
• Does your doctor believe polypropylene mesh can harbor bacteria and infection?  Has he had those complications and how does he deal with them? Polypropylene tends to harbor bacteria and infection, as all mesh can. Removing a permanent implant is very difficult so know what your doctor is telling you.
• If you are being told it’s a “New Mesh” just how is it new?  Does it have larger pores? Is it made from cadavers?  Is it polypropylene (PP), the most common material for hernia repair, or is it a composite of PP and ePTFE, polyester, plain ePTFE, biological mesh, or a hybrid mesh? How are they different?
• What is the brand name of the product you use?  Who makes it?  How long have you been using it?  (Answer: See how honest and up front the provider is). Does his/her hospital buy this particular mesh and why?
  
• What is your relationship with the mesh manufacturer? Answer:  Look up Dollars for Doctors prior to your appointment.  A database from ProPublica, it has documented the financial relationship between doctors and the manufacturers. While that does not indicate this is a bad doctor, you might want to discuss his/her relationship with industry. Does it influence the doctor’s opinions?  How can receiving $1 million a year NOT influence your opinion of a product?  But that is for you and your doctor to decide.
• If I have a complication will you still be my doctor and help me resolve the issues?  Some doctors in the pelvic mesh litigation abandoned their patients when the patient had complications, then said publicly they didn’t have patients with complications!  While you obviously cannot get this doctor to give you an unconditional assurance, at least see what he says and ask how he has dealt with other patients with complications in the past.   If he says he doesn’t have any, the red flag may be waving. Again, you decide. ###