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Clinical Value of Hernia Mesh Pathology Evaluation
Negin Fadaee1, Laura Mazer2, Rajeev Sharma3
1University of California, Los Angeles, CA.
Background:
Hernia mesh removal is growing in demand. Meanwhile, there is no standard for handling the mesh specimen or any consensus on the clinical value of the surgical pathology findings.
Study Design:
All hernia mesh specimens gathered from 2013 to 2018 were analyzed. Patients were categorized based on indication for mesh removal. The "mesh reaction" group included those with clinical reaction deemed to be related to the mesh material. The "mesh nonreaction" group included patients who had mesh removed for a clinical indication unrelated to the mesh material.
Results:
One hundred and one patients had 115 mesh specimens that were microscopically evaluated. Patients with clinical diagnosis of mesh reaction were significantly younger (39 vs 56 years; p = 0.023) and more likely to be female (71% vs 39%; p < 0.001) than those without mesh reaction. Although the clinical symptoms were significantly different, the pathology findings were quite similar.
Conclusions:
There is no clinical value in submitting mesh specimens for microscopic surgical pathology evaluation, regardless of clinical indication for the mesh removal. Also, no clinical claims can be made based on pathology findings from explanted mesh. In addition, microscopic evaluation does incur additional costs to the consumer. We recommend explanted mesh be submitted for gross examination only for documentation purposes in the medical records.
Insights
Microscopic evaluation of explanted hernia mesh shows no clinical value. Gross examination is recommended for documentation, avoiding unnecessary costs and claims based on pathology findings.
Area of Science:
- Surgical Pathology
- Biomaterials Science
Background:
- Hernia mesh removal is increasingly common.
- Current practices lack standardized mesh specimen handling and consensus on pathology findings' clinical value.
Purpose of the Study:
- To evaluate the clinical utility of microscopic surgical pathology for explanted hernia mesh specimens.
- To determine if pathology findings correlate with clinical indications for mesh removal.
Main Methods:
- Analysis of 115 hernia mesh specimens from 101 patients (2013-2018).
- Categorization of patients into "mesh reaction" and "mesh non-reaction" groups based on clinical indication for removal.
- Microscopic evaluation of all mesh specimens.
Main Results:
- Patients with mesh reaction were younger (39 vs 56 years) and more often female (71% vs 39%).
- Despite differing clinical symptoms, microscopic pathology findings were similar between groups.
- No significant correlation found between microscopic pathology and clinical indication.
Conclusions:
- Microscopic surgical pathology evaluation of explanted hernia mesh offers no clinical value.
- Pathology findings from explanted mesh do not support clinical claims.
- Recommend gross examination only for documentation, avoiding consumer costs associated with microscopic analysis.
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