Hi,

I had a bilateral inguinal hernia repair done about 2 and a half years ago. I am experiencing some pain in my lower abdomen.

I keep reading about hernia mesh migration, yet I cannot find any description of symptoms which are present when this is the case.

It is my opinion that "mesh migration" is a very rare (if ever) event in inguinal hernia repairs, and therefore not a common cause of Post-Herniorrhaphy Pain Syndrome. Polyprolylene, the most commonly utilized mesh in inguinal hernia repairs, rapidly (within hours) becomes quite adherent to surrounding tissue. And within days, the onging tissue ingrowth makes that adherence almost inextricable. Thus mesh migration is not likely to occur to any great extent because of its natural fixation.

It is my contention therefore that mesh, found to be in a 'wrong place' in the groin was more likely placed in that wrong place rather than it migrated there. This is however different from the process of mesh contraction, which occurs with polypropylene and may uncover a recurrent hernia if insufficient size/overlap of mesh is used.

Thank you.

I have been researching the subject of mesh migration and found the following information:
"As far as the mesh being close to the bladder there are more and more reports of this type of migration" (Source: Hernia (2006) 10: 79-82 Mesh Migration Following Repair of Inguinal Hernia: A Case Report and Review of Literature.) In the case report the patient also struggled with recurrent infections. The article states that migrations are slow and gradual movements of the mesh through trans-anatomical planes. These are secondary to foreign body reaction-induced erosion and are increasingly being recognized in the literature. The article specifically mentions the PerFix mesh plug (made of Marlex) migrating to various areas. It goes on to state that PTFE (polypropylene) has a bioinstable nature and long-term infection rates.
An experimental study in rats comparing polypropylene, polyglactin and mixed polypropylene-polyglactin mesh revealed frequent and deeper penetration of the bladder by polypropylene. It found erosion of polypropylene into the muscularis mucosa of bladder with 14 days.
So while most herniologists tend to believe that the problems with mesh have more to do with it being improperly fixed during the initial surgery, that certainly wouldnt account for the erosion, hardening, infectious processes, etc. that are being reported. Hopefully with some of the newer meshes, such as the coated ones, this might not be as much of an issue.
As far as detecting the mesh throughout various areas, it does not show up well, if at all, on most imaging tests. From the article, Sometimes calcifications and intra-vesical stones have been visualized which turn out to be actual mesh with calcareous deposits on the surface.
From this, and other research, it seems to suggest that a mesh patch, or plug in particular, can migrate en masse but that shards from a mesh product can also break off due to frayed edges or the breakup of the mesh from erosion and that in such cases it is extremely difficult to pick up on this and effectively locate these pieces - especially when they become encapsulated with the aforementioned calcerous deposits.