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 ¼ 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.

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In our practice, we have noticed an increased number of patients requiring mesh removal due to a systemic reaction to their implant. We present our experience in diagnosing and treating a subpopulation of patients who require mesh removal due to a possible mesh implant illness (MII). All patients who underwent mesh removal for indication of mesh reaction were captured from a hernia database. Data extraction focused on the patients’ predisposing medical conditions, presenting symptoms suggestive of mesh implant illness, types of implants to which reaction occurred, and postoperative outcome after mesh removal. Over almost 7 years, 165 patients had mesh removed. Indication for mesh removal was probable MII in 28 (17%). Most were in females (60%), average age was 46 years, with average pre-operative pain score 5.4/10. All patients underwent complete mesh removal. Sixteen (57%) required tissue repair of their hernia; 4 (14%) had hybrid mesh implanted. Nineteen (68%) had improvement and/or resolution of their MII symptoms within the first month after removal. We present insight into a unique but rising incidence of patients who suffer from systemic reaction following mesh implantation. Predisposing factors include female sex, history of autoimmune disorder, and multiple medical and environmental allergies and sensitivities. Presenting symptoms included spontaneous rashes, erythema and edema over the area of implant, arthralgia, headaches, and chronic fatigue. Long-term follow up after mesh removal confirmed resolution of symptoms after mesh removal. We hope this provides greater attention to patients who present with vague, non-specific but debilitating symptoms after mesh implantation.

Background The opioid crisis demands novel solutions for postoperative pain control. Traditional Chinese medicine (TCM) has used herbs for the treatment of pain for thousands of years. We studied whether a synergistic multimodal TCM supplement could reduce the need for conventional pain pills for low risk surgical procedures. Methods In a Phase I/II, prospective, double-blind, placebo-controlled, randomized clinical trial (PRCT), 93 patients were randomized to either TCM supplement or placebo oral medication for low-risk outpatient surgical procedures. Study medications began 3 days preoperatively and continued for 5 days postoperatively. Conventional pain pill use was not restricted. Patients were monitored postoperatively for all forms of pain pill use (Pain Pill Scoring Sheet) and subjective pain ratings (Brief Pain Inventory Short Form). Primary outcomes included type and number of pain pills used and subjective pain ratings. Secondary outcomes included an assessment of mood, general activity, sleep, and enjoyment of life. Results TCM use well tolerated. Conventional pain pill use was similar between groups. Linear regression analysis revealed that TCM reduced postoperative pain 3 times faster than placebo ( P < .0001) with a 4-fold greater magnitude of relief by postoperative day 5 ( P = .008). TCM also significantly improved sleep habits ( P = .049) during the postoperative period. TCM effect was independent of type of surgery or amount of preoperative pain. Discussion This PRCT is the first to show that a multimodal, synergistic TCM supplement is safe and can effectively reduce acute postoperative pain more rapidly, and to a lower level, than conventional pain pills alone.