If hernias can’t heal on their own, why do mesh patches dissolve?

Question

A hernia is a soft bulge that can be apparent on physical exam, caused by an organ having found its way to somewhere it shouldn’t be, usually through damage to a muscle lining that holds the organ in place.

A surgically-implanted mesh patch can be used to treat a hernia. A surgeon first reduces the organ back into its proper spot. Then, the patch “covers up” the hole in the muscle wall where the organ had been bulging out of. Over a few months, the mesh patch disintegrates into the body. Patches used these days will eventually disappear completely, avoiding potential patient discomfort/infection of having a foreign fibrous patch in their body. By this time, it’s assumed the muscle wall has healed. This is evidenced by the lack of a bulging organ on physical exam.

However, it’s also stated everywhere that hernias can’t heal on their own without surgery. On the contrary, a dissolvable mesh patch implies that hernias can heal assuming the hernia remains reduced behind the muscle wall for a long period of time. Otherwise, the mesh would be a permanent implant, and not dissolve away over time.

Doesn’t the existence of a dissolvable mesh patch as a treatment for hernia imply that by keeping a hernia fully reduced for that time (using a hernia belt or other device), a person could also also permanently heal the hole in the muscle wall?

Answer 1

Consider this: you're a surgeon and you need to suture a layer of tissue that's beneath the skin. If you use sutures that don't dissolve, you'll have to reopen the wound weeks later, remove the lower layer(s) of sutures, and then re-suture the upper layer(s). That adds time, risk, cost, scarring, discomfort, and recovery time.

That's why dissolvable sutures exist and it's no different with mesh. First, consider that a hernia isn't just a bulge. It's a gap that has opened in the abdominal muscles that allows intestines to protrude though the gap. These muscles aren't cut or injured, so just pulling them back together with an external device will do nothing. The muscles will not grow back together and once you remove the external device the hernia will still be there.

So in a hernia repair operation the muscles aren't just pulled back together as is. The gap is surgically repaired, which basically means sutured back together.

https://www.upmc.com/services/general-surgery-trauma/services/hernia-surgery

To repair your hernia, your surgeon will:

• Push the bulging tissue or organ back where it belongs.
• Repair the weak spot or opening in your muscle.
• Use surgical mesh to strengthen and cover the hernia defect in some cases.

Emphasis is mine, highlighting the point that answers your question.

The mesh is there to strengthen the weak area of muscle without relying solely on the sutures. Once the repair is fully healed the mesh may no longer be needed so having it dissolve is desirable so that you don't have a permanent foreign object present.

Although I hate using videos as supporting evidence, this video is barely a minute long and illustrates quite nicely what I explained above.