Can mesh be removed or is it dissolved
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Here is a thorough answer based on surgical textbooks and current FDA guidance:
Can Surgical Mesh Be Removed or Does It Dissolve?
The answer depends entirely on the type of mesh used.
1. Non-Absorbable (Permanent) Mesh
The most common type used today - made of materials like polypropylene or polyester. It:
- Does not dissolve or get absorbed
- Remains in the body indefinitely, though it may undergo some degradation over time
- Over weeks to months, the body encapsulates it with scar/fibrous tissue (ingrowth), making it progressively harder to remove
Can it be removed? Yes, but it is a complex, technically demanding surgery. As described in Fischer's Mastery of Surgery, laparoscopic inguinal mesh removal involves careful dissection away from the inferior epigastric vessels, iliac vessels, gonadal vessels, and vas deferens - structures that can become densely adhered to the mesh. Preservation of these structures is not always possible. The FDA guidance on surgical mesh confirms permanent mesh will stay in the body unless surgically taken out.
2. Absorbable Mesh
Made from materials such as Vicryl (polyglactin), oxidized cellulose, poly-4-hydroxybutyrate (Phasix), or biologic mesh (porcine/bovine tissue). It:
- Is gradually broken down and absorbed by the body
- Loses strength over weeks to months
- Is replaced by the body's own new fibrous tissue
- Is not intended for permanent structural reinforcement
Animal-derived biologic meshes (pig or cow intestine/skin) are also absorbable.
When Is Permanent Mesh Removed?
Removal of permanent mesh is indicated mainly for complications:
| Indication | Notes |
|---|---|
| Mesh infection | Occurs in 1-4% of hernia repairs. Surgical removal is almost always required. Waiting ~3 months after symptom onset allows uninfected portions to incorporate and infected parts to separate, making removal easier. Complete removal is preferred over partial, as it leads to less recurrence of infection. |
| Chronic pain / nerve entrapment | Mesh can entrap nerves (ilioinguinal, iliohypogastric, genitofemoral), causing persistent pain |
| Fistula formation | Mesh involving permanent material rarely closes spontaneously and usually requires surgical removal |
| Pelvic/prolapse mesh complications | Women with pelvic organ prolapse mesh complications may need surgical excision; however, pelvic pain may not always resolve after removal |
| Erosion or exposure | Particularly in pelvic/vaginal mesh |
- Sabiston Textbook of Surgery, p. 1691
- Fischer's Mastery of Surgery, 8th ed., p. 6182
Key Takeaways
- Permanent mesh (polypropylene, polyester) does NOT dissolve - surgical removal is the only option if it needs to come out, and it is a complex operation
- Absorbable mesh (Vicryl, biologic, biosynthetic) DOES dissolve over time (weeks to months)
- After mesh removal for infection, replacement with another mesh or a tissue-based repair can be performed
- Partial mesh removal carries a higher risk of re-infection, SSI, and failure compared to complete removal
If you are asking because you or someone you know is dealing with mesh complications, the appropriate step is a consultation with a surgeon who specializes in mesh revision - these are complex cases that require individualized assessment.
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