What action has been taken on the use of mesh in hernia repair.

In February 2018, the then-Chief Medical Officer wrote to NHS Scotland Medical Directors about public interest in the use of mesh implants, including in hernia repair. Medical Directors were asked to ensure that clinicians offer patients all appropriate options for surgery, as well as the option of no surgery. In addition, the importance of shared decision making, informed consent and listening and acting upon patients concerns was noted.
The Scottish Government commissioned a review by the Scottish Health Technologies Group (SHTG) of primary inguinal hernia repair in men. SHTG published their report in early 2020 and this concluded that, compared to non-mesh procedures, using mesh resulted in lower rates of recurrence, lower rates of serious adverse events and similar or lower risk of chronic pain. The advice for NHS Scotland was that surgical mesh should be used in elective repair of inguinal hernia in adult males.
Further to this, the Scottish Government asked SHTG to examine hernia repair more broadly, to include women, and to review the outcome of mesh versus non-mesh surgery in a variety of groin or abdominal wall hernias. SHTG have published their report today which is available online at: Elective surgery using mesh to repair primary or incisional hernias in adults (shtg.scot) . This states that the current evidence supports the continued availability of surgical mesh for elective repair of primary ventral hernias, incisional hernias, and primary inguinal hernias in adults in Scotland. This notwithstanding, SHTG also recommends that consideration should be given to patient preference and that patients should have access to alternative hernia treatment options such as non-mesh (suture and natural tissue) repair. Once again, the importance of shared decision making and informed consent has been emphasised.
The Chief Medical Officer has written to Board Chief Executives and Medical Directors to draw their attention to the report’s findings. The Scottish Government will continue to work with Health Boards, Specialist Associations and the relevant Royal Colleges on the issues raised within the report.