A study by researchers in the Netherlands is set to track 50 patients who developed symptoms of autoimmune conditions following hernia and pelvic mesh surgery – which should be a step towards understanding potential risks associated with polypropylene mesh.

HOWEVER, we agree with expert concerns that the proposed study methods for diagnosing ASIA syndrome (Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants) could fail to capture the full extent of harm.

Experts warn that the study design could overlook critical details, particularly long-term complications that often emerge years after implantation.

While this research should be a move in the right direction, we say it must go further. Comprehensive testing, longer follow-up periods, and consideration of mesh degradation over time are essential to truly understand the impact on patients.

Furthermore we note the following Conflicts of Interest – One of the study authors is a consultant for Boston-scientific and Medtronic. Another is a trainer for Coloplast.

Why Are Experts Concerned?

The study will only run for one year, yet complications can take many years to develop. Experts say around 40% of patients develop ASIA symptoms more than 1 year after implantation.

The study assumes that polypropylene mesh remains inert and unchanged inside the body. Experts – and we as campaigners – strongly disagree. Our lived experience shows that mesh can degrade and alter its properties over time, leading to serious complications.

The study wont include blood tests that could show immune activity. Some common markers, like C-reactive protein, are usually normal in people with mesh-related ASIA. Other markers are often raised in these patients – but the study won’t test for them. This means important clues could be missed.

Study authors will use a chemical called methyl ethyl ketone (MEK) to “dissolve” a piece of mesh for allergy testing. But in reality, MEK cannot fully dissolve polypropylene mesh. It can only pull out some substances from the surface, like additives. This matters because the test will only show short-term reactions to these additives, NOT the long-term changes that happen when mesh breaks down inside the body over time. Those changes – such as tiny particles breaking off – are what can trigger ongoing immune problems, and this test won’t capture that.

The study plan for mesh removal is not well described. Full mesh removal isn’t feasible in most cases due to particle detachment and migration, therefore residual PP fragments may continue to stimulate the immune system and cause systemic symptoms even after ‘complete’ mesh removal.

What Needs to Change?

Future research should:

• Include long-term follow-up of several years, not just one
• Use better testing methods that reflect real-life degradation
• Cover a wider range of autoimmune markers
• Consider the complexity of mesh removal and residual fragments

Read the Protocol for the new Dutch study here

Read the expert concerns below