The use of surgical mesh
Surgical mesh is a medical device usually made of synthetic tissue, to provide support for weakened or damaged tissue. It is frequently used in hernia repairs when the hernia has pushed through the wall of the abdomen and upon repair the abdomen wall requires additional support due to muscle damage.
Pelvic organ prolapse and stress urinary incontinence
A less frequently discussed, and perhaps lesser known use for mesh until recently, is for pelvic organ prolapse (POP), where the muscles and ligaments supporting the pelvic organs have weakened causing organs in the pelvis to move out of place; and stress urinary incontinence (SUI) which is the involuntary loss of urine during movement or activity, including coughing or sneezing, from pressure on the bladder. In both cases, mesh is used to support either the pelvis or urethra.
Both POP and SUI can occur as a result of damage caused in a variety of ways. The most common causes are natural childbirth (when the pelvic floor can be weakened) or following a hysterectomy (the removal of the uterus).
The resulting symptoms may occur a number of years after the event.
The need for mesh surgery
Surgery is often required to restore the prolapse or support the bladder when non-surgical procedures have been unsuccessful. One surgical option available is the insertion of tape through an incision which is threaded behind the urethra. There are two way in which the tape is inserted, through either incisions at the top of the inner thigh, known a transobturator tape procedure (TOT) or two incisions in the abdomen known as retropubic tape procedure or tension-free vaginal tape procedure (TVT).
Alternatively a mesh sling can be inserted through an incision in the lower abdomen and vagina, around the neck of the bladder to support it. In these procedures the sling that is used is often a synthetic material. Alternatively tissue can be taken from another part of the body, or donated from another person or taken from an animal.
Problems with mesh surgery
Recent reporting in the UK has highlighted potential problems with mesh surgery, the side effects of which may not become apparent until a number of years after the procedure has been performed.
In 2008 the US Food and Drug Agency (FDA) reported potentially serious complications with mesh surgery where the mesh was implanted through the vagina. Further concerns were raised in 2016 when the FDA changed the classification of the use of mesh to repair POP transvaginally and considers it a high risk device. Complications surrounding the device appear to be higher in POP procedures as the size of the mesh used is larger, however they can also arise in SUI procedures. A large amount of on-going litigation in the USA centres around the re-categorising of this particular type of mesh, dropping the work ‘experimental’, despite minimal human trials before its release.
In the UK mesh was released for use in the 1990’s. However as the mesh was categorised as a ‘device’ rather than a ‘medication’ no extensive trials were required prior to its introduction. At that time mesh was considered to be a ‘quick fix’ which was relatively cheap; a procedure often referred to as ‘the gold standard’.
Have the risks of mesh surgery been underestimated?
Complications can arise in any surgical procedure when a foreign object, such as mesh, is introduced into the body. Even where the patient’s own tissue is used to form a sling risks arise. However, it appears that the potential complications of these procedures may have been underestimated. Our medical negligence team have been contacted by numerous women who have undergone such procedures using synthetic mesh and who are experiencing abdominal or leg pain, bleeding, frequent urine infections and pain during intercourse, among other symptoms. This is often caused as a result of the mesh having moved. In some cases the mesh has hardened and worn through the tissue wall causing organ perforation, known as ‘erosion’.
The need to consider alternatives to mesh surgery
Whilst mesh surgery can often be successful, it is always important to consider all the options available. Many of the women we have spoken to who are experiencing issues with mesh surgery had not been advised of any alternatives available to them.
Some of those experiencing problems with mesh surgery have been required to undergo additional surgery to rectify the issue. In some cases surgeons are unable to remove the mesh.
So when considering whether mesh surgery is the right course of action it is important to weigh the benefits against the possible complications, and to consider all options available. If medical professionals have failed to do this then patients who have suffered as a result may be entitled to bring a claim for compensation for medical negligence.
Free mesh surgery helpline
Discussing issues surrounding mesh complications and, in particular, acknowledging bladder incontinence can be very upsetting and a difficult conversation to have. However if you are experiencing issues following mesh surgery, contact Penny Beales. She will listen to your concerns with care, sympathy and discretion. She will let you know where you stand legally and whether you have a claim for compensation that we will be able to deal with on a No Win, No Fee basis.
Call Penny on 0808 139 1606 or email her at [email protected]sleeblackwell.co.uk