Mesh solicitor, Caroline Webber-Brown, explains what LVMR is and why it is in the news
The LVMR (laparoscopic ventral mesh rectopexy) procedure has received significant media coverage since mesh support groups began lobbying the government for a ban on pelvic mesh in 2015 and campaigns such as ‘Sling the Mesh’ emerged. Even greater attention was focussed on the procedure following a government announcement in February 2018 that pelvic mesh was to be reviewed.
The ‘First Do No Harm’ review
A two year investigation was carried out involving over 700 individuals and families. This led to the publication of the ‘First Do No Harm’ review on 8 July 2020.
The review acknowledged that patients had been abandoned by the system and adversely affected by clinicians who did not listen. The overall recommendation was the need for a patient voice and a robust system of long-term monitoring. Nine recommendations were made in the review, including:
- the appointment of an Independent Patient Safety Commissioner;
- the implementation of a discretionary payment scheme to help fund the costs of treatment; and
- setting up specialist mesh centres to provide treatment, including mesh removal.
Specialist Mesh Centres
From 1 April 2021, the following Trusts will be providing specialist mesh services:
- Newcastle Upon Tyne Hospitals NHS Foundation Trust;
- Sheffield Teaching Hospitals NHS Foundation Trust;
- Manchester University NHS Foundation Trust;
- Cambridge University Hospitals NHS Foundation Trust;
- University College London Hospitals NHS Foundation Trust;
- University Hospitals of Leicester NHS Trust; and
- Nottingham University Hospitals NHS Trust.
There has been disappointment that the First Do No Harm review did not specifically include the LVMR procedure. Its exclusion was particularly surprising given the widely reported injuries that have been associated with it, the suspension of Mr A Dixon (the surgeon renowned for performing and pioneering the LVMR procedure) and the subsequent internal reviews carried out by both North Bristol NHS Trust and Bristol Spire Healthcare PLC where Mr Dixon practiced.
Laparoscopic Ventral Mesh Rectopexy (LVMR)
The LVMR procedure was developed to treat intussusception, symptomatic rectocele and external rectal prolapse by straightening and fixing the rectum back into it’s normal anatomical position. Historically, this procedure was viewed as being a minimally invasive procedure, with a short hospital stay and short recovery times when compared with alternative surgical procedures.
Following the internal investigations by North Bristol NHS Trust and Spire Healthcare it has become apparent that prior to patients undergoing the LVMR procedure there was a:
- failure to fully explain the procedure or the risks;
- failure to offer alternative procedures;
- failure to explain that mesh could protrude/erode; and
- failure to warn that when performing the LVMR procedure additional procedures in the form of a sacrocolpopexy (a gynaecological procedure which is performed to repair the a vaginal prolapse by using mesh to attach the top of the vagina to the base of the spine, to support the pelvic organs) or colporrhapy (a gynaecological procedure used to repair the front or back walls of the vagina) would be performed and involve inserting mesh into the vagina.
While some patients have found the LVMR procedure beneficial, a significant number of patients have reported life altering complications including:
- mesh protrusion/erosion;
- chronic pelvic pain;
- nerve damage;
- severe constipation requiring pessaries, irrigation or stomas;
- incontinence; and
- the need for further surgery to repair the damage.
This has led to victims turning to a specialist mesh solicitor and pursuing legal action.