Updates in Gynaecology

Edited by Dr Roman

DO WE USE MESH FOR VAGINAL PROLAPSE REPAIR ?

by Jose Roman

Our opinion about the use of vaginal mesh for prolapse repairs has always been clear for the past 12 years. We enclose an interview with the New Zealand Herald from 2012 where we clearly indicated our position with regards to the use of vaginal mesh. It is important to mention that this does not apply to the use of mid-urethral slings for correcting incontinence. 

 

HEALTH BODIES STAND BEHIND SURGICAL MESH - HERALD ON SUNDAY 

7 Oct, 2012   5:30am 

 3 minutes to read 

 

A.A has suffered for eight years. Photo / Doug Sherring

 

 

ACC pays out $3m but authorities say treatment safe.

Health authorities are backing the use of a controversial implant, despite mounting evidence of serious complications.

Last week the Herald on Sunday revealed hundreds of people had been harmed after receiving surgical mesh.

The mesh is a permanent material made from either polypropylene or pig collagen. It is used to repair hernias, incontinence and prolapsed pelvic organs and muscles.

More than a dozen people have contacted the Herald on Sunday with horrific accounts of complications.

AA, 48, feels like she has been "sitting on barbed wire" for eight years since an operation to repair a prolapsed bladder.

She said her gynaecologist agreed her reaction to the mesh was rare and severe but did not offer removal.

After living in pain for a year she consulted another gynaecologist who immediately removed the mesh, claiming it had been inserted too tightly.

"It's not as bad now but it still feels like I'm sitting on something sharp," AA, of Auckland, said.

AA applied for accident compensation under the old ACC legislation but was declined because she had no clinical evidence of physical injury - only pain.

Since 2008, ACC has paid out $3.1m for treatment, rehabilitation and compensation for complications relating to mesh.

 

ACC spokeswoman Stephanie Melville said 600 claims had been lodged but only 389 had been accepted for "treatment injuries", which were formerly known as medical misadventures.

Professor Ajay Rane, who is vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said warnings from the US Food and Drug Administration (FDA) last year related only to the use of mesh in prolapsed pelvic organs and tissue. There were no official concerns over the use of mesh for hernias, he said.

Rane said the mesh was not dangerous and the college supported its use. "If it was dangerous the FDA would have withdrawn it," he said.

He said complications could be a result of a lack of post-operative care, not the product. The college provides ongoing training to gynaecologists.

"I can assure the women of New Zealand that [the college] has a robust training programme and is constantly updating surgeons."

However, Hamilton gynaecologist and laparoscopic surgeon Jose Roman disagreed, blaming a lack of product research for the complications.

He said the use of mesh to repair hernias of the abdominal wall was usually a "good procedure" with a low complication rate. Because of this, manufacturers and the FDA wrongly assumed mesh could also be used for genital prolapse in women.

"Mesh in the abdomen behaves very differently to the mesh in the vagina, which is never sterile," Roman said. "They assumed it would work the same so they approved it without proper research and clinical trials."

Medsafe's group manager, Dr Stewart Jessamine, said he was confident surgical mesh was safe when used according to the manufacturers' instructions.

Health Minister Tony Ryall refused to comment.

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