VAGINAL MESH COMPLICATIONS
Mesh is a commonly used material in pelvic floor surgery for both incontinence and prolapse. In urinary incontinence procedures, ie slings, it is the standard of care and is used in retropubic slings (ie TVT, SPARC), TOT slings and the newer single incision Mini-slings. In prolapse it has been used for many years for the abdominal approach to vaginal vault suspension and is considered standard of care for this procedure (ie abdominal sacralcolpopexy). More recently, it has been used vaginally in Mesh Kits to treat prolapse such as cystocele and rectoceles and when performed by properly trained and experienced surgeons, studies have shown good results with low rates of complications. Mesh is used secondary to the fact that it has been shown in many studies to have higher cure rates versus traditional repairs using the patient’s own native tissue. This stems from work that the general surgeons did many years ago showing that hernia repairs with mesh had a much higher cure rate versus using the patient’s own weakened tissue.
Mesh technology has improved over the years, as well as techniques of mesh placement vaginally to help minimize risks, unfortunately mesh complications still occur and therefore must be recognized and managed properly. Unfortunately, many patients suffer needlessly secondary to the fact that they are told that nothing can be done…and this is far from the truth. While it is true that complications from any pelvic floor surgery are complex (whether mesh has been used or not), true experts in pelvic surgery should be able to handle and treat those complications….or send the patient to someone who does have that expertise.
Types of Mesh Complications Encountered
Type of Mesh and Mesh Technology
Over the years mesh technology has improved and complications have actually been reduced because of this. However, at the same time, because of the increased cure rates associated with mesh graft placement at the time of incontinence and prolapse surgery, more surgeons are placing mesh and therefore more patients have mesh than ever before which will unfortunately will have a baseline risk of complications. An important note though is one has to remember that with ANY prolapse or incontinence surgery, even “traditional” surgery without mesh, complications do occur including pain, failure or recurrence. The complications associated with mesh may be unique, however in many cases are minor compared to some complications associated with procedures that don’t use mesh.
All Meshes are NOT created equal
Studies have shown that a Type I mesh is the best tolerated mesh with the fewest complications seen in prolapse and incontinence surgery. Infection and/or rejection of this type of mesh is very, very rare. These type of meshes are monofilament (ie each strand of the mesh is a single strand and not braided) and macroporous (ie all openings are >75 microns) to allow bacteria fighting cells to gain access into the mesh. They have also recently become lighter, softer and less dense which has reduced complications even further. Drs. Miklos and Moore recently published the largest series in the world with the use of a Type I mesh for Laparoscopic Sacralcolpopexies for vaginal vault prolapse. Overall complication rate was <1% with mesh extrusions <2%. Over the past 3 yrs, Dr. Moore has been leading studies using an even lighter and softer mesh for vaginal mesh placement (Intepro Lite) and has seen complications such as mesh extrusion decrease by 50%. This mesh is 50% lighter, softer and less dense than the previous mesh they were using. This is the future trend in mesh technology, lighter, softer mesh that still has the strength to hold things in place. Older meshes that were NOT type 1 meshes, such as the Obtape sling for SUI, IVS tape for prolapse and grafts such as Gore-tex have been shown to have high rates of infection, abscess, rejection, erosion/extrusion and many of these materials have been taken off the market because of this.
COMPLICATIONS ENCOUNTERED
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