The term surgical mesh refers to a permanent synthetic implant that is usually made from a non-absorbable polypropylene (plastic) material. It is known by multiple names such as ‘tape’, ‘sling’, ‘patch’, ‘ribbon’, ‘graft’ or ‘hammock’ TVT.
On this page, you can find the following information:
- What is surgical mesh?
- What is surgical mesh used for?
- What are the concerns about surgical mesh?
- What should I consider before agreeing to surgical mesh being used?
- Questions you might want to ask your doctor before considering a surgical mesh implant
- What are some of the complications of surgical mesh?
- What are the symptoms of surgical mesh complications?
- What can I do if my surgical mesh has caused complications?
- What actions are being taken to monitor and improve the safety of surgical mesh?
Key points about surgical mesh
- There are 2 types of surgical mesh – partially absorbable or non-absorbable. The most common mesh used is non-absorbable mesh. This remains in your body indefinitely so should be considered a permanent implant. If there are complications it may not be able to be removed.
- Surgical mesh is widely used for hernia repair and often in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP), which includes bladder, uterine, vaginal, bowel and rectal prolapse.
- While some people who have mesh inserted experience no complications, a number do. Some experience adverse events immediately after their operation, while for others they can develop years later. The delay in symptoms for people developing complications can be up to 10–20 years.
- Complications can range from mild to very severe. They can have significant physical and psychological impacts and effects on your quality of life and mental wellbeing.
- To give informed consent, make sure you have had all the information, options and risks explained to you. This includes the possible benefits and risks of complications, as well as any alternative treatment options. Take time to consider your options and ensure you have sufficient information to make an informed decision.
- If you notice any unexpected symptoms or complications from surgical mesh, see a doctor straight away.
Surgical mesh is a medical device used to repair and provide support to parts of your body that have become weakened. Mesh is used to treat stress urinary incontinence, rectal/bowel, vaginal, uterine and bladder prolapse and for hernia repairs.
These medical device implants are made from synthetic plastic and are designed to be a permanent implant. It is important to note that these devices may or may not be able to be fully removed. This is something you should consider when deciding on which surgical procedure is the right option for you.
Surgical mesh is used to treat stress urinary incontinence, rectal/bowel, vaginal, uterine and bladder prolapse and for hernia repairs.
Some people experience complications immediately after their operation, while for others they develop years later. Complications may range from mild to severe. They can have physical impacts and affect your quality of life.
In 2017 some surgical mesh products were withdrawn from use in Aotearoa New Zealand. These were products used for pelvic organ prolapse (POP) via transvaginal implantation (inserted via your vagina) and a single incision mini-sling for the treatment of SUI. Other devices may be used by some surgeons using laparoscopic surgery. There are now only limited situations where mesh might be considered, eg, for a mid-urethral sling or Sacro-colpopexy.
Each type of mesh procedure carries its own risks and benefits. As part of the informed consent process, you need to be fully informed on what is involved in the procedure, the possible benefits and risks of complications, as well as any alternative treatment options (both surgical and non-surgical).
If you are considering surgical mesh to treat stress urinary incontinence you should receive a copy of this document to discuss with your surgeon and support your decision-making: Considering surgical mesh to treat stress urinary incontinence?
Take the time you need to read it and make sure you understand it. If not, ask someone to help you with that. Also, discuss any concerns or questions that you have with your surgeon.
You have the right to seek a second opinion if you are not satisfied with the information you receive or would like further advice on your treatment options.
- Do you have any written information that I can take away with me?
- Before signing the consent form on the day of the operation, will there be an opportunity to contact you with any questions I have about the operation?
- Can you explain all my possible options, including non-surgical treatment, surgery with mesh and surgery without mesh?
- Why is mesh being suggested for me and what are the benefits over non-mesh alternatives?
- What are the benefits of alternative options being used instead of mesh?
- What brand of mesh will be used?
- What results have your other patients had?
- How many mesh operations have you performed using this particular mesh?
- How many removals of mesh have you undertaken?
- How many mesh-related complications have you come across?
- What will my follow-up care be like after the operation?
- What side effects can I expect after surgery and what side effects should I report to you?
- What happens if I experience complications or unusual symptoms in years to come?
- What are the risks associated with using this mesh product?
- If there is a complication will you be able to completely remove the mesh device?
- What happens if this surgery does not correct my problem?
- What are the long-term effects of complications?
- How will these long-term complications impact on my other body symptoms or organs?
- What is the management of these symptoms once they occur?
Surgical mesh device implants have been known to cause erosion (where mesh pushes against and into the surrounding tissue, nerves and organs). Although not as common, mesh can cause extrusion (where mesh pushes through or perforates surrounding tissue, nerves and organs). Mesh can cause scarring and adhesions.
Mesh is no longer thought of as inert or unchanging, as there has been significant research to show that after implantation the mesh can break down, shrink and change over time.
If you experience any of these symptoms after you have had surgical mesh implanted, contact your doctor immediately:
- pain (at the site of the mesh implant, including vaginal, groin, pelvic, referred pain down leg and back pain)
- urinary tract infection
- difficulty urinating (peeing)
- pain during sexual intercourse
- although not as common, painful sex experienced by the partner when they feel the mesh during sexual intercourse
- onset of autoimmune disorders.
If you have implanted surgical mesh and it causes pain or infection, or if you have any concerns, contact the surgeon who implanted the mesh. Alternatively, you can contact your GP if you would like to be referred to another specialist in the use of surgical mesh. Make sure you ask for a longer appointment so that you have enough time to discuss your concerns.
In 2019, the Ministry of Health led a process to hear directly from New Zealanders affected by surgical mesh. The stories shared through this process were independently analysed by a team from the Diana Unwin Chair in Restorative Justice, Victoria University of Wellington and resulted in the report Hearing and responding to the stories of survivors of surgical mesh, released in December 2019. The Ministry has said that it is committed to progressing the actions included in the report and working with other agencies to support those who have been affected and to minimise future harm.
Accident Compensation Corporation (ACC) review of declined surgical mesh claims
From October 2020 onwards, ACC is offering to reassess declined surgical mesh injury claims. This was one of the actions agreed to in the report. If you have had a claim for a surgical mesh injury declined, you can ask ACC to reassess it. This will apply to cover decisions made before 28 October 2020.
To have your claim reassessed, you can contact ACC by:
- calling 0800 735 566 and choosing option 5
- emailing email@example.com
- visiting your GP and taking information with you from this ACC page or saving the page on your phone
- discussing this with your specialist doctor if you have one at an upcoming appointment.
Read more about reassessing declined surgical mesh claims ACC, NZ, 2020
Hearing and responding to the stories of survivors of surgical mesh Ministry of Health, NZ, 2019
- Surgical mesh Ministry of Health, NZ
- Mesh Down Under A consumer organisation dedicated to offering support and information to New Zealanders affected by the use of surgical mesh.
|Dr Jeremy Steinberg is a GP with special interests in musculoskeletal medicine, evidence-based medicine and use of ultrasound. He's been reviewing topics for Health Navigator since 2017 and in his spare time loves programming. You can see some of the tools he's developed on his website.|