Surgical mesh is a medical device used to repair and provide support to parts of your body that have become weakened.
Key points about surgical mesh
- There are two types of surgical mesh: absorbable or non-absorbable. Non-absorbable mesh remains in your body indefinitely, so should be considered a permanent implant.
- Surgical mesh is widely used for hernia repair and also often in the treatment of stress urinary incontinence (SUI). It is no longer used in New Zealand for repair of pelvic organ prolapse (POP).
- While many people who have mesh inserted experience no complications, a number do. Some experience complications immediately after their operation, while for others they develop years later.
- Complications may range from mild to severe. They can have significant physical impacts and effects on your quality of life.
- To give informed consent, 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.
- If you notice any complications from surgical mesh, see a doctor straight away.
What is surgical mesh used for?
Surgical mesh is widely used to repair hernias and is also often used in the treatment of stress urinary incontinence (SUI). It is no longer used in New Zealand for repair of pelvic organ prolapse (POP).
It was introduced because of the high failure rate of both initial surgery and revision surgery. Using mesh increases the effectiveness of surgery and dramatically reduces the rate of recurrence for hernias and stress incontinence. Most people who have mesh implanted don’t have complications.
What are the concerns about surgical mesh?
For many people, surgical procedures using mesh provide an effective form of treatment. However, while many people who have mesh inserted experience no complications, a number do.
Some people experience complications immediately after your 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.
What should I consider before agreeing to surgical mesh being used?
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.
What should I ask my doctor about before considering a surgical mesh implant?
- 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 regarding 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?
What are some of the complications of surgical mesh?
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, as there has been significant research to show that after implantation the mesh can break down, shrink and change over time.
What are the symptoms of surgical mesh complications?
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.
What can I do if my surgical mesh has caused complications?
If you have implanted surgical mesh and it causes pain or infection, or 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.
What actions are being taken to monitor and improve the safety of surgical mesh?
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.
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, October 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.
|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.|