Monday, January 23, 2012

Transvaginal Mesh: The Types of Surgeries Which Use this Controversial Device



As more information comes to light regarding the potential safety issues of the transvaginal mesh implants, women across the nation have more questions regarding the device. The FDA has yet to make a final determination on how mesh devices will be approved in the future and whether the current manufacturers will be subject to more rigorous scrutiny regarding the mesh device. It appears that there are now thousands of women coming forward with stories of adverse events following their transvaginal mesh surgery leading the FDA to require sterner warnings regarding use of the mesh. Physicians are being warned to strongly consider alternative or more traditional surgical methods in repairing pelvic organ prolapse and stress urinary incontinence and women are urged to be fully informed of potential risks before undergoing transvaginal mesh surgery.

Hernia Repair Using Mesh

The mesh used in many surgeries today was originally used strictly for abdominal hernia surgeries and appeared to work well in this application although there were some complications reported. The patch for a hernia repair is typically larger than one used in a transvaginal application so remains in place more securely. Studies show that a Type I mesh tends to be tolerated better, resulting in the fewest complications when used in hernia, POP and SUI surgeries, and infections using this type of mesh are rare. Type I meshes are monofilament and somewhat porous, which allows the body’s bacteria-fighting cells to have unimpeded access to the mesh implant. Mesh made of Gore-tex has been shown to cause the highest rates of infection and erosion therefore is being used less and less often in the transvaginal application.

Necessity for Pelvic Organ Prolapse Surgery

In a woman’s twenties and thirties her natural connective tissues and ligaments will hold her pelvic organs firmly in place.  As women age and undergo pregnancy and childbirth, those connective tissues begin to stretch out of place, allowing the descent of one or more of the pelvic organs including the uterus, vagina, bladder or rectum. The fascia in a healthy pelvic floor is comprised of a natural elastic mesh layer which keeps the organs where they should be. When this fascia begins to break down and weaken, organ prolapse can occur in varying degrees of seriousness. It is estimated that as many as half of all women who have had at least one full term pregnancy have some level of pelvic organ prolapse.

Risk Factors for Pelvic Organ Prolapse

The known risk factors which increase the odds of pelvic organ prolapse consist of the ever-present genetic link, menopause, being older than sixty, previous pelvic surgery or surgeries, number of full-term pregnancies as well as issues associated with increased stomach pressure such as being overweight. Even though fifty percent of women who have gone through childbirth may have some level of POP, most of them do not have symptoms so severe as to require surgery.

For those women who do have symptoms severe enough to affect their overall quality of life, they may need to have some form of surgical treatment to alleviate the pain and other symptoms. It is necessary to fully evaluate each woman’s individual case before deciding on a course of action. The length and severity of the symptoms will of course be a factor as well as the woman’s desire for treatment the degree of the prolapse and whether or not she is healthy enough to undergo surgery.

Surgical Types and Issues

The goal of surgery is to provide the necessary support for your pelvic organs, and mesh is used in an attempt to reduce the risk of recurrence of the prolapse. Mesh typically offers a longer-lasting repair when all goes well and is successful in at least 80% of the POP surgeries it is used in. What the patient must remember is that mesh is a synthetic material and becomes a permanent part of the body.

The mesh has tiny holes which allow the body’s own tissue to grow into it, providing the necessary support framework. Women undergoing the surgery may have either general or regional anesthesia; incisions are made by the surgeon inside the vagina, and the surrounding tissues are strengthened with stitches. The mesh will be placed under the vaginal skin, and the tissues of the body will grow into the mesh within 3-4 weeks which provides the reinforcement needed for the weakened tissues.


Complications of Transvaginal Mesh Surgery

The complications of the mesh surgery result primarily from mesh erosion, meaning the mesh erodes into the vaginal walls or into other organs. This erosion can lead to severe—or in rare cases, even fatal—consequences, and typically requires another surgery to correct the erosion and remove the mesh patch. Women who have suffered mesh erosion from the transvaginal mesh surgery may experience repeated infections, chronic abdominal or back pain or urinary tract problems, and depending on the severity of the erosion could require multiple surgeries.

If the use of mesh has caused you to have severe complications, it is important that you first take care of your health then consult a reputable attorney who can evaluate the facts of your mesh surgery and determine whether you have a potential case.
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Author: Andrew Sullo
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Andrew Sullo is a National Trial Lawyer's Top 100 Selection for 2013-2019. He is a member of the American Association of Justice (2013-2019), and a recipient of the 2019 AVVO Client's Choice Award.

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