4th October 2019, Volume 132 Number 1503

Rowan J Collinson, Andrew R Moot

The use of mesh prostheses in pelvic surgery is under significant scrutiny. Recent developments in gynaecological pelvic floor surgery have led to a broad reappraisal of mesh-related procedures in many…

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Summary

The use of prosthetic mesh products in pelvic prolapse surgery is under significant scrutiny, because of widely reported adverse outcomes. However, the reasons why patients are recommended this type of surgery, and the surgical techniques used, vary between different surgical specialty groups. In the bowel surgery subspeciality (‘colorectal surgery’), a mesh repair is sometimes recommended for bowel prolapse problems, which can cause functional problems such as loss of bowel control. The emergence of bowel mesh procedures has provided an extra treatment option, in some cases where a satisfactory treatment did not exist before. The available evidence suggests that bowel prolapse surgery using the mesh technique is much safer than that of the gynaecological approach and should not necessarily be dismissed without due consideration. However, there are recommendations relating to improved reporting, training and patient education around this procedure.

Abstract

The use of mesh prostheses in pelvic surgery is under significant scrutiny. There are justifiable concerns around the transvaginal use of mesh products for POP surgery. The latter part of 2017 saw the announcement of wide-ranging regulatory actions relating to transvaginal mesh products, by the Therapeutic Goods Administration in Australia and subsequently Medsafe in New Zealand. In colorectal surgery, pelvic mesh is predominantly used in the treatment of rectal prolapse, with ventral mesh rectopexy (VMR) becoming popularised in recent years. The available evidence suggests that despite the current mesh controversy, VMR is an acceptable procedure, with functional advantages over other colorectal prolapse procedures. With only short-term outcome data available however, comparative studies and longer follow-up are required to answer the question of long-term mesh safety. In the meantime, there are areas where surgical practice can be optimised, in particular around reporting, training and patient education. The aims of this paper are to summarise the current status of pelvic floor mesh surgery and examine how this will impact colorectal pelvic floor surgery.

Author Information

Rowan J Collinson, Colorectal and General Surgeon, Department of General Surgery, Auckland City Hospital, Auckland District Health Board, Auckland; Andrew R Moot, Colorectal and General Surgeon, Department of General Surgery, North Shore Hospital, Waitemata District Health Board, Auckland. 

Correspondence

Rowan J Collinson, Colorectal and General Surgeon, Department of General Surgery, Auckland City Hospital, Auckland District Health Board, Park Road, Grafton, Auckland 1023.

Correspondence Email

rowanc@adhb.govt.nz

Competing Interests

Nil.

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