Place of mesh in vaginal surgery, including its removal and revision

In this review, I aim to establish the place of vaginal pelvic organ prolapse surgery with mesh, drawing on personal experience. Physiopathologic justifications for the use of synthetic implants are described, and reasonable indications are highlighted. Major recommendations for the insertion are made. Possible complications, such as erosion, retraction, pain, failure and dysfunction are explained, and treatments, including secondary surgery are reviewed. The need for specific training is emphasised, including indications, standard techniques of insertion, follow up, and mesh-related symptoms of complications, their management, including indications, and techniques of revision or excision. Mesh surgery in pelvic organ prolapse aims to replace defective ligaments and fascias by a synthetic implant that provokes a foreign body reaction and fibrosis around it, recreating new connective support. Women indicated for this type of surgery include those at high risk of recurrence after autologous surgery resulting from defective connective tissue. Insertion techniques and the management of complications need specific training before using mesh in pelvic organ prolapse surgery. Revision and removal should be carried out in referral centres.