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Related Experiment Videos

When and how to excise vaginal mesh.

Lisa Rogo-Gupta1, Mario Castellanos

  • 1aUrogynecology and Reconstructive Surgery, Obstetrics and Gynecology and (by courtesy) Urology, Stanford University, Stanford, California bDivision of Surgery and Pelvic Pain, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.

Current Opinion in Obstetrics & Gynecology
|June 9, 2016
PubMed
Summary

Synthetic mesh complications in pelvic surgery are rising, leading to increased excisions. Pain is a common reason for removal, but explantation carries significant risks for patients.

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Supracervical Hysterectomy Is Protective against Mesh Complications after Minimally Invasive Abdominal Sacrocolpopexy: A Population-Based Cohort Study of 12,189 Patients.

The Journal of urology·2021

Area of Science:

  • Urogynecology
  • Pelvic Reconstructive Surgery
  • Biomaterials in Medicine

Background:

  • Synthetic mesh (grafts) use in pelvic reconstructive surgery has increased since 2011.
  • While intended for improved outcomes, mesh implants can cause complications like erosion, chronic pain, and dyspareunia.
  • Patient evaluation and surgical techniques for mesh complications are complex and carry risks.

Purpose of the Study:

  • To review current opinions and approaches to synthetic graft excision for managing mesh-related complications.
  • To summarize recent findings on mesh excision trends and patient outcomes.
  • To highlight the challenges and risks associated with mesh explantation.

Main Methods:

  • Review of recent studies and current literature on synthetic graft use and complications in pelvic reconstructive surgery.

Related Experiment Videos

  • Analysis of trends in mesh placement versus excision procedures.
  • Examination of indications for mesh excision, particularly pain.

    • Main Results:

    • Mesh excisions are increasingly performed, while graft placement is decreasing.
    • Patients operated on by lower-volume surgeons face a higher risk of complications and subsequent need for excision.
    • Pain, often elicited by palpation of mesh arms, is the most frequent indication for vaginal mesh excision.
    • Mesh explantation is technically challenging and associated with significant risks.

    Conclusions:

    • Surgical excision is an increasingly common management strategy for vaginal synthetic graft complications.
    • Careful patient evaluation of symptoms and objective findings is crucial for guiding management decisions.
    • Surgeons must counsel patients thoroughly on the substantial risks of excision, including hemorrhage, nerve damage, muscular injury, and potential symptom recurrence.