How new guidelines for mesh operations will affect patients
Mesh operations should only be carried out “as a last resort” for women suffering from incontinence and prolapse, a health body has concluded.
The National Institute for Health and Care Excellence (Nice) has issued new draft guidance which states that clinicians should offer non-surgical options before any mesh procedures take place.
The organisation has also called for a national database to be set up to record all procedures involving the use of surgical mesh or tape to “help with future decision-making”.
But mesh victims believe the draft guidance doesn’t go far enough and have called for the operations to be banned altogether.
Mesh implants have devastated the lives of thousands of people across the UK and left many in permanent pain, unable to walk, work or make love to their partners.
Made out of plastic and typically used in women after childbirth, the devices are implanted to support organs such as the vagina, uterus, bowel, bladder or urethra.
But complications appear to be rife in the UK, with women reporting severe and constant abdominal and vaginal pain following the surgery. Others have experienced incontinence, infections and bleeding.
Now Nice has changed its guidance in a move which could substantially reduce the number of mesh operations taking place.
Nice chief executive Sir Andrew Dillon said: “Our independent advisory committee looked at a range of evidence for interventions for urinary incontinence and pelvic organ prolapse in women and made a series of detailed recommendations using the best evidence currently available.
“It is important that every woman is supported to make decisions that are right for her, consents to a procedure, and fully understands the benefits and risks of the procedure being offered before consenting to it.
“Where surgical mesh/tape could be an option, there is almost always another intervention recommended in our guideline which does not involve surgical mesh/tape. If a surgeon cannot provide a full range of choices to the patient, then she should be referred to one who can.
“Surgeons must also record any intervention using surgical mesh/ tape in a national database.
“The guideline committee was asked to look at a range of interventions and examine the evidence for them. Importantly, our recommendations offer women a range of options for treatment that don’t involve the use of surgical mesh/tape.”
Carolyn Churchill, who had a mesh implant seven years ago to combat her stress incontinence, said the device stopped her walking properly and ruined a 14-year relationship with her partner.
She fears many women will continue to have the mesh procedure.
“Many of us feel that the campaign to ban mesh has taken a huge step backwards,” said the Nantgarw resident. “This opens the doors for many more people to be abused by surgeons who don’t have the skills to repair with natural tissue.
“By banning mesh, it will open the floodgates for compensation.”
Kath Sansom, of campaign group Sling The Mesh, added: “Ideally we want all pelvic mesh banned. The risks are too great. It is totally unacceptable that women come out of a ‘simple little operation’ with shattered lives.
“One in seven women in Sling The Mesh have lost their marriages because of mesh. Seven in 10 have lost their sex life. Eight out of 10 suffer pain so great it affects their daily life. More than half suffer ongoing urinary infections. Not surprisingly, many are suicidal and six in 10 are on antidepressants.
“Sling The Mesh has nearly 7,000 members. Sadly, many thousands have been harmed in the last 20 years. This guidance should have come a long time ago.”
The concerns with mesh are not just isolated to woman.
Former supermarket manager Peter Corbett, who had a mesh inserted following a hernia, said the procedure and subsequent removal of the implant left him struggling to walk or play with his grandchildren.
His wife Dawn, from Llwydcoed, Aberdare, said of the new guidance: “I think it’s a good solution but it still does not answer the question of why it was used in the first place.
“It also doesn’t solve the problem that many men are suffering, like my husband.”
Non-surgical options for urinary incontinence advised by Nice include:
■ Lifestyle interventions
■ Physical therapies
■ Behavioural therapies
■ Medicines Non-surgical options for pelvic organ prolapse include:
■ Lifestyle modification
■ Topical oestrogen
■ Pelvic floor muscle training
■ Pessary management
The draft guideline also recommends how complications associated with surgical mesh surgery should be assessed and managed.
Nice says consultants at specialist centres should develop individualised investigation plans for each woman with suspected or confirmed mesh-related complications.
Complications related to the device should also be reported to the Medicines & Healthcare products Regulatory Agency (MHRA) and details of the complications should be collected in a national registry.
In July the UK Government announced a national “pause” in the use of the devices to treat stress urinary incontinence and prolapse where the mesh is inserted through the vaginal wall.
Nice says this will remain in place until a number of conditions are met, including:
■ Registering all operations and any complications on a national database
■ Surgery being performed by specialist surgeons at specialist centres
Owen Smith MP, chairman of the All-Party Parliamentary Groups on Surgical Mesh Implants, said: “This is a welcome U-turn from Nice, who in their 2016 guidelines for mesh did not recommend any other treatment options for stress urinary incontinence and in fact stated that complications from mesh were ‘infrequent.’
“While I am pleased that Nice is now taking action to advise against mesh as a first-line treatment, this announcement is well overdue. I have called on them to get on and urgently publish these guidelines for the last two years and I’m glad they have finally listened.
“This news is also a complete vindication of the thousands of women injured by mesh surgery who have campaigned tirelessly to get the procedure halted.
“I believe that the announcement of these guidelines, along with the Department for Health’s current suspension of mesh surgery, will mean the end of mesh surgery for incontinence, other than for a handful of women for whom all other options have been ruled out.”
The campaign to ban mesh has taken a huge step backwards. This opens the doors for many more people to be abused by surgeons who don’t have the skills to repair with natural tissue... CAROLYN CHURCHILL