Mesh: the story so far

Thompsons Solicitors’ national practice lead for clinical negligence, Linda Millband, guides you through the recent developments in mesh usage, its complications and what is being done to review its use.

During the 1990s, tension-free vaginal tape’, also known as TVT, was introduced as a treatment for women with stress urinary incontinence – a condition that can sometimes occur following pregnancy or a hysterectomy. It involves placing medical mesh under the urethra, like a sling, to keep it in place.

TVT is still used today for all kinds of vaginal and rectal conditions, for both men and women.

Surgeons often explain to patients that the procedure is quick and simple - It is considered a quicker and easier option than other alternatives.

The National Institute for Health and Care Excellence (NICE), which provides guidance and advice on best practice for health and social care, set out guidelines in 2002 on mesh that broadly deemed it safe for use.

Mesh complications

As more mesh operations have been performed on patients, it has become clear mesh is not as safe as previously thought. Some people have reported serious pain and discomfort following mesh procedures.

Virtually every country in the world has received complaints regarding mesh, with its use already restricted in Australia, New Zealand and Scotland.

Some women have reported internal bleeding and bladder infections, while others have suffered vaginal scarring and even lost the ability to walk unaided.

Many people who have had a mesh implant are now suffering severe pain, life-long injuries and psychological trauma as a result of their mesh operation.

In the UK, more than 127,000 women have had mesh and tape implants on the NHS. Hundreds more, including men and children, have been offered mesh surgery as a treatment for rectal prolapses and abdominal hernias. Private healthcare providers do not publish their figures, which suggests the number of patients who have received mesh treatment could be higher.

It has become clear that many surgeons who used mesh on patients were not properly trained to do so, and patients were not made aware of either the risks involved in the surgery, or the alternatives that were available. A non-mesh related 2015 court case, Montgomery v Lanarkshire Health Board, decided that a patient had the right to be informed of any potential risks of treatment and to decide whether or not to consent if the treatment involved a substantial risk of grave adverse consequences - in essence, to not simply have to take the doctor’s word for it. With that ruling in mind, it is clear that clear that many mesh patients have not been properly informed of the risks involved in mesh surgery, nor have they properly consented.

It was also in 2015 that UK journalist Kath Sansom launched the Sling the Mesh campaign to raise awareness of the potential risks associated with vaginal and rectal mesh surgery.

Cumberlege review

In February 2018, the government asked Baroness Cumberlege to review the use of surgical implants, including mesh, to decide if they are safe for the NHS. In July 2018, following a recommendation by the review, the government announced a ‘high-vigilance restriction’ on the use of vaginally-inserted mesh and tape to treat stress urinary incontinence and pelvic organ prolapse. The restriction is only to be lifted when certain criteria had been met by the NHS nationally and by trusts locally. The criteria includes making sure that surgeons only undertake mesh operations if they are appropriately trained and that a register of operations is maintained to ensure every procedure is notified. Those criteria remain some distance from being met.

In 2019, however, NICE published updated guidelines on mesh. These guidelines stated mesh could be safe to use for pelvic organ prolapse and stress urinary incontinence procedures.

Where are we now?

For now, a pause on mesh use for most NHS England patients remains in place. However, NHS England says mesh procedures remain the only viable option for some patients. In those cases, it will still be used.

Baroness Cumberlege’s final report on mesh is yet to be published. When it is, it should contain full recommendations on mesh use, which the government will then need to consider and respond to.

With that in mind, a full mesh ban is unlikely to happen in the near future.