Inaccurate media reporting about vaginal mesh implants and the lawsuits associated with them has caused patients to become fearful of mesh procedures that may be essential to improving their health, New Zealand general surgeon Dr Steven Kelly says.
In a piece published in the New Zealand Medical Journal on Friday, Kelly said the media “have over previous years done great harm to the reputation of mesh abdominal wall and groin hernia repair”.
Concerns have been escalating after thousands of women around the world reported chronic pain, mesh cutting through tissue and being left unable to walk or have sex after having mesh surgery to repair urinary incontinence and prolapse – conditions often caused by childbirth.
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US pharmaceutical company Johnson & Johnson, a major manufacturer of mesh implants, is fighting class actions in Australia and the US, and could face legal proceedings in the UK.
But the media had “published multiple articles claiming that mesh is unsafe and unproven”, Kelly said. “That is simply not true,” he wrote. “Patients whom require abdominal wall hernia repair are now fearful of mesh. New Zealand general surgeons are well trained in modern hernia surgery and the management of complications.”
Most short-term clinical trials have found high efficacy and low complication rates for the most common mesh implants used to treat incontinence and hernias. But there is a growing body of evidence that efficacy is lower and complication rates are higher when the mesh, also known as transvaginal mesh, is used to treat pelvic organ prolapse.
“It is very important for the public to understand that transvaginal mesh repair has a different risk profile compared to abdominal wall mesh repair [to treat hernia],” Kelly wrote.
“Transvaginal mesh is placed into the vaginal wall in an attempt to treat pelvic organ prolapse. It was initially presumed to be as safe as abdominal wall hernia mesh repair. However, over time there were increasing reports of significant problems with this mesh technique, including mesh erosion, chronic pain, mesh infection and dyspareunia [painful intercourse].”
While many of the problematic meshes have been removed from the market, controversy remains among experts about the risk profile of contemporary meshes and how they should be utilised to treat prolapse. But Kelly said it was essential to also reassure people that the complication rate for abdominal wall hernia repair using mesh was low.
The president of the Australian Medical Association, Dr Michael Gannon, said even in the case of mesh used to treat prolapse, “a minority of women having these kinds of operations have been damaged”.
“One in eight women who have delivered vaginally will need an operation for either prolapse or incontinence, and using surgical tape or mesh may be a part of their legitimate care,” Gannon said.
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“We seem to have forgotten how many women have been helped by these operations over the journey in acknowledging that some may have been harmed by it.”
Gannon, who is an obstetrician, said he had been involved in the treatment of women who had been harmed by the meshes. Like Kelly, he said the media had been guilty of misrepresenting the scale of the problem.
“I have a lot of sympathy for the minority of women injured by gynaecological mesh operations; they have chronic pain and a lot of cases are very hard to fix,” he said.
“Stories like theirs are highly charged, emotional stories that make for good copy and its inevitable the media would report them. It’s less interesting to talk to a woman who had an operation five years ago and their lives have been made a whole lot better.”
More than 100,000 transvaginal mesh lawsuits have been filed in the US, while more than 700 women comprise the Australian class action. NHS records have revealed that thousands of women have undergone surgery to have vaginal mesh implants removed during the past decade in the UK due to traumatic complications linked to the devices.
The CEO of the Health Issues Centre in Australia, Danny Vadasz, said pointing out that the majority of women to undergo mesh procedures had not been harmed was an attempt to deflect attention away from the medical profession.
He used the example of the drug Thalidomide, prescribed to women to treat insomnia and morning sickness and which was subsequently found to have caused severe deformities in babies born to women on the drug.
“No one said, ‘Oh yes, but hundreds of thousands of women got a good night’s sleep on the drug, and that outweighs the harm’,” Vadasz said.
Related: Vaginal mesh lawsuit: executive denies prioritising Johnson & Johnson interests
Vadasz said while it may be the case that complication rates were much lower among those who had mesh procedures to treat hernia, “patronising” comments from doctors were not helpful.
“Doctors need to stop taking this patronising ‘we are the experts why aren’t you listening to us’ approach,” he said.
“My frustration is that I’m on various reference groups and government committees dealing with the mesh issue and this narrative of ‘we made mistakes in the past and its fine now’ keeps emerging. But it’s not fine.
“To me it’s a part of this larger, poor attitude towards women and not listening to women when they say something is wrong, and not explaining the risks to them so they can give informed consent to procedures.”
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