20 Jun 2016

Surgical mesh causes excruciating pain

11:08 am on 20 June 2016

New figures released by ACC show it has spent over $10 million dealing with the fallout from surgical mesh implants that have gone wrong.

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Photo: 123rf.com

Surgical mesh is a plastic product increasingly being used in hernia repairs, bowel and pelvic organ prolapse and other gynaecological operations to repair weak or damaged tissue.

But there can be serious problems if the mesh erodes or ruptures in the body and binds with other tissue, causing chronic pain and infection.

Thousands of class action suits are underway in the United States against manufacturers and some have been joined by women in New Zealand.

The latest figures show that since July 2005 the Accident Compensation Corporation (ACC) has received 624 claims for surgical mesh related injuries, and has accepted 502 of them.

As a result ACC has paid out $10,029,387 to deal with the problems created. That includes $4,725,667 on treatment, $591,657 on rehabilitation and $4,712,063 on compensation costs.

For those living with the problems associated with surgical mesh implants, the pain and complications can be permanent because surgical removal is not always successful - or even possible - when the mesh breaks away and binds to other organs, such as the bowel.

One surgical mesh patient, who does not want to be identified, is an Auckland man in his 30s who had a hernia operation five years ago.

The mesh was infected within a week, but the surgeon was reluctant to remove it. Peter (not his real name) subsequently contracted an infection that is yet to fully heal, as the mesh is breaking up, embedding in his bowel and trying to force its way out of his body.

He has an open, "horrible smelling" wound which needs to be drained by a district nurse several times a week.

"The wound is always infected because it's always open", he said. Peter is unable to lift anything, work or exercise and is practically housebound. He has undergone 70 surgeries and is on the strong painkillers Oxycontin and Tramadol.

He is due for another operation soon, so surgeons can try to unpick and remove the mesh. But that could result in the removal of the bowel and the prospect of being on a feeding tube for the rest of his life.

Peter feels very let down by the health system, isolated and worried about what his future holds.

Botched surgery left nurse in severe pain

Patrica Sullivan is a registered nurse who had surgery for pelvic organ prolapse in 2008.

Soon after the surgery she knew something was wrong: she had a swollen abdomen, excruciating pain that extended into her legs, and was left incontinent after the surgical mesh - which was meant to act like a sling - "bunched up" in her body and affected her bladder.

It took nearly four years and the intervention of six specialists before an admission came that there was a problem with the mesh. Subsequent surgery has failed to remove all of the mesh as some is now embedding into her blood vessels and further surgery could risk uncontrollable bleeding or paralysis.

Speaking to Nine to Noon, Ms Sullivan said Peter's story was not unusual, not just in New Zealand but throughout the world.

She has more than 40 years experience as a nurse, including as a theatre nurse.

She said she knew "absolutely nothing" about surgical mesh before her surgery. Her surgeon told her if they had to use the mesh, there was a 1 to 3 percent risk of minor irritation if anything went wrong, and it would be easy to sort it out.

"Now we know that that percentage is far greater - the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have just suggested it's about 12 percent but we believe it's up to about 29 percent of a possible rejection rate.

Ms Sullivan said reclassifying mesh is crucial, as is early diagnosis by GPs if things are going wrong.

"The quicker we get there, the better the outcomes."

Dr Ian Page is chair of the New Zealand committee of RANZCOG. He said the problem with using "native tissue" - from a woman's own body - to correct prolapse was that it did not last.

The first use of surgical mesh for prolapse was in mid-urethral sling procedures for urinary incontinence, and long-term follow up had shown it to work well.

But Dr Page said when similar mesh was used for whole vaginal prolapse would be equally successful, but it was now realised that for a lot of women, that was not the case.

Select committee recommends register

The government has yet to respond to a Health Select Committee report recommending that the regulator Medsafe (which does not test products for safety) investigate setting up a register to monitor all surgical mesh operations and any problems that occur. The Health Minister has said he is taking advice from officials on the matter.

Although Medsafe had told the select committee a register would be expensive to set up and might cause unnecessary worry, it did not have an estimate of set-up costs, saying in a statement that it would depend on a lot of variables.

Medsafe has received 101 adverse event reports about surgical mesh since 2005, more than half of them coming through ACC. Only two of the reports have come from health professionals.

The Royal Australasian College of Surgeons has yet to consider the select committee report but is in favour of collecting data about surgical mesh. It said the risks and benefits of surgical mesh were part of a conversation between doctors and patients before a decision was made to progress with surgery.

The chair of the Medical Association's General Practitioner Council, Kate Baddock, said a register was good idea, and should have been set up 15 years ago, when surgical mesh was starting to be used more widely.