Surgery to Remove Pelvic Mesh
Some women who have had synthetic mesh implanted to treat prolapse and/or stress urinary incontinence, experience complications that requires surgery to remove all or part of the mesh. Pelvic mesh related complications can be enormously distressing for some women and expert multidisciplinary care is required to treat physical and psychological problems arising from pelvic mesh complications. The type of surgery that will be recommended will be customized to individual needs. It will depend on the type of mesh and any surgery that has already been performed, including partial removals. Any complications that were experienced are also taken into consideration. It is essential that Dr Carey has access to a copy of your operation report and, if possible, the prosthesis identifying sticker in order to confirm the exact mesh device that was used. Dr Carey and his staff can assist in obtaining any information that is required.
Dr Carey has extensive experience in removing pelvic mesh, including complete mesh removal, and has been successfully removing many types of pelvic mesh since 2001. Occasionally, for some women undergoing pelvic mesh removal surgery, a team approach is required and Dr Carey will operate together with a colorectal surgeon, plastic surgeon or urologist.
The type of surgery required to remove mesh used to treat stress urinary incontinence, depends on the type of sling that was used. For a sling that has been placed behind the pubic bone, such as TVT, Advantage Fit, SPARC, TVT Exact and IVS, combined vaginal and laparoscopic (or robotic) surgery will be recommended. For trans-obturator slings such as TVT-O, MONARC and Obtryx, vaginal and groin surgery is required, and Mini-slings or Single-Incision Slings such as MiniArc, TVT Secur and Solyx, can be removed by vaginal surgery.
The type of surgery that may be recommended to remove pelvic mesh for prolapse will depend on where the mesh has been placed. Meshes that have been placed in the front and/or back walls of the vagina require vaginal surgery for mesh removal. However, if mesh straps have been placed in the groin, then additional groin surgery will be required. When mesh that has been placed into the pelvis by abdominal or laparoscopic surgery, laparoscopic or robotic removal is usually required.
Pelvic mesh removal surgery ranges from being relatively straight forward to complex. In Dr Carey’s experience, the most complex mesh removal surgery occurs in women who have had mesh straps placed in their groin area. The names of some of these types of mesh are TVT-O, MONARC, PROLIFT, Perigee and Apogee. Mesh exposure in the bladder, urethra or bowel is always complex. Vaginal, laparoscopic or robotic surgery is usually relatively straight forward when groin surgery is not required.
After the mesh has been removed, further surgery may be required if prolapse or stress urinary incontinence recurs. Dr Carey has extensive experience in performing different types of mesh-free procedures for prolapse and stress incontinence as well as advising on non-surgical options.