Lessons learned from the use of mesh in vaginal prolapse surgery

Dr. Lucila Pavan
Consultant, Gynecology, Urogynecology and Pelvic Reconstructive Surgery
Hospital Italiano de Buenos Aires,
Argentina

The use of transvaginal mesh (TVM) in vaginal prolapse surgery remains a relevant option in many countries worldwide. However, its ban in certain regions arose from indiscriminate use, often by surgeons lacking adequate training and the skills to manage its specific complications. This shift, from the success of TVM to viewing it as risky or dangerous, led some to revert to older, less advanced surgical techniques. Even so, the experience with these devices has taught us valuable lessons.

One of the greatest advantages of TVM is that it can be effectively used in vaginal surgery. It reduces operative times compared to traditional procedures and allows for uterus preservation through hysteropexy. Additionally, it facilitates the simultaneous treatment of multiple compartments without the need for switching surgical approaches, enabling faster recovery and immediate ambulation for patients.

Nevertheless, as any surgeon knows, no procedure is without complications, and TVM is no exception. TVM carries the same risks as any vaginal surgery, with the exception of mesh exposure, which is specific to its use. The key lies in understanding how to prevent complications, minimize their occurrence, and manage them effectively if they happen. This requires a multidisciplinary approach and a commitment to guiding and supporting patients through any unexpected situations.

The use of TVM has underscored the importance of patient selection. Not every patient is suited for every procedure. Surgeons must be adequately trained and focus on procedures they perform regularly, becoming high-volume specialists. This expertise not only improves outcomes but also enables surgeons to have a clear understanding of their own practice, complication rates, and effectiveness. These statistics are not merely for publication but are essential for self-evaluation and improvement. 

Patient education is another critical lesson. Informed consent is essential. Patients must understand the potential risks and benefits of any procedure, particularly in the hands of their surgeon. Today, it is our duty as physicians to present all available options, provide comprehensive information, and empower patients to make informed decisions about their care.

Finally, we must be prepared to address complications, whether intraoperatively or postoperatively, either through our expertise or by referring patients to specialists equipped to handle complex situations. Listening to patients, understanding their needs, and ensuring their well-being—whether by resolving issues ourselves or through appropriate referrals—is at the core of good urogynecology practice.

As a urogynecologist and pelvic floor surgeon, I believe TVM is still a good option for many patients when used properly. The lessons learned from its use have reinforced the importance of skill, patient-centered care, and the ongoing improvement. By keeping these priorities in mind, we can continue to offer safe and effective solutions for pelvic floor disorders while respecting the autonomy and preferences of the women we treat.