Can we still have a clear conscience, routinely offering vaginal mesh operations in plastic and reconstructive surgery of the pelvic organ prolapse?

introductionSince many years, plastic and reconstructive surgery in pelvic organ prolapse (POP) has been performed by vaginal mesh surgery. Although warnings from the scientific societies and the FDA have been published, vaginal mesh surgery still remains a routine treatment of genital prolapse in the female.

backgroundMany third-degree referral centres in operative gynaecology found a high number of severe complications after mesh repair. Compared to the minor complications known from the classical non-mesh plastic and reconstructive surgery, there is a clear difference concerning the severity of complications. Additionally, mesh vaginal surgery was implemented in gynaecological prolapse operations because of the relatively high recurrence rate in classical vaginal surgery without implants; no major studies however have revealed a lower long-term recurrence rate with mesh vaginal techniques. DISCUSSION: As the recurrence rate could not be lowered evaluating the meta-analysis of the published scientific studies, the higher rate of severe complications should emphasise the fact that the risk of vaginal mesh surgery is too high for these techniques to be implemented in the surgical work of a routine gynaecological operative department.

conclusionVaginal mesh surgery can no longer be a primary plastic and reconstructive therapy of pelvic organ prolapse in a routine gynaecological operative setting and department, due to the high rate of severe complications.