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Gynecologic Mesh Sherri F. Caplan, DO Health First Ob/Gyn February 2013

Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula

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Page 1: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula

Gynecologic Mesh

Sherri F. Caplan, DO

Health First Ob/Gyn

February 2013

Page 2: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula

What is Mesh?

• According to the FDA, surgical mesh is a medical device that is generally used to repair weakened or damagd tissue; it is made from porous absorbable or non-absorbable synthetic material or absorbable biologic material.

Page 3: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula

Types of Mesh

• Synthetic

– Polypropylene, gortex

• Biologic

– Autologous (self—abdominal fascia or tensor fascia lata)

– Fetal bovine

– Porcine

Page 4: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula
Page 5: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula

Indications

• Vaginal Vault Prolapse

• Uterine Prolapse

• Symptomatic Cystocele

• Symptomatic Rectocele

• Stress Urinary Incontinence

• Paravaginal Defects

Page 6: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula

Cystocele

Page 7: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula
Page 8: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula
Page 9: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula
Page 10: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula
Page 11: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula

Complications

• Mesh erosion (most common 5-19%)

• Vaginal mesh extrusion

• Perforation into bladder or bowel

• Bladder or bowel fistula

• Abscess

• Dyspareunia

• Reoperation (1-7.6%)

• Failure

Page 12: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula

Why all the lawyer commercials?

• The FDA Safety Communication and Update on the use of transvaginal mesh for the repair of pelvic organ prolapse made some recommendations to health care providers

Page 13: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula

• Obtain specialized training for each mesh placement technique and be aware of the risks of surgical mesh;

• Be vigilant for potential adverse event from mesh, especially erosion and infection;

• Watch for complication associated with the tools used in transvaginal placement, especially bowel, bladder, and blood vessel perforation;

• Inform patients about the potential for serious complications and their effect on quality of life, including pain during sexual intercourse, scarring, and narrowing of the vaginal wall in pelvic organ prolapse repair using surgical mesh;

• Inform patients that implantation of the mesh is permanent and that some complications associated with the implanted mesh may require additional surgery that may or may not correct the complication;

• Mesh placed abdominally for pelvic organ prolapse repair may result in lower rates of mesh complications compared to transvaginal surgery with mesh

Page 14: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula

In Conclusion

Transvaginal mesh is an excellent option to correct pelvic organ prolapse in some individuals.

Page 15: Gynecologic Mesh - AAPC€¦ · What is Mesh? •According to the FDA, surgical mesh ... •Vaginal mesh extrusion •Perforation into bladder or bowel •Bladder or bowel fistula