Mesh use in surgery for pelvic organ prolapse

By age 80 years, one in eight women will undergo surgery for pelvic organ prolapse (POP), a condition where the pelvic organs descend into or through the vaginal canal.1 In the United States, about 80% of procedures are performed transvaginally.2 3 4 Building on the experience of general surgeons and the treatment of abdominal hernias, pelvic surgeons began using synthetic mesh to augment prolapse repairs to reduce prolapse recurrence seen frequently after native tissue (non-mesh) repairs. However, use of synthetic mesh also results in increased adverse events, in some cases with serious consequences.2 5 As a result, the use of mesh for transvaginal POP surgery has been the source of much scrutiny, including two public health notifications from the US Food and Drug Administration (FDA), a change in the US regulatory process for mesh devices, and substantial litigation.2 6

In a linked article (doi:10.1136/bmj.h2685), Chughtai and colleagues report on mesh use and risk of complications and reintervention of POP surgeries from a large, population based cohort from New York state between 2008 and 2011. Overall, 26% of the 27 991 patients in the cohort received mesh as part of their POP surgery. In a propensity matched analysis, mesh …