Tobacco use, immunosuppressive, chronic pain, and psychiatric conditions are prevalent in women with symptomatic mesh complications undergoing mesh removal surgery

Abstract

To identify demographic and clinical characteristics of patients with symptomatic pelvic floor mesh complications who underwent mesh removal at our academic medical center. The secondary goal was to determine patient-reported outcomes after mesh removal. Materials and Methods: We conducted a retrospective review of consecutive patients from 2011-2016 undergoing removal of mesh graft for treatment of symptomatic mesh-related complications. Patient demographics, comorbidities, symptoms, and mesh factors were evaluated. Outcomes after explant were determined by the Patient Global Impression of Improvement and a Likert satisfaction scale. Results: One hundred fifty-six symptomatic patients underwent complete or partial pelvic floor mesh removal during the study period. Mid-urethral slings comprised 86% of explanted mesh grafts. Mesh exposure or erosion was identified in 72% of patients. Eighty-one percent of patients presented with pain, and 35% reported pain in the absence of exposure or erosion. Pre-operative comorbidities included psychiatric disease (54.5%), chronic pain (34.0%), irritable bowel syndrome (20.5%) and fibromyalgia (9.6%). Forty-three percent of patients reported current or past tobacco use. At mean follow-up of 14 months, 68% of responding patients reported improvement on the Patient Global Impression of Improvement after surgery. Conclusions: This research identified tobacco use, and psychiatric, immunosuppressive, and chronic pain conditions as prevalent in this cohort of patients undergoing mesh removal. Surgical removal can improve presenting symptoms, including for patients with pain in the absence of other indications.

Pain after midurethral sling; the underestimated role of mesh removal

“…The heterogeneity of pain measurement and small cohort sizes make the comparison of studies and determination of optimal treatment difficult. Nevertheless, other studies also found a reduction in pain after MUS removal [ 20 , 21 , 22 ]. In our series, partial vaginal and complete vaginal MUS removal showed no significant difference in both pain scores and rates of recurrent SUI, which was also reported by Jambusaria et al [ 24 ].…”

The Long-Term Impact of Vaginal Surgical Mesh Devices in UK Primary Care: A Cohort Study in the Clinical Practice Research Datalink

“…Other study designs have also suggested poor health outcomes. A large Canadian database cohort study found higher risks of depression and self-harm in women who required a surgical intervention for complications after a mid-urethral mesh sling procedure; 21 a retrospective case series review found a high prevalence of psychiatric and chronic pain conditions in patients undergoing mesh removal; 22 and a qualitative study of women presenting to a tertiary care clinic with complications relating to vaginal mesh found that these complications caused both physical and emotional pain. 23 The latter study suggested that women’s experiences followed different trajectories: some women experienced worsening health problems, anxiety and desperation, others who once considered themselves healthy, believed themselves unhealthy and adjusted their views accordingly, and a minority of women described a return to health.…”

Prediction of successful revision surgery for mesh-related complaints after inguinal hernia and pelvic organ prolapse repair

“…Variables attempted to be extracted from the electronic patient files were age at time of revision surgery, gender, BMI, smoking, pain scores (using Numerical Rating Score (NRS) or Visual Analogue Scale (VAS)), postmenopausal state, sexual activity, vaginal deliveries in the past, number of abdominal surgeries in the past, amount of time between mesh placement and removal, a foreign body feeling, presence of neuropathic pain, comorbidities (including pain syndromes and/or systematic auto-immune disease), duration of presence of pain, use of NSAIDs and/or opioids, type of mesh implant, exposure of mesh, percentage of the mesh removed, number of revision surgeries, intraoperative macroscopic presence of a meshoma, and patients’ description of his/her clinical situation (normal, mild, moderate, severely or intense pain). Selection of parameters was based on prognostic factors for developing postoperative pain described in available published literature [ 2 , 9 , 12 , 14 , 16 – 18 , 23 , 24 ].…”

“…Earlier research in both medical fields has signaled several predictors and patient characteristics that can aid in predicting whether reoperation will lead to beneficial results. However, since the list is neither exhaustive nor specified for mesh removal, more research is necessary to draw conclusions [16][17][18].…”