Complications of polypropylene mesh in prolapse surgery

Traditional surgical repair for pelvic organ prolapse may be associated with a high recurrence rate. Mesh is being used increasingly to replace damaged endo-pelvic fascia, in an attempt to reduce recurrence. Polypropylene mesh is currently preferred over biological and synthetic absorbable meshes, aiming to reduce failure. Mesh may be placed abdominally (sacro-colpopexy) or vaginally to correct prolapse. Whilst sacro-colpopexy is a well-established procedure for the correction of vault prolapse, there is a lack of strong evidence of safety and efficacy for vaginal placement of mesh. The majority of reported complications related to mesh are minor though occasionally severe complications arise. The management of complications can be difficult, particularly when experience and evidence are lacking. Guidelines suggest that vaginal mesh repairs should only be performed by surgeons with training and expertise, with special arrangements for clinical governance, consent, audit and research.