Surgical mesh: Half of surgeons assessed for removing mesh did not meet minimum standards

Sally Walker, who advocates for women who have been injured by mesh implants, said she was concerned at the number of surgeons who did not meet minimum standards for mesh-related procedures. Photo / Dean Purcell

Half of the surgeons who were assessed on their ability to remove surgical mesh did not meet a minimum standard set by the Ministry of Health.

The results of the credentialling process raised concerns among patient advocates, who said a relatively high rate of surgeons had failed to make the grade for potentially risky mesh operations.

The Ministry of Health said the process was ongoing, and surgeons would have further opportunities to upskill and get credentialled.

The use of surgical mesh in some procedures is under intense scrutiny in New Zealand because of complications experienced by patients.

Several changes are under way, including a new national service to support women who have been injured by mesh implants.

In an unusual move, a credentialling process has been set up for a specific set of urogynaecological operations because of concerns about avoidable harm. So far, the process has focused only on highly-specialised operations such as removing mesh implants.

In the first round of assessments, 12 surgeons applied to be credentialled. Six of them were found to meet the minimum standards.

It is understood that the first round of applicants was made up of surgeons who would have been highly confident that they would be successful.

Advocates were supportive of the credentialling process but expressed concern about the initial results.

They said many of the applicants would have been performing operations on patients, yet the credentialling process had shown they were possibly not skilled enough to do some of those operations safely.

“It is very concerning for women’s safety,” said Sally Walker, who suffered debilitating injuries following surgery for a common birth injury.

“It is so easy to implant [mesh]. But it is damn hard to remove. These surgeons shouldn’t have been operating, in my view.”

Walker, who advocates for 66 other patients who have been injured by mesh implants, said the suffering was often lifelong. It could lead to intense pain, affect movement, and ruin relationships by making intimacy difficult.

“I am still very concerned that the harm will not stop - it still needs to be taken very seriously.”

A Ministry of Health spokesperson said credentialling was an “ongoing improvement process”.

Clinicians who might not have been successful in the first round could reapply once recommendations had been met, the spokesperson said.

The ministry also noted that the certification of six doctors was sufficient to roll out the National Mesh Complications Service.

This service, based in Auckland and Christchurch, provides wraparound support for women who have been injured by pelvic surgical mesh implants.

Dr Hazel Ecclestone, consultant urologist at Taranaki Base Hospital, will be one of the surgeons involved in a new national service for women who have been injured by mesh implants.

Dr Hazel Ecclestone, a consultant urologist at Taranaki Base Hospital, was one of the six doctors who was credentialled.

She said it was an “intensive” process which included a review of five years of procedures, 300 pages of supporting evidence, a 3.5 hour interview, and in-depth analysis of several of her cases.

Asked about the success rate for applicants, she said it was difficult to comment without knowing the details of each of their applications.

Ecclestone said that she still offered all of her patients the option of mesh implants but urged caution.

“I have seen so many catastrophes from mesh that when I sell it to the patients, I tell them you’re going to open yourself to a risk and a set of complications that you don’t get when you use non-mesh.

“Your recovery will be quicker, that will be the advantage. The disadvantage is if we have to take it out, it’s difficult, it can stop you from having sex, can give you pelvic pain. You can find mesh in places that it shouldn’t be.”

In response to a petition by Walker, the ministry is also considering a “pause” on the use of mesh in some surgeries. It said in May that it was not yet sure how this would work in practice.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists opposed a halt to mesh surgeries, saying it did not agree that the risks of mesh outweighed the benefits.

The Royal Australasian College of Surgeons (RACS) said that rather than pause mesh surgeries, the implants should be limited to specialist centres and credentialled surgeons.

The RACS said that for some patients, such as elderly women with severe incontinence, mesh was the best and only option.

*This story was amended to clarify that some surgeons did not meet the minimum standard for mesh removal, rather than mesh insertion.

Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics, and social issues.