Monday, December 11, 2023

Health DG pauses use of surgical mesh

Director-General of Health, Dr Diana Sarfati, has supported a time-limited pause on the use of surgical mesh for stress urinary incontinence.

The Surgical Mesh Roundtable (MRT) – an oversight and monitoring group chaired by Manatū Hauora | Ministry of Health – has been investigating a pause since earlier this year.

Alongside this, Parliament’s Health Committee recommended in June that Manatū Hauora investigate a pause in the procedure after it considered the petition of Sally Walker, a woman who has been injured by mesh.

The MRT’s assessment is that the balance of benefit and harm from the procedure will be improved by the series of additional measures already planned, and it recommends a pause until those measures are substantively in place.

“After considering the MRT’s assessment, I have decided to support a pause to allow the following steps to be put in place to reduce the harms linked to the procedure as much as possible,” Dr Sarfati said.

Those steps are:  

  • providing tailored training and certification for surgeons performing the procedure;  
  • establishing a registry of all public and private patients who could benefit from it;  
  • reviewing patients and the decision to carry out the procedure at multi-disciplinary meetings, which include a range of experts from physiotherapists to surgeons; and  
  • using a structured and guided informed consent process for patients.

“No surgery is without risks, and it’s important to remember that this particular procedure has changed the lives of many people for the better,” Dr Sarfati says.

“However, we recognise it has caused ongoing pain and lessened the quality of life for some people, and we therefore need to act to minimise these outcomes.  

“We also acknowledge the process has been slow at times and that has potentially added to the frustrations of those who have suffered harm from surgical mesh.”

Recognising the length of time to put these measures in place has been a significant factor behind the decision to put in place the time-limited pause, she said.

“It is important to note the procedure is paused, not banned. That means there may be exceptions, and that the procedure might be carried out during the pause if a multi-disciplinary team agree there is no viable alternative. Any use would only happen after extensive consultation and review.”

“We acknowledge that this pause may cause additional uncertainty for patients awaiting treatment, and concern for those who have recently had it. However, we need to make sure that patients are given treatment that appropriately limits the risk of harm for as many people as possible, and we believe this move will help us achieve that,” Dr Sarfati said.

Surgical mesh is a net-like fabric or tape that can be introduced as part of surgery to help repair weakened structures in the human body. As a net-like fabric it is used in the treatment of hernias and historically was also used in the treatment of pelvic organ prolapse (POP). As a tape it is used in the treatment of stress unrinary incontinence. These tapes are frequently known as TVTs (tension-free vaginal tapes) or MUS (mid-urethral slings). Mesh for treatment of POP has not been available for some years. This pause only affects mesh tapes used for stress urinary incontinence.

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