By Kath Sansom and Ruth MacLeod

Patient safety campaigners and MPs are demanding an immediate suspension of rectopexy bowel mesh surgeries, amid growing concerns over the credibility of research that underpins the procedure.

The call comes after disgraced surgeon Tony Dixon was struck off for dishonestly falsifying patient notes long after he was involved in the patient care as well as operating on patients without obtaining informed consent.

Dixon’s research work helped promote the use of rectopexy mesh across the UK. One of his research papers has been withdrawn and nine further research papers are now under expressions of concern in medical journals.

Rectopexy mesh is currently the most widely used type of pelvic mesh in the UK, used to treat bowel conditions, but its continued use has come under fresh scrutiny in the light of concerns about the integrity of some of Dixon’s research which helped underpin its widespread adoption.

Tony Dixon, the Bristol-based surgeon at the heart of the controversy, pioneered the controversial LVMR (laparoscopic ventral mesh rectopexy) procedure and promoted its safety and efficacy through a series of studies.  He was also a founder of the Pelvic Floor Society, helping to promote the use of rectopexy mesh across the UK.

However, some of his studies are now flagged with formal editorial warnings due to concerns about the validity of the data, ethical approval processes, and informed consent.

Kath Sansom, founder of the patient-led campaign group Sling the Mesh, said: “We are appalled that the most used pelvic mesh procedure in the UK has been pioneered by a doctor who has been struck off and whose research is either withdrawn or under investigation. Women have suffered horrific complications – pain, mesh erosion where it slices into nearby organs and tissues, nerve damage – and many were never warned. Our rectopexy members suffer some of the most horrific life-changing complications, including a high number now living with stoma bags as a result. The government must suspend rectopexy mesh procedures immediately and launch a full review. How can we say, ‘First Do No Harm’ when this is allowed to continue?”

She added: “According to patient accounts shared within our group, many women who underwent surgery performed by Tony Dixon report that they were never sent a follow-up questionnaire to assess their outcomes. This contrasts with published claims stating that every patient operated on within a certain time frame received such questionnaires.”

Sharon Hodgson MP, Chair of the All-Party Parliamentary Group (APPG) on First Do No Harm: Mesh, Primodos and Valproate, added: “This is exactly the kind of systemic failure that the Cumberlege Review warned us about. We cannot allow research flagged with concerns and under scrutiny to inform clinical practice – especially when it risks patient safety. I support the call for an urgent suspension of rectopexy mesh.”

Campaigners are calling for:

• A suspension of rectopexy mesh procedures until a full, independent safety review is conducted.
• Transparency and accountability from NHS bodies and medical regulators.
• Support and compensation for patients harmed by rectopexy mesh.

The controversy echoes previous pelvic mesh scandals that led to thousands of women across the UK suffering life-altering complications. The First Do No Harm report, chaired by Baroness Julia Cumberlege in 2020, urged systemic change in how patient harms are recognised and addressed.

Dixon’s research

One of Dixon’s research papers has been withdrawn due to “concerns about the legitimacy of the data and allegations of a lack of informed consent from patients who underwent the surgical procedure.”

Nine of Dixon’s research papers with expressions of concern state investigations are ongoing. The papers are: 

• “A Prospective Evaluation of Stapled Haemorrhoidopexy/Rectal Mucosectomy in the Management of 3rd and 4th Degree Haemorrhoids,” published in 2007, 29 citations. 
• “Laparoscopic Ventral Rectopexy for External Rectal Prolapse is Safe and Effective in the Elderly. Does This Make Perineal Procedures Obsolete?” published in 2010, 103 citations.
• “Outcome of Laparoscopic Ventral Mesh Rectopexy for External Rectal Prolapse,” published in 2014, 44 citations. 
• “Laparoscopic Ventral Mesh Rectopexy in Male Patients with Internal or External Rectal Prolapse,” published in 2014, 28 citations.
• “Medium-Term Results of Stapled Transanal Rectal Resection (STARR) for Obstructed Defecation and Symptomatic Rectal-Anal Intussusception,” published in 2010, 32 citations. 
• “Laparoscopic Ventral Mesh Rectopexy in the Management of Solitary Rectal Ulcer Syndrome: A Cause for Optimism?” published in 2012, 23 citations.
• “Use of the Ethicon EndoSurgery Anoscope Retractor for Anorectal Procedures Other than Stapled Haemorrhoidectomy,” published in 2012, two citations. 
• “Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction,” published in 2007, 131 citations. 
• “Consensus on ventral rectopexy: report of a panel of experts,” published in 2013, 92 citations. 

While it has no expression of concern, a key study underlying NICE guidance on the use of rectopexy mesh was authored by Tony Dixon and others- A Multicenter Collaboration to Assess the Safety of Laparoscopic Ventral Rectopexy.  This study sets out the results for the use of rectopexy mesh in 674 patients operated on at North Bristol National Health Service Trust Frenchay Hospital. The study claims to have included all patients undergoing laparoscopic ventral rectopexy over a 14-year period (1999–2013).