Rectopexy Mesh surgeon denied knowledge of mesh complications – despite writing a book and articles about them!
By Ruth MacLeod and Kath Sansom
Our tenacious Sling The Mesh member found a textbook and articles written by her surgeon outlining complications of rectopexy mesh – which proved gold dust in her medical negligence claim when her surgeon denied knowing anything about mesh complications!
The book was being written before the time of her surgery.
Charlotte’s story
Charlotte, underwent an ill-advised Laparoscopic Ventral Mesh Rectopexy (LVMR) surgery at the John Radcliffe Hospital in Oxford in 2010.
She was told nothing by her Oxford surgeon about the potential for debilitating mesh complications including pain, erosion or autoimmune diseases.
Over the following years, the mesh eroded into Charlotte’s pelvis and she suffered eight years of life-altering problems including pelvic pain, back pain, an auto-immune reaction and bowel incontinence.
A significant number of patients undergoing LVMR have reported mesh erosion, chronic pelvic pain, nerve damage, incontinence and need for further surgery to repair the damage. These numbers emerged in the Sling the Mesh campaign in 2015 where mesh support groups demanded a ban on pelvic mesh and the First Do No Harm review in 2018. The review highlighted the devastating impact of mesh on these women.
Autoimmune reaction
A complication in Charlotte’s case was that shortly after the insertion of the mesh, she began to suffer from an autoimmune reaction including stomach cramps, intensive burning sensation in the balls of her feet, dry eyes, unexplained itching, joint pain, neck pain and chronic fatigue.
It was not until Charlotte’s mesh was removed eight years later that her autoimmune symptoms completely resolved.
During the removal surgery, the mesh was found to have eroded into her pelvis and she required a low anterior bowel resection.
Legal action
Charlotte instructed a legal team after her mesh was removed and they instructed experts including a gynaecologist, colorectal surgeon and rheumatologist to consider her case. It became clear following meetings with the team that there were several concerns including:
- Laparoscopic Ventral Mesh Rectopexy LVMR was not the appropriate procedure at the time as she had not been offered conservative treatments beforehand;
- She had not been advised adequately or at all with respect to the risks of the LVMR;
- Had she been offered conservative measures first and/or had all of the risks explained to her, she would have declined the LVMR.
The hospital sent a lengthy and detailed denial of the criticisms, primarily suggesting that in 2010 the surgical team were not even aware of many of the risks to the procedure.
But the legal team (with significant help from Charlotte herself) were able to demonstrate that not only were the surgeons aware of the risks, they had in fact written articles and a text book about them at around that time.
Eventually, the Defendant Trust agreed to meet and Charlotte’s legal team were able to agree an out-of-court settlement. For further information about this surgery negligence claim, please call Jonathan Zimmern on 03304606779 or email jonathan.zimmern@fieldfisher.com.
Charlotte’s letter to the GMC
Charlotte was so incensed that her surgeon had lied under oath claiming he didn’t know about rectopexy mesh complications that she sent a letter to the GMC . They were not interested, despite their remit. GMC rules cover dishonesty:
The General Medical Council (GMC) is the regulator of doctors and takes action against those who don’t act with honesty, integrity, and probity. Dishonesty is a common allegation against doctors and is considered a character flaw that can be difficult to fix. Doctors who are found guilty of dishonest conduct are almost certain to be found to have committed professional misconduct.
Charlotte’s implanting surgeon admitted not advising her of all the risks during the consent process but claimed it was because those risks were not known about at the time – this is simply not true, he did know of the risks and had written about them.
Charlotte’s trawl of the information that was around at the time (2010), found papers that proved the risks were known for many years prior to the date of her surgery (mid 2010), then also the book, published five months after implantation and authored by the defendant. This book evidences quite clearly, that he did indeed know about all of the risks he denied knowing. References to papers written years before publication (some also authored by the defendant) are listed within the book.
The book
Pelvic Floor Disorders for the Colorectal Surgeon.
Print Publication Date: Oct 2010
by Ian Lindsey (Editor), Karen Nugent (Editor), Tony Dixon (Editor)
On page 9, it lists the following as contributors: Ian Lindsey, Oliver Jones, Roel Hompes and Chris Cunningham.
Page 13, paragraph 2 of the book was particularly damning and was highlighted to the consultant’s legal team:
“The patient who is seeking to improve quality of life must be aware of the chances of a poor outcome that will result in impaired status…..injury or mesh erosion after rectopexy are just a few outcomes, that although rare, may destroy quality of life. In the author’s opinion the road toward surgical intervention must demonstrate due consideration to these risks which must be grasped by the patient.”
Here is a link to the book on sale at Amazon
Here is a link to a readable and searchable version in Google Books
Pages of interest based on the following search terms
A global search within the book for the word “erosion” brings up the following page mentions:
4 – Technologies such as artificial sphincters are appealing and likely to gain wider application as technical issues relating to infection and device erosion are conquered.
13 – Chronic Pain after staple anopexy, pelvic sepsis or urgency after STARR; and bowel injury or mesh erosion after rectopexy are just a few outcomes…
65 – Management of complications, Mesh erosion post rectopexy
128 – Often, there is erosion of surface epithelium
192 – Patients are informed about possible complications and side effects: voiding and continuing evacutory problems, stress incontinence, mesh infection, mesh erosion, dyspareunia.
195 – Non absorbable suture material may increase the risk of mesh erosion
197 – It is our practice in Bristol to recommend courses of topical vaginal oestrogen to maintain “plumpness” which might reduce the risk of mesh erosion.
198 – As with erosion repair…
262 – Recent experience suggests that there is less erosion of the device if it is placed below the rectus sheath.
264 – Infection is the commonest complication with rates over 50% in many series, often resulting in erosion of the device and eventual explantation.
271 – (is an index that mentions erosion.)
A global search on “Foreign Body”, “Chronic Fatigue” “Painful sacrum”, brings up the following results:
141 – It can also cause foreign body reactions in the intestinal mucosa and regional lymph nodes
158 – Coccydynia, a painful coccyx may occur for a number of reasons.
159 – A proportion of patients will go on to develop Chronic Fatigue syndrome and Fibromyalgia.
Additionally, important information in the book:
Page 13, paragraph 2 of the book:
“It is important for professional and medico-legal reasons that all conservative measures have been explored thoroughly before proceeding with surgical treatment” and “It is clear that the best approach is optimisation before surgery, but this can be difficult because it is easier for a surgeon with limited infrastructure to perform an operation than to undertake 6 sessions of biofeedback”
On page 27 of the book:
“However the reliability of clinical diagnosis has been brought to question, with overall sensitivities and specificities as low as 63% and 57% respectively reported. As a result, a wide range of tests exist to objectively assess anorectal function to supplement clinical examination.”
