Editorial: Pause on surgical mesh operations long overdue

OPINION

The Ministry of Health’s decision to suspend surgical mesh operations for stress urinary incontinence, a common childbirth injury, is welcome but overdue.

It should not have taken this long for officials and the Government to act on a problem that has plagued women for many years, with clear evidence medical guidelines were failing to protect many mothers from horrific long-term injuries.

Accident Compensation Corporation (ACC) payments for surgical mesh injuries have soared more than tenfold from $500,000 in 2017 to $5.1 million in 2021. Even after the ministry ordered hospitals to take action to minimise the danger from these operations five years ago, at least 38 more women have been seriously harmed by mesh, according to ACC records last year.

Perhaps even more disturbingly, eight women complained to the Health and Disability Commission that surgeons implanted mesh into their bodies, leaving them with severe injuries, without their informed consent.

Behind the figures are the faces and stories of women who have faced excruciating pain, revealed last year by former Herald health reporter Emma Russell in her women’s health series, In Her Head.

Sally Walker, who bravely led the campaign to stop mesh operations, was forced to get her bladder removed to save her life and to have her vagina sewn closed. Merrissa Haa said she woke up screaming in agony after her surgical mesh operation, which she pleaded not to have. Another woman said the mesh felt like a grater rubbing on raw wounds inside her.

The medical establishment has been reluctant to make changes in the face of such frequent and serious complaints. Speaking to a Parliamentary select committee addressing the issue, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists argued the benefits of mesh operations to the population as a whole outweighed the risks.

Those benefits included less pain, shorter hospitalisations, a faster return to activities and reduced cost when compared to historical treatments for severe incontinence.

The college said a ban on mesh implants would remove the most commonly used procedure worldwide for this condition. It also noted mesh implants were the only option for some women.

The arguments overlook several key points in favour of swift, decisive action.

First, New Zealand is not alone in dealing with this problem. The United Kingdom promptly announced a pause on surgical mesh operations for stress urinary incontinence in 2018 and now uses the procedure only as a last resort.

It has also become clear many New Zealand surgeons do not have enough training to perform the operation safely.

When the Ministry of Health set up a special credentialling process to ensure surgeons were qualified to remove surgical mesh, half the surgeons who applied did not meet the minimum standard.

Patient advocates claim this strongly suggests some surgeons who have performed the operation for years lack the required skills, as only the most confident would have applied straight away.

For this reason alone, the ministry should retain the pause until there is clear evidence surgeons are not putting women at risk.

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