Category Archives: Removal Surgeons

Hazards of Laparoscopic Mesh Removal

Online message from Dr. Dionysios Veronkis (slightly edited for clarity) :

Vaginal mesh is placed extra peritoneally[1] (outside the body cavity and away from bowels). Although laparoscopy is touted as minimally invasive, [it is minimally invasive in] abdominal surgery. Vaginal surgery is less invasive than both laparoscopic and robotic surgery.

Robotic surgery is laparoscopic surgery aided by a computer to help the surgeon move robotic arms [which guide instruments].

When mesh is placed vaginally and removal is attempted laparoscopically, the surgeon must place small 5mm to 12mm incisions and ports in the abdomen, [adding] the risk of injury to the bowel blood vessels during trocar insertion. The peritoneum must then be cut and the bladder and vagina or rectum and vagina must be separated [by cutting through the connecting fascia].

Bear in mind that when instruments are inserted thru the abdomen, that port creates a fulcrum and a vertical angle thru the abdominal wall limits the movement of the instruments [while they operate on the horizontally-oriented] vagina.

While all this is going on you are tipped head down pelvis up so your bowels move out of harm’s way. The surgeon is operating while standing at your side with thin 5mm to 10mm instruments pushed thru your abdomen to reach your vagina—17 to 25 inches [away].

[Your alternative is to] find a vaginal surgeon who can forgo all that and go directly thru your vagina to the mesh. Remember, mesh was placed vaginally.

The thin laparoscopic instruments were never designed for the structural stiffness of the mesh. Laparoscopic instruments were designed to be thin and delicate since bowel is always present. Due to the nonspecific delicate instruments used in laparoscopic and robotic surgery, in order to remove mesh in laparoscopic surgery, robotic energy must be used. Laparoscopic surgery uses electricity to cut tissue and stop bleeding which generates heat.

Mesh is plastic. Heat melts plastic.[2] Removals done with the use of electricity will look blackened or burned with no clear edges or ends and small blood vessels need to be cauterized.

Liberal use of energy will melt the mesh, create a thermal injury that will kill tissue days later (and may result in a hole in the rectum or the bladder) or, in order to avoid melting the mesh, more tissue will be removed [than necessary], increasing the risk of a hole or a fistula.

Mesh in both groins from a TOT and mesh under the skin and muscles from a TVT can NOT be accessed by laparoscopy. They [require] an incision.

Finally, you can do all that or have the mesh removed vaginally with sharp dissection using more durable instruments designed specifically for vaginal surgery.

– D. K. Veronikis M.D. of St Louis, MO

[1] Peritoneum: the serous membrane that lines the walls of the abdominal cavity and folds inward to enclose the viscera. Normally, it is separate from the pelvic viscera.

[2] When polypropylene melts, depending on the particular material, it releases plasticizers, stabilizers, and biocides. Most of these materials will have a very low vapor pressure, so they will probably form aerosols (white smoke) and should be taken care of with a little fresh air
Burned polypropylene (black smoke, and/or flames) can form a large number of organic compounds (oxidation and/or decomposition products) including some formaldehyde, an eye and respiratory irritant, as well as related compounds.

 

 

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Peggy Day is working on a book to combine all these stories. This is an excerpt from Pelvis in Flames: Your Pelvic Mesh Owner’s Guide. Your input is welcome to help make Pelvis in Flames the book you need to read.

If you’d like to join an online support group and learn about erosion, partial removals, surgeons, or just find out that you are not alone, join my group, Surgical Mesh or check the list of support groups here.

Subscribe to PelvicMeshOwnersGuide.com to learn more about pelvic mesh. I’d like to hear from you if you are helped by what you read here or if you need to know more about any particular topic. Comment below or email me privately at [email protected]..

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UPDATE: Australian Pelvic Mesh – Carolyn Chisholm

UPDATE: Carolyn (Caz) Chisholm, of Perth Australia, started a search three years ago to find a surgeon and a hospital to sponsor a visit by Dr. Dionysios Veronikis (St. Louis, Missouri) to Australia because is skilled in the removal of pelvic mesh devices from women that no Australian surgeon can. Today, women must travel to the United States to have pelvic mesh removed in its entirety. Veronikis invented equipment to reach deep into the pelvis to retrieve mesh that no Aussie surgeons can reach. He’s removed more than 2000 meshes.

Larger prolapse meshes are very complicated and dangerous to remove, and it takes a special surgeon to remove them. Dr. Veronikis designed and patented specialized pelvic mesh removal equipment and instruments, which no other surgeon in the world has.

Recently, Caz left her leadership role in the Australian pelvic support group to devote her time and efforts to finding a surgeon and a hospital to sponsor a visit from Dr. Veronikis in the hopes that he would teach Aussie surgeons safe mesh removal techniques.

Like anti-mesh advocates across the globe, Aussie’s leaders do not like mesh or support mesh. They do not believe in partial removals and encourage full removal wherever possible to minimize the trauma to women. They want Australia to have the same removal possibilities that the U.S. does.

“This is a huge undertaking, and it involves a hell of a lot of work from numerous people including mesh-injured women themselves. Unfortunately, the RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) stand by their statement that a partial removal is an acceptable form of treatment. They refuse to get on board with full removal procedures  [even though] when pain occurs the only way is to remove all of the mesh,” wrote Chisholm.

Aussie injured women do not agree with RANZCOG’s and Professor Vancaille’s position about partial removal because “every single woman who has had this procedure ends up with more complications, [goes] back into hospital for more surgery, and often ends up with infections that don’t go away and [long-term] antibiotics.”

Aussie activists also try to help mesh injured women find pain specialists, accurate diagnoses, psychological help, and referrals to competent mesh removal surgeons—even if it means traveling half-way across the world.

Caz distinguishes between mesh used to treat prolapse and that used to treat urinary incontinence. Prolapse mesh is considered “high risk” by FDA officials but the SUI meshes are treated as the “gold standard.” There are no long-term studies proving the use of mesh is safe or efficacious. “RANZCOG states the clinical trials still need to be done for the SUI meshes; so this means that women are still guinea pigs,” wrote Chisholm.

She says women are being implanted with mesh unnecessarily and afterward, their GP’s don’t know how to treat them, and gynecologists deny care by saying their new problems are not related to mesh (duplicating the actions of doctors in the U.S. and all other countries). “These surgeons don’t want to know anything about the complications that their implants have caused women. In fact, I have read stories about surgeons being rude to the women, some shout at them, some get angry with them, simply because the woman is presenting with pain and complications. They are turning their backs on the women.

“It is diabolical what is happening. This is why we need t

Caz Chisholm winning two awards for her advocacy work.

o set up clinics Australia wide and find ethical and empathetic surgeons who want to be trained in full removal and to find the right medical professionals that really want to listen to these women, to believe them and not turn them away. It is a very specialised issue and needs to be addressed immediately,” the determined activist added.

Caz Chisholm won two awards for her advocacy work.

 

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Peggy Day is working on a book to combine all these stories. This is an excerpt from Pelvis in Flames: Your Pelvic Mesh Owner’s Guide. Your input is welcome to help make Pelvis in Flames the book you need to read.

If you’d like to join an online support group and learn about erosion, partial removals, surgeons, or just find out that you are not alone, join my group, Surgical Mesh or check the list of support groups here.

Subscribe to PelvicMeshOwnersGuide.com to learn more about pelvic mesh. I’d like to hear from you if you are helped by what you read here or if you need to know more about any particular topic. Comment below or email me privately at [email protected]..

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Multiple Surgeries: Signing Up For Just One Surgery With Pelvic Mesh?

Imagine this: Two women had tree branches fall across their homes causing major damage. Both trees did the most damage to the kitchen. Cindy Lu hires the guys who promises to get the job done the fastest for the least money. Her contractor comes in one day, and chops out the middle of the branch and cleans up the mess on her kitchen floor and replaces her kitchen faucet so it will run. He gets the job done in less than a day. Karen hires a more experienced contractor who takes out the entire branch and repairs all her plumbing, appliances and replaces her furniture and cleans up every tiny piece of bark or wood chip. It takes several days. He comes back later on and fixes the broken walls, windows and doors and returns her home to as close to pre-storm conditions as possible.

Which contractor would you hire?

This is an analogy to what happens when pelvic mesh goes bad. The surgeon who chips away at pelvic mesh, one eroded bit at a time, sets up a patient for multiple surgeries— today’s mesh problem. Recently, Linda Gross won over 11 million dollars at trial after 18 surgeries to repair erosion, scarring, and tissue damage from a Gynecare Prolift pelvic sling. Surgeries performed after the pelvic mesh implant correct erosion, new or continued incontinence, difficulty urinating, infections, scar tissue, pain, deheisance, or fistulae. Women experiencing generalized symptoms they attribute to mesh opt for removals as well and report an improvement in their symptoms.

Did you know one study found 41% of mesh implant patients had to have at least one other surgery?

Synthetic surgical pelvic mesh was first thought to be faster, easier and better than traditional repairs like culpopexy and porcine and native tissue sling repairs. Newer research says it  just wasn’t true.  In a 2013 review, authors concluded that, even though sacral colpopexy had a longer operation time: “the sacral colpopexy had a higher success rate on examination and lower reoperation rate than high vaginal uterosacral suspension and transvaginal polypropylene mesh.”

Mesh removal is risky business due its faulty design. Absent-minded scientists have been accused of not stepping back and looking at the “big picture” ever since Thales, the Greek mathematician, looked up at the stars so often that he fell down a well. Designers of pelvic mesh imagined they found the best thing since the flat turret lathe or bifocal eyeglasses. It was so perfect, they must have thought, nobody would ever want to remove it.

It is an interesting observation that more doctors are prone to diagnose only what they can see—on your body, an x-ray, in a lab report then by the patient’s description of her problems. Headaches, backaches and now pelvic pain are the least recognized and treated medical complaints today. Until the “BLUE sh*t” (as Johnson & Johnson execs called Gynecare mesh in a secret email) could actually be seen by the doctors, women’s complaints were ignored. If they got an answer from their doctors, they were advised to have it snipped, dissected, ligated, trimmed or revised. When the mesh kept sneaking back, surgeons removed more little bits.

It takes a highly skilled surgeon like Veronikis, Una Lee in Seattle, and Shlomo Raz at UCLA to remove all of the mesh, including the anchors (secured ends).  The few surgeons who do remove the mesh in its entirety complain that removing all of shards of mesh from healthy human flesh is like getting bubblegum out of hair.

Dr. Dionysios Veronikis of St. Louis, MO invented a surgical instrument that dissects the mesh away from the healthy tissue without cutting surrounding structures. He finds one end of the mesh and then carefully cuts, moving his instrument forward until it frees up the entire sling in one piece. It is hours and hours of painstaking work and healing from the procedure takes a long time.

Once mesh is removed, more surgeries are often needed to revise the damage left behind and fix structural problems. Complications, like bleeding, infection, and nerve damage, from mesh removal surgery are common. After finally going through removal surgery, 87% said they would never have had the artificial mesh implant in the first place, if they had only known. If you’ve not yet had an implant, you are one of the lucky ones because, now that there is more research and information is available on the net–mesh does not appear to be easier or better. Many, if not most, doctors are reverting to traditional fixes. You can save yourself a boatload of trouble by finding a surgeon who can repair your problem without mesh.

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Peggy Day is working on a book to combine all these stories. This is an excerpt from Pelvis in Flames: Your Pelvic Mesh Owner’s Guide. Your input is welcome to help make Pelvis in Flames the book you need to read.

If you’d like to join an online support group and learn about erosion, partial removals, surgeons, or just find out that you are not alone, join my group, Surgical Mesh or check the list of support groups here.

Subscribe to PelvicMeshOwnersGuide.com to learn more about pelvic mesh. I’d like to hear from you if you are helped by what you read here or if you need to know more about any particular topic. Comment below or email me privately at [email protected]..

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