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BBC’s ‘Casualty’ shines a light on the complications of vaginal mesh surgery

Television is a powerful source of education if presented appropriately and with the correct background of research. Soaps in the UK are renowned for covering prominent societal issues, and especially crucial matters that are initially overshadowed in the media. British drama series, Casualty, quite recently raised awareness of the dangers of vaginal mesh implant and their risk to older women. The procedure is used for treating Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI) but has been riddled with complications that are finally being identified and addressed on screen.

A still from Casualty to be aired on 17 April 2021
Casualty viewers will see fictional character Bibi treated for complications following vaginal mesh surgery

In the storyline, Marty Kirkby (Shaheen Jafargholi) a student nurse at the fictional hospital, Holby City, is having breakfast with his mother Bibi Kirkby (Fisun Burgess) when she suddenly loses consciousness and hits her head on the table. At the hospital, Bibi feels uncomfortable telling her son about her situation, so he confronts a staff member who reveals Bibi had vaginal mesh surgery to treat her stress incontinence. The private clinic where the surgery was held never warned her about any potential complications or provided her with the appropriate support. It is later discovered, Bibi is now suffering from a pelvic abscess and that the mesh has fused to her bowel, that if removed, could leave her in chronic pain for the rest of her life.

To make matters worse, the clinic in which Bibi had the surgery, is shown to perform the illegal procedure on more women, after it had been temporary suspended pending further investigation. After Marty discusses the situation with the paramedic, Jan, they team up to go undercover as a potential patient and eventually confront the man behind the illegal procedures at the Clinic. In a direct line, Jan states:  “You are still performing a procedure that is banned by the NHS. You have left so many women in chronic pain”. The line is a correct indication reflecting the turmoil encountered by many women across the UK.

The plot was inspired by 53-year-old Kathy Sansom from Cambridgeshire, who had her own painful experience with a pelvic mesh implant back in 2015. The procedure was undertaken to treat ‘incontinence from childbirth’ but the surgery-induced an “intense burning sensation” in her vagina and excruciating pain in her legs. Determined to confront the reality of complications provoked by the surgery, she founded the ‘Sling The Mesh’ campaign. Her efforts have so far led to a government review and have created a strong community for women to share their stories and find comfort.

In a recent study, it was revealed, ‘one in four women needed repeated surgery after TVT mesh insertion’. Transvaginal tape (TVT) is a type of mesh used for treatment, the other being transobturator tape (TOT). Many women who experience vaginal mesh complications suffer the following symptoms: Unusual bleeding or discharge, pelvic abdomen pain or swelling, chronic infections, recurrent UTIs, dyspareunia, new or worsening bowel/bladder symptoms and pain in the vagina. The most frequent complications are ‘mesh extrusion, mesh erosion and mesh exposure’. Extrusion of the mesh ‘is when the mesh protrudes through the skin and tissues of the vaginal wall become exposed’. Erosion of the mesh occurs when ‘the mesh erodes into the vaginal tissue or surrounding organs’. If either of these complications occurs, patients are referred to further surgery, which will consist of ‘removal of a part or all of the mesh’. However, this is considered a ‘very difficult procedure’ and can cause permanent chronic pain.

Kath Sansom was left in intense pain after having a mesh implant
Image of Kath Sansom who founded the campaign group ‘Sling the Mesh’ and inspired the vaginal mesh storyline for the show.

The core issue with vaginal mesh surgery is that in many cases, ‘complications often occur over time and may not materialise until years after the initial surgery was performed’. Additionally, there have been cases that have wrongfully admitted patients to vaginal mesh surgery that should have never had the procedure in the first place. Patients who have been assessed and have reported minor symptoms of prolapse or stress are not suitable candidates for surgery and can make minor issues considerably worse.

There have also been cases where the surgery did not meet acceptable standards, inciting errors such as inserting the mesh in the wrong place. In this circumstance, the fault is not resolved until the ‘complications arise, and a patient undergoes a scan’ to identify the problem. This delay in the fixture is another reason why women are unable to fully recover from the incident and why their health is greatly impacted.

As portrayed on, Casualty, Bibi was not warned of the risks associated with vaginal mesh surgery, and this is the real-life reoccurring dilemma faced by patients who have undertaken the surgery. Both legally and ethically, all patients ‘should have been advised of vaginal mesh erosion or extrusion, dyspareunia, chronic pain and the potential requirement for mesh removal surgery’ before the procedure is carried out. If the medical advisors fail to advise the patient of the risks, there could be a ‘clinical negligence claim concerning informed consent’. However, there is ‘a three-year limitation period to make any clinical negligence’, which means a ‘potential claimant has from the date of the negligence to issue a claim in the courts’, although this is dependent on the state of the case.

The UK government has been ‘asked to apologise, and to set specialist centres for those affected’ by the complications. Safety minister, Nadine Dorries said: “Our health system must learn from those it has failed. We will now give this independent review the full and careful consideration it deserves before setting out our full response”. The impact of the procedure on the thousands of women across the UK is detrimental but the steps going forward to raise awareness and create changes to the policy will help prevent women in the future from experiencing such a drastic impact on their health.

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