Vaginal mesh complications and miscommunications

A review of pathology evaluations of explanted vaginal mesh specimens highlights a need for greater communication between surgeons and pathologists, says a team of researchers including John O.L. DeLancey, MD, a member of the Contemporary OB/GYN editorial board. Better communication will help to ensure accurate documentation, diagnosis, and opportunity for study of the pathophysiology of mesh complications, they claim.

“We recommend improved communication between surgeon and pathologist first and foremost through more complete documentation to aid the pathologist's examination and enable understanding of the pathophysiology of mesh complications,” the authors write in the July-August issue of Female Pelvic Medicine & Reconstructive Surgery. “This is particularly germane as this subject is ‘under the microscope,’ as it were, by health care providers, regulatory bodies, the legal system and patients.”

The researchers, of the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, studied the process by which specimens from vaginal mesh removal operations are submitted to pathology departments for evaluation.

Their most striking finding was of limited surgical team documentation of mesh product type or material type on pathology requisition forms. While such requisition details might seem trivial, the authors note, these details help guide the pathologic exam. Explants containing metal or other nonbiological material generally cannot be submitted for standard tissue processing and sectioning. This is because metal and other foreign materials may not be sectioned and made into slides by standard means.

“No history was provided to the pathologist in 24.5% and the mesh type or product name was indicated on only 7% of requisitions. In the absence of this information, 1 in 5 specimens were described as “metal” or “metallic,” reports that would clearly be confusing and potentially damaging in the current climate of escalating regulatory and medicolegal concerns,” said Tovia Smith, MD.

Grossly undetectable metal fibers may prevent sectioning. Even fine polypropylene mesh fibers may make tissue evaluation difficult due to splintering or lack of adhesion to slides.

The group suggests that either gross or histopathologic examination is appropriate for mesh explants. They found that documentation of clinical history, mesh product, and material was frequently incomplete and associated with increased submission of tissue for histology and inaccurate gross impression of material type.

They recommend improved documentation to aid pathologic examination and enable future study of the pathophysiology of mesh complications.

Smith TM, Smith SC, DeLancey JO, et al. Pathologic evaluation of explanted vaginal mesh: Interdisciplinary experience from a referral center. Female Pelvic Med Reconstr Surg. 2013;19(4):238-241.