There have been growing concerns over the use of surgical mesh in recent decades. But following an increase in media coverage, and the dismissal of a top colorectal surgeon, the controversial Laparoscopic Ventral Mesh Rectopexy (LVMR) procedure has resulted in a rise in mesh compensation claims.
What is LVMR?
Laparoscopic Ventral Mesh Rectopexy (LVMR) is an operation which is performed to straighten and attach the rectum back into its normal anatomical position within the pelvis. The surgeon then frees the rectum from the pelvis but operates only in front of the rectum and away from the nerves supplying the bowel and genitalia. A piece of mesh is stitched to the front of the rectum and this mesh is in turn secured to the sacrum (lower backbone). The effect of this is to pull the bowel up out of the pelvis and prevent it from telescoping down, restoring it to its normal anatomical position.
The procedure was pioneered by colorectal surgeon, Anthony Dixon, who worked at North Bristol NHS Trust and Spire Healthcare between 2000-2017. An NHS investigation was launched into his conduct in 2017 following concerns raised by patients. He was then dismissed in 2019.
What is the rectopexy mesh investigation?
Dixon claimed LVMR was a 'simple and straightforward' procedure to patients suffering with crippling pelvic floor and bowel issues, many of whom had turned to his expertise in times of desperation.
However, an investigation by North Bristol NHS Trust found that 57 women out of 143 treated by Dixon should have been offered an alternative, non-invasive option before surgery. The legal pitfalls are that he was too quick to use his techniques without a second thought for any long-term complications. He also failed to ensure his patients made an informed choice in their treatment options.
Spire Healthcare have also launched their own investigations into patients treated privately at Spire Bristol Hospital (The Glen). Around 300 patients who underwent rectopexy have been recalled for a consultation with an independent specialist consultant surgeon at no charge to ask questions regarding their treatment. In mid-2019, Spire set up their own Clinical Advisory Group, consisting of four expert external consultant colorectal surgeons, with patients who had undergone LVMR being offered an outpatient appointment to identify any ongoing symptoms and establish any concerns surrounding the care they received.
Concerns highlighted are:
- Not assessing the type and extent of the symptoms experienced by patients
- Failure to arrange initial investigative pre-operative tests
- Incorrectly recording bowel prolapse as justification for surgery
- Failure to recommend alternative, non-invasive treatments
- Failure to inform patients of associated risks
- Quality of the consent process
- Inappropriately prescribing mesh surgery
- The quality of the surgery itself
What is rectal prolapse?
Rectal prolapse can either be external, where the rectum either falls out of the anus, or internal where it inverts back on itself within the body.
Causes of rectal prolapse can include:
- Chronic constipation
- Straining when using the toilet
- Weakened pelvic floor or anal sphincter muscles
- Conditions that cause you to cough, such as COPD or Cystic Fibrosis
- Pregnancy
- Enlarged prostate
- Obesity or being overweight
- Trauma to the lower back
- Neurological conditions such as MS
In the last 150 years, there have been few medical trials to compare the treatments for rectal prolapse and even fewer into the outcome. However, for a large proportion of Dixon’s clients, they were not told of alternative treatment options, let alone given the opportunity to decide on their care pathway.
Things like diet and lifestyle changes can improve the constipation or incontinence experienced by those with a prolapsed bowel. Information and guidance can also be given to educate patients how to avoid bowel problems and how to irrigate the bowel to relieve symptoms. If symptoms are as a result of a weakened pelvic floor following childbirth, patients should be given information on the importance of doing pelvic floor exercises to strengthen the sling of muscles which hold in the internal organs to reduce their risk of prolapse.
What is mesh and what are the risks?
Mesh is used routinely in medical procedures to reinforce tissue, most often without issues. It is often used in procedures to repair hernias, rectal prolapse, or urinary incontinence. It is made from synthetic polymers or biopolymers, the same plastic found in ropes, carpets and plastic containers.
But when bacteria is present, particularly around the bowel and vagina, this can cause the mesh to erode, degrade or adhere to surrounding tissue.
Complications from using mesh to treat rectal prolapse vary, with some patients experiencing severe pain from where parts of the mesh have eroded and dislodged into the rectal wall, soft tissue, or nerves. In some instances, the mesh has pierced a patient’s bowel, leading to infection, risk of sepsis, and the need for a stoma.
Compensation for rectopexy
The deadline for NHS complaints about Anthony Dixon has now ended, but as previously mentioned the Spire investigation is still underway. We are working with Spire clients who have received a letter following a review of their care to assess whether they have a claim to be made.
Medical Solicitors offer advice free of charge before clients sign up to CFA funding. To get in touch email help@medical-solicitors.com