There is a subset of patients who require the transvaginal mesh. Expecting hospitals to be the gatekeeper regarding credentialing surgeons is not the solution. “
(Vaginal Mesh Website News) As reported by Mary Ellen Schneider, Ob.Gyn. News Digital Network, the American Urogynecologic Society is pushing back against attempts to ban transvaginal mesh implant surgery in the treatment of pelvic floor disorders. “In a recent position statement, officials at the American Urogynecologic Society (AUGS) voiced their strong opposition to restrictions on the use of transvaginal mesh surgery when performed by qualified, credentialed surgeons. The policy statement comes after a state medical organization, a health care system, and a medical malpractice company have considered or adopted bans on the use of transvaginal mesh implants for pelvic organ prolapse or stress urinary incontinence.” Dr. Anthony Visco who is the president of AUGS and chief of urogynecology at Duke University is against an across the board ban and believes that the situations related to vaginal mesh complications should be managed by the hospitals and health systems by adopting strict credentialing guidelines and better assessing the competence of surgeons.
His position related to the mesh is absolutely on par with my recent comments, “Greg Vigna, MD, JD Replies To Dr. Kevin Windom” that is posted on my blog and published on the web. My response to the same question is the following:
“Likely there are carefully selected patient who have severely weak fascia that there is no other viable choice but to use the mesh. A vast majority of patients can be managed with non-mesh related procedures with similar rates of successful outcomes. The next question is who is putting in the mesh. Mesh implant procedures should be carried out by trained urogynecologist with mesh tailored for the particular procedure as opposed to utilizing a mesh kit. Finally the patient must be adequately be informed of the risk versus benefits prior to surgery.”
I disagree with Dr. Visco who believes that this issue should be managed by hospitals. From my experience in private practice providing care in both rural and very competitive metropolitan markets to expect hospitals to police themselves is not practical and borderline naive. Hospitals live and die based on surgical procedures, diagnostic test, and ancillary services. To expect a hospital administration to tell a referring surgeon that they are not qualified to perform an elective surgery will just force that surgeon to direct their cases to another hospital. Hospitals have a duty to provide a safe environment for patients but to expect them to analyze the specific qualifications of a particular surgeon for a specific procedure cannot be reasonably undertaken. Further to cancel surgical procedures of a physician who is in good standing at a hospital with current privileges would open the hospital to lawsuits by the denied physician.
At some point the manufacturers will devise a safe vaginal mesh kit, we are not there now. Thousands of women can attest to this with evidence of their pelvic pain, dyspareunia, and erosions.
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