Abstract
Key content Mesh used in gynaecology can be permanent or absorbable. According to the Amid classification, there are four types of permanent synthetic mesh. In gynaecology, type 1 monofilament polypropylene mesh is used. Autologous, cadaveric (allograft) or porcine/bovine (xenograft) meshes are more correctly termed ‘grafts’. All are prepared so they are acellular, and free of antigens and viruses. Mesh usage has seen a rise and subsequent decline. When using mesh in practice, it is imperative to adhere to criteria recommended by the National Institute for Health and Care Excellence. Learning objectives To gain an overview of the types of mesh used in gynaecological surgery and their characteristics. To understand the origins of the use of meshes in practice, and their advantages and disadvantages. To understand the criteria that must be fulfilled before using mesh to avoid litigation. Ethical issues Informed consent through shared decision making is perhaps the most important ethical issue associated with the use of vaginal mesh in prolapse surgery. The characteristics of some patients might preclude them from accessing the best surgical approach for their problems, even if it involves the use of mesh. The use of mesh is associated with greater litigation than native tissue repair.
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