Status In progress
Process IP
Description Surgical repair with mesh involves removing some of the stretched tissue if needed, and tightening the underlying tissue (colporrhaphy). Mesh is then used to support the repair. The procedure is usually done with the patient under general anaesthesia. Anterior colporrhaphy involves dissection of the vaginal mucosa through a midline incision in the anterior vaginal wall to expose the bladder and pubocervical fascia. The fascia is then plicated (folded), some excess tissue may be removed and the incision is closed. Posterior colporrhaphy involves a vaginal incision and plication of the levator ani. Other site-specific procedures, such as paravaginal repair, may also be done using methods similar to colporrhaphy. The technique for inserting mesh varies. Mesh placement is usually done using an open technique, although trocar introducers can also be used without direct visualisation. The mesh may be positioned and sutured over the fascial defect as an 'inlay', or the whole vagina may be surrounded by mesh ('total mesh' technique). Mesh repair is theoretically suitable for any degree of symptomatic anterior or posterior vaginal wall prolapse. A number of different synthetic and biological mesh materials are available, which vary in structure and in their physical properties such as absorbability. Newer lightweight meshes have been developed.

Timeline

Key events during the development of the guidance:

Date Update
15 September 2017 Expected publication
19 June 2017 - 17 July 2017 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance