Professor Mark Ashton is a Melbourne-based plastic surgeon who specialises in pelvic mesh removal procedures.
Between 2000 – 2016 Professor Ashton was Head of Plastic Surgery at The Royal Women’s Hospital. Within this capacity he set up a breast reconstruction service at The Royal Melbourne Hospital, where he was also Head of Plastic Surgery. Professor Ashton also set up a gynaecological reconstructive service, addressing perineal, vaginal and labial soft tissue defects after cancer removal. This service also addressed correction of botched labiaplasty surgery performed by surgeons outside of the Women’s Hospital. More recently Professor Ashton has been working closely with Dr Marcus Carey and Dr Salwan Al-Salihi in the removal of pelvic mesh.
With advancing understanding of biofilm and its role in complications associated with mesh repair, we are now able to reliably and effectively treat complications of biological meshes when things go wrong.
In the late 2000’s a very common method of treating vaginal prolapse, either from the bladder or from the rectum, was through the insertion of a loose weaved series of meshes which were inserted via the vagina.
In almost every case this exposed the mesh to potential bacterial contamination which could then over time lead to the development of a biofilm or a coating of bacteria around the mesh itself. This is more likely because the meshes frequently were open weave and therefore lots of small interstices and spaces in which the bacteria could live protected away from the natural human body’s immune system.
In most cases this bacterial biofilm was unable to be treated with standard antibiotics and meant that almost inevitably patients complained of non-specific, vague lower abdominal or vaginal pain which may or may not radiate either into the buttock or down the leg. In addition, it was not infrequent for us to find that certain movements resulted in sharp jabbing or stabbing pains which radiated from the site of the mesh insertion.
Unfortunately, the only effective way to treat this infected mesh and these symptoms is to remove the mesh in its entirety. This involves the combined team of a Urogynaecologist and a plastic surgeon who together will remove both the vaginal part of the mesh and the two limbs of the mesh which have been inserted through the obturator foramen from inside the pelvis out into the thigh and the anterior inner groin crease.
The surgery normally takes somewhere between an hour to an hour and a half depending on the complexity and whether or not the mesh was inserted in the prescribed and standard manner or if it has been inserted in a non-text book way. We would normally keep you in hospital overnight and two small drain tubes would be placed and stay in situ for 24 hours. Most people find they tolerate the procedure extremely well, are not in a lot of pain and usually only require Panadol for pain relief in the postoperative period. Most importantly we find that their pain and discomfort is relieved upon removal of the mesh.
If you have any further questions please do not hesitate to contact us on (03) 8560 0590 (www.ashtonplasticsurgery.com.au) or our associate, Dr Salwan Al-Salihi’s, rooms on (03) 9347 9909.
