Foundation for an evidence-informed algorithm for treating pelvic floor mesh complications: a review.

Abstract

To address evidence gaps on the management of complications related to mesh in pelvic floor surgery, we created an evidence-based algorithm that includes defining evidence gaps. We utilized the Delphi method within a panel of surgeons treating mesh complications to define a treatment strategy. The first round provided a list of clinically based postulates that informed a review expanding postulates to recommendations and included grading of the quality of evidence. A second round informed the final algorithm. While the quality of the available evidence is low, it provides a framework for planning diagnosis and management of mesh-related complications. Removal of mesh must balance resolution of complications with the risk of removal and recurrence of pelvic floor symptoms.