Mesh injury claims can raise difficult questions about the choice of procedure, informed consent, surgical technique and the management of complications. For solicitors investigating these matters, an appropriately qualified expert witness can explain the clinical evidence and provide an independent opinion on breach of duty, medical causation, condition and prognosis.

McCollum Consultants helps law firms identify mesh injury expert witnesses for independent clinical opinions. The right appointment depends on the procedure involved, the alleged injury and the questions the legal team needs to resolve.

Understanding mesh injury and vaginal mesh complications

Surgical mesh is a net-like implant that surgeons use to support weakened tissue. In pelvic surgery, this may involve treating stress urinary incontinence — urine leakage when someone coughs, sneezes or exercises — or pelvic organ prolapse. Prolapse occurs when an organ, such as the bladder or womb, drops from its usual position and bulges into the vagina. The pelvic floor is the group of muscles and supporting tissues that helps hold these organs in place.

The operation and the route the surgeon uses to insert the mesh matter. A mesh sling or tape supports the tube that carries urine out of the bladder. Other procedures use mesh to support the vaginal walls, the top of the vagina or the womb. Sacrocolpopexy supports the top of the vagina, while sacrohysteropexy supports the womb; surgeons perform these operations through the abdomen, often using keyhole surgery.

Other mesh injury cases concern hernia repair or bowel surgery. An expert needs experience in the particular operation and complications the claim concerns.

Vaginal mesh complications can include lasting pain in the lower abdomen or vagina, pain during sex, bleeding or discharge, and infection. Mesh may also become exposed through the lining of the vagina. Patients may have difficulty passing urine or develop repeated urinary infections. The expert reviews these symptoms alongside the surgical records, test results and later treatment to assess what caused them.

NICE recommends that clinicians check whether new symptoms after mesh surgery could result from a mesh complication. For solicitors, this makes the response to the patient’s symptoms an important part of the case chronology.

What can a mesh injury expert witness assess

Depending on the case and the expert’s experience, an opinion can address the decision to recommend mesh surgery, the care clinicians provided during surgery and the management of later complications. A complication alone does not establish negligence. The expert must assess the relevant standard of care and explain whether any identified departure caused or contributed to the alleged injury.

The expert should consider the knowledge, guidance and clinical circumstances at the time of the treatment. This is particularly relevant where a surgeon inserted the mesh many years before a patient developed symptoms or underwent removal surgery.

Treatment selection and consent

An expert can assess why the clinician recommended surgery, the patient’s symptoms and previous treatment, and the suitability of the proposed procedure. They can also explain the reasonable treatment alternatives and the risks relevant to the patient’s circumstances.

In consent disputes, the clinical opinion helps solicitors understand what information about the procedure, potential complications and alternatives mattered to the decision. The principles in Montgomery v Lanarkshire Health Board concern disclosure of material risks and reasonable alternatives. The legal team must consider the applicable law and the patient’s evidence about what they would have chosen with appropriate information.

Surgical care and the response to complications

Operative records can help an expert assess the surgeon’s technique, the position of the implant and any injury the surgical team recognised during the procedure. Follow-up records may show when symptoms began, how clinicians investigated them and whether specialist referral was appropriate.

A solicitor may need an opinion on whether clinicians responded adequately to repeated reports of pain, urinary difficulties or other symptoms. Where the allegation concerns delayed investigation or referral, the expert can assess whether earlier action would probably have changed the outcome.

Medical causation and the effects of injury

The expert assesses whether the mesh, a complication of surgery or another condition caused the patient’s symptoms. For example, the patient may have had pain or bladder problems before the operation, or later treatment may have contributed to their difficulties. The order of events helps the expert investigate the cause, but symptoms starting after surgery do not by themselves prove that the mesh caused them.

Condition and prognosis evidence explains the patient’s current symptoms, how those symptoms affect everyday life and what recovery or further treatment they can reasonably expect. The expert can address effects on work, daily activities and sexual function. The legal team may also need separate opinions on psychological injury, pain treatment or care needs.

The expert must also assess mesh removal carefully. Newcastle Hospitals’ specialist mesh service explains that some patients continue to experience pain after removal and describes the risks of further surgery. An expert should explain the likely benefits and limitations in the individual case, including uncertainty about recovery.

Choosing the appropriate McCollum Consultants expert

Mr David Iles, Consultant Subspecialist Urogynaecologist, has a specialist interest in mesh-related complications. He assesses and manages complications of incontinence and prolapse mesh and performs surgery to remove mesh or correct problems after an earlier operation.

Mr Matthew Izett-Kay, Consultant Gynaecologist specialising in Urogynaecology, has clinical interests in vaginal mesh, mesh complications, persistent pelvic pain and complex problems affecting pelvic support, bladder or bowel function. He accepts claimant and defendant instructions.

Mr Gregory Thomas, Consultant General and Colorectal Surgeon, contributes to McCollum Consultants’ mesh injury expertise. His practice includes pelvic floor conditions, hernias and other complex abdominal wall problems. His suitability for a particular instruction will depend on the procedure and issues in dispute.

An expert perspective on mesh injury

An expert with clinical experience in mesh injury can explain how they assess the relationship between the original procedure, later symptoms and the patient’s current condition. Their perspective can help solicitors understand which clinical questions and records require closer attention.

“Mesh injury opinions require careful assessment of causation, consent and prognosis. Pain may be multifactorial: its temporal and anatomical relationship to mesh must be considered alongside pre-existing symptoms, other pathology and chronic pain mechanisms. Association alone does not establish causation.

Consent often warrants particular scrutiny. The evidence supporting different procedures, including retropubic and transobturator slings, and awareness of their complications have evolved. Assessment must distinguish what was known or reasonably knowable at the time from later evidence, while applying the relevant legal principles to the patient’s circumstances.

Contemporaneous records are central: patient-reported outcome measures, urodynamics, operative notes, consent discussions and the information provided to the patient help reconstruct the clinical decisions and advice. Prognosis requires a separate, individualised assessment of the complication and likely outcomes with or without mesh removal, recognising that the evidence continues to develop and symptom resolution cannot be assumed.”

– Mr David Iles, Consultant Subspecialist Urogynaecologist.

Preparing an instruction

A useful initial enquiry identifies the procedure and treatment dates, the alleged injury, the issues requiring an opinion and the reporting deadline. Relevant records may include consultation and consent documentation, the surgeon’s notes, details of the mesh implant, scans, follow-up correspondence and records of any further surgery to adjust or remove mesh.

Focused instructions help the expert distinguish questions about breach of duty from those about causation and prognosis, and identify gaps in the evidence. In civil proceedings in England and Wales, CPR Part 35 establishes the expert’s overriding duty to the court. Their opinion must remain independent of the party instructing them.

Discuss a mesh injury expert witness instruction

If your firm is investigating a vaginal mesh injury claim or requires an opinion on another mesh-related complication, contact McCollum Consultants with a brief case summary and the questions you need answered. We can help identify an appropriately qualified expert, subject to suitability, availability and conflict checks.

Contact the team to discuss an instruction.

T: 0161 218 0223

E: info@exp-w.com