In 2008, plaintiff from Missouri underwent an anterior repair of the cystocele using defendant’s mesh support system. Immediately after surgery to implant the defendant’s polypropylene mesh product, plaintiff began experiencing pain. Eventually, the intense inflammatory reaction caused the polypropylene to erode into the vagina.
The plaintiff experiences daily pain in her legs, thighs, spine and vagina. Additionally, intercourse is painful for her husband.
Question(s) For Expert Witness
- 1. Did the defendant’s mesh product cause plaintiff’s injuries?
- 2. By what mechanisms?
Expert Witness Response
To a reasonable degree of medical probability plaintiff has had many problems due to the defective polypropylene mesh products and the procedure for insertion as described below.
Plaintiff’s pain immediately after surgery indicated that the path of the trocars and/or the pulling of the mesh through insufficiently dilated tissues damaged sensitive nerve tissues. This created pain that has persisted throughout her treatment course and continues to this day. To a reasonable degree of medical probability it is likely that her pain will never be completely controlled, despite continuing operative interventions that will continue into the foreseeable future.
It took only 2.5 months after implantation for the polypropylene of the product to erode into the vagina. Such erosion results from the intense inflammatory reaction caused by the defendant’s polypropylene mesh product. This prevents adequate incorporation into tissue interfering with the blood supply of the overlying vaginal wall causing it to break down and allows the mesh to be exposed to the vagina. Since polypropylene has been shown to wick bacteria and fluids, such exposure may further contaminate the surrounding tissues by moving more bacteria into the tissues and potentiate the chronic inflammatory reaction also contributing to the presence of white blood cells in the urine. To a reasonable degree of medical probability the defendant’s products are the cause of these erosions.
Plaintiff also complained of intermittent vulvar pain at the site of an incision which is likely where fully three mesh arms were placed into and through the obturator membrane. To a reasonable degree of medical probability the chronic inflammatory reaction induced by the defendant’s polypropylene mesh is the cause of this pain.
Plaintiff also complains of bilateral leg pain and pain with sitting which is the result of the anchoring mechanism for the defendant’s product into the pelvic side wall which is very near to the ischial spines and, therefore, very near to the sciatic nerves. The intense inflammatory reaction induced by the presence of the polypropylene mesh in this area irritates the sciatic nerve and the muscles around it, including the coccygeous and pyriformis. The sciatic nerve is the major nerve to supply the legs and its inflammation creates pain felt in the legs. To a reasonable degree of medical probability the defendant’s products are the cause of this leg pain.
A second source of pain to the inner thighs is the proximity of the obturator nerve to the mesh implanted into the obturator membranes bilaterally. To a reasonable degree of medical probability, the intense chronic inflammatory reaction to the product is the cause of this pain.
The intense inflammatory reaction caused by the defendant’s products implanted in plaintiff resulted in painful vaginal scarring to the vaginal walls. A scarred vaginal wall is rigid and non-distensible during episodes of attempted coital activity causing the pain of dyspareunia which persists and has made plaintiff unable to have intercourse without pain. Her husband also experiences pain during intercourse. To a reasonable degree of medical probability the defendant’s polypropylene mesh is the cause of this pain.
In summary, to a reasonable degree of medical probability, the mesh erosions, the vaginal, vulvar and thigh pain, difficulty walking and painful sitting along with plaintiff’s husband’s pain during intercourse, are all the result of the insertion of the mesh product. She also cannot enjoy life as she did before the mesh insertion. She will continue with her new normal of constant pain for the foreseeable future. Since mesh remains in her body, future erosions or other complications will occur, necessitating additional surgeries one of which is already planned, and other surgeries will occur well into the foreseeable future. To a reasonable degree of medical probability her pain is untreatable and she will suffer with this the rest of her life.
In the Rule 26 report submitted by defendant’s expert, he opines that there is no evidence of any defect in the defendant’s products that has caused or contributed to plaintiff’s ongoing conditions. He further opines that there are no defects in the products implanted in plaintiff when he states “I have experienced no defects in the products or the tools used to implant them”. He provides no specific data from his experience to support this statement.