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Prospective, randomized clinical trial of laparoscopic totally extraperitoneal inguinal hernia repair using conventional versus custom-made (mosquito) mesh performed in Cameroon: a short-term outcomes

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Abstract

Background

Adverse economic conditions often prevent the widespread implementation of modern surgical techniques in third world countries such as in Sub-Sahara Africa.

Aim of the study

To demonstrate that a modern technique (laparoscopic totally extraperitoneal inguinal hernioplasty [TEP]) can safely be performed at significantly lower cost using inexpensive mesh material.

Settings

Douala University Hospital Gynecology, Obstetrics and Pediatrics and two affiliated centers, Ayos Regional Hospital and Edéa Regional Hospital in Cameroon.

Patients and methods

Prospective randomized controlled trial (RCT) of consecutive adult patients presenting with primary inguinal hernia treated by TEP, comparing implantation of sterilized mosquito mesh (MM) with conventional polypropylene mesh (CM). Primary endpoints were peroperative, early and midterm postoperative complications and hernia recurrence at 30 months.

Results

Sixty-two patients (48 males) were randomized to MM (n = 32) or CM (n = 30). Groups were similar in age distribution and occupational features. Peroperative and early outcomes differed in terms of conversion rate (2/32 MM) due to external (electrical power supply) factors and mesh removal for early obstruction (1/30 CM). No outcome differences, including no recurrences, were noted after a median follow-up of 21 months.

Conclusion

In this RCT with medium-term follow-up, TEP performed with MM appears not inferior to CM.

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Funding

The Project was funded by Accadémie de Recherche de l’Enseignement Supérieur (ARES) Belgium, ARES-PFS2016-Cameroon grant to J. S.

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Authors and Affiliations

  1. Department of Surgery and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon

    B. Essola, J. Engbang Ndamba, A. Limgba, E. Ngaroua & E. T. Mboudou

  2. Faculty of Medicine, Université Libre de Bruxelles, Bruxelles, Belgium

    B. Essola, J. Himpens, D. Djomo, P. Lingier, J. Souopgui & P. Loi

  3. Faculty of Medicine, Université Catholique de Louvain, Bruxelles, Belgium

    J. Landenne & P. M. Hermans

Authors
  1. B. Essola
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  2. J. Himpens
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  4. A. Limgba
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  7. E. Ngaroua
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  9. E. T. Mboudou
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Corresponding author

Correspondence to B. Essola.

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Disclosures

The authors: Dr Essola Basile, Professor Himpens Jacques, Dr Engbang Ndamba Jean Paul, Dr. Limgba Augustin,Dr. Djomo Tamchom Dominique, Dr. Landenne Jacques, Dr.Ngaroua Esdras, Professor Hermans P. Michel,, Mboudou Emile Telesphore, Dr. Lingier Pierre, Professor Souopgui Jacob, Professor Loi Patrizia declare no conflict of interest in relation to the content of this manuscript.

Ethical approval

The study was performed in accordance with the principles of the Declaration of Helsinki. All patients provided written informed consent. IRB approval was obtained from the ministry of health under the reference 2018/0042/HGOPED/DG/CEI. Reference of study registration: ISRCTN24826334.The study was conducted according to CONSORT guidelines and Checklist (Schulze et al., 2010).

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Essola, B., Himpens, J., Ndamba, J.E. et al. Prospective, randomized clinical trial of laparoscopic totally extraperitoneal inguinal hernia repair using conventional versus custom-made (mosquito) mesh performed in Cameroon: a short-term outcomes. Surg Endosc 36, 6558–6566 (2022). https://doi.org/10.1007/s00464-022-09046-8

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  • DOI: https://doi.org/10.1007/s00464-022-09046-8

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