Low-cost mesh for inguinal hernia repair in resource-limited settings
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Hernia repair is one of the most frequently performed surgical procedures worldwide, yet more than half of hernias may be untreated in African countries that lack adequate and affordable surgical care. Although this disease burden can be effectively reduced by surgical repair, public health efforts to promote repair have been sparse because of the presumed high cost of surgery.
To review the epidemiology and treatment of hernias in African countries and to assess the efficacy and safety of using low-cost mesh for repair in resource-limited settings.
An extensive literature search was performed using PubMed and the Cochrane Library to locate pertinent background information and studies that used low-cost alternatives to commercial mesh.
Most hernia repairs in Africa are performed as high-risk emergency procedures. When treatment is provided, fewer than 5% are repaired using implanted mesh because of its high cost, despite the demonstrated improvement in clinical outcomes with tension-free repair. A total of four studies using low-cost mesh were reviewed. Three of the studies compared postoperative outcomes for repairs using sterile mosquito nets with those using commercial surgical mesh. The fourth study randomized patients to receive either an indigenous bilayer device or the Prolene Hernia System. No significant differences in recurrence or in incidence of wound complications between repairs using low-cost and commercial mesh were observed. The price of low-cost mesh was generally less than 1/1,000 the price of commercial mesh.
There were no significant differences in outcomes between repairs using low-cost and commercial mesh. While the size of the study populations and the limited time for follow-up preclude conclusive measures of effectiveness, recurrence, and long-term complications, these studies demonstrate that providing an improved standard of surgical care need not be prohibitively expensive.
KeywordsInguinal hernia Herniorraphy Tension-free repair Surgical mesh Low-income country Africa Low-cost mesh
Conflict of interest
- 4.Annual Estimates of the Population for the United States, Regions and Divisions: April 1, 2000 to July 1, 2003. Population Division, US Census Bureau 2004Google Scholar
- 5.Population Statistics, Statistics Sweden (2008) http://www.scb.se/Pages/PressRelease223452.aspx. Accessed 15 July 2010
- 10.The World Bank Group Data Reports (2008) http://ddp-ext.worldbank.org/ext/ddpreports. Accessed 15 July 2010
- 11.World Population Data Sheet (2010) Population reference Bureau. http://www.prb.org/pdf10/10wpds_eng.pdf. Accessed 15 July 2010
- 13.Debas HT, Gosselin R, McCord C, Thind A (2006) Chapter 67 Surgery. In: Disease control priorities in developing countries, 2nd edition. The World Bank and Oxford University Press, Washington, DCGoogle Scholar
- 23.Leubner KD, Chop WM, Ewigman B, Loven B (2007) What is the risk of bowel strangulation in an adult with an untreated inguinal hernia? Family Phys Inq Net 56:1039–1041Google Scholar
- 25.Odula P (2004) Groin hernia in Mulago Hospital, Kampala. East Central Afr J Surg 9:48–52Google Scholar
- 30.Choo S, Perry H, Hesse AA, et al. (2010) Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospital using a WHO assessment tool. Trop Med Intl HealthGoogle Scholar
- 32.Amato B, Moja L, Panico S, et al. (2009) Shouldice technique versus other open techniques for inguinal hernia repair. The Cochrane LibraryGoogle Scholar
- 33.Scott N, Go PM, Graham P, et al. (2002) Open Mesh versus non-mesh for groin hernia repair-review. The Cochrane LibraryGoogle Scholar
- 36.Just E, et al. (2010) Reduction of the complication rate in Liechtenstein hernia repair. Intl J Surg 1–4Google Scholar
- 40.World Health Organization (WHO) Statistical information system. http://www.who.int.whosis/en. Accessed 15 July 2010
- 43.Tongaonkar RR, Reddy BV, Mehta VK et al (2003) Preliminary multicentric trial of cheap indigenous mosquito-net cloth for tension-free hernia repair. Indian J Surg 65:89–95Google Scholar