Abstract
Background
The use of alloplastic mesh is now commonplace in hernia repair. However, in developing countries, cheaper alternatives to commercial mesh are required due to the high associated cost. Whilst nylon mosquito net mesh has been trialled previously, this study aimed to assess the use of polyester mosquito net mesh in tension-free inguinal hernia repair in Ghana.
Methods
All patients undergoing inguinal hernia repair during the 5-day ‘Operation Hernia’ mission in 2007 were eligible for the study. A piece of sterilised 10 × 15-cm 100% polyester mosquito net mesh, manufactured and donated by Scotmas Limited, was implanted for all tension-free hernia repairs. The surgeons’ ease of handling and incidence of complications at 6 weeks and 6 months were assessed.
Results
Ninety-five patients underwent inguinal hernia repair using a total of 106 polyester mosquito net meshes. The mean (range) age of patients was 44.3 (15–78) years. Seventy-two (76%) were repaired using local anaesthesia. At 6 weeks and 6 months, a total of seven (7%) patients suffered wound complications (five haematomas, two wound infections). Ease of practical handling improved after the first 2–5 cases. The cost of an individual 10 × 15-cm mesh was estimated at US$0.0072–0.014, and the cost of sterilisation and packaging was US$1.46 per mesh.
Conclusions
Polyester mosquito net mesh represents a cost-effective alternative to commercial meshes in developing countries, with a relatively low rate of early complications and similar short-term recurrence rates. The use of local anaesthesia may enhance this further.
Similar content being viewed by others
References
EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 235:322–332
Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM (2002) Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev 4:CD002197
Nordberg EM (1984) Incidence and estimated need of caesarean section, inguinal hernia repair, and operation for strangulated hernia in rural Africa. Br Med J 289:92–93
Ohene-Yeboah M (2003) Strangulated external hernias in Kumasi. West Afr J Med 22:310–313
Ohene-Yeboah M, Adippah E, Gyasi-Sarpong K (2006) Acute intestinal obstruction in adults in Kumasi, Ghana. Ghana Med J 40:50–54
Harouna Y, Yaya H, Abdou I, Bazira L (2000) Prognosis of strangulated inguinal hernia in the adult: influence of intestinal necrosis. Apropos of 34 cases. Bull Soc Pathol Exot 93:317–320 (in French)
Wilhelm TJ, Anemana S, Kyamanywa P, Rennie J, Post S, Freudenberg S (2006) Anaesthesia for elective inguinal hernia repair in rural Ghana––appeal for local anaesthesia in resource-poor countries. Trop Doct 36:147–149
Tongaonkar RR, Reddy BV, Mehta VK, Singh NS, Shivade S (2003) Preliminary multicentric trial of cheap indigenous mosquito-net cloth for tension-free hernia repair. Indian J Surg 65:89–95
Freudenberg S, Sano D, Ouangré E, Weiss C, Wilhelm TJ (2006) Commercial mesh versus nylon mosquito net for hernia repair. A randomized double-blind study in Burkina Faso. World J Surg 30:1784–1789
Wilhelm TJ, Freudenberg S, Jonas E, Grobholz R, Post S, Kyamanywa P (2007) Sterilized mosquito net versus commercial mesh for hernia repair: an experimental study in goats in Mbarara/Uganda. Eur Surg Res 39:312–317
Thill RH, Hopkins WM (1994) The use of Mersilene mesh in adult inguinal and femoral hernia repairs: a comparison with classic techniques. Am Surg 60(8):553–556 (discussion 556–557)
Stoppa RE, Rives JL, Warlaumont CR, Palot JP, Verhaeghe PJ, Delattre JF (1984) The use of Dacron in the repair of hernias of the groin. Surg Clin North Am 64(2):269–285
Alexandre JH, Bouillot JL (1996) Recurrent inguinal hernia: surgical repair with a sheet of Dacron mesh by the inguinal route. Eur J Surg 162(1):29–33 (discussion 35–36)
World Health Organisation (WHO) Statistical Information System. Home page at: http://www.who.int/whosis/en
Kingsnorth AN, Oppong C, Akoh J, Stephenson B, Simmermacher R (2006) Operation Hernia to Ghana. Hernia 10:376–379
Sanders DL, Kingsnorth AN (2007) Operation hernia: humanitarian hernia repairs in Ghana. Hernia 11:389–391
Operation Hernia. Home page at: http://www.operationhernia.org.uk
Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157:188–193
Kingsnorth AN (2004) A clinical classification for patients with inguinal hernia. Hernia 8:283–284
Alilio M, Mwenesi H, Barat LM, Payes RM, Prysor-Jones S, Diara M, McGuire D, Shaw W (2007) Broken promise? Taxes and tariffs on insecticide treated mosquito nets. Am J Trop Med Hyg 77(6 Suppl):227–231
Agbakwuru E, Arigbabu AO, Akinola OD (1995) Local anaesthesia in inguinal herniorrhaphy: our experience in Ile-Ife, Nigeria. Cent Afr J Med 41(12):405–409
Ofili OP (1991) A comparison of wound complications after inguinal hernia repair under local and general anaesthesia. Trop Doct 21(1):40–41
Debas HT, Gosselin RA, McCord C, Thind A (2006) Surgery. In: Jamison DT, Breman JG, Measham AR et al (eds) Disease control priorities in developing countries, 2nd edn. The World Bank and Oxford University Press, Washington DC
Duba RB, Hill AG (2007) Surgery in developing countries: should surgery have a role in population-based health care? Bull Am Coll Surg 92:12–18
Spiegel DA, Gosselin RA (2007) Surgical services in low-income and middle-income countries. Lancet 370:1013–1015
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (2006) The global burden of disease and risk factors. Oxford University Press and the World Bank, Oxford
Musgrove P, Fox-Rushby JA (2006) Cost-effectiveness analysis for priority setting. In: Jamison DT, Breman JG, Measham AR et al (eds) Disease control priorities in developing countries, 2nd edn. The World Bank and Oxford University Press, Washington DC
World Development Indicators Data Query website. Available online at: http://ddp-ext.worldbank.org/ext/DDPQQ/member.do?method=getMembers
Acknowledgements
The authors are grateful to Bernard Boateng-Duah and Brian Dixon, who have been instrumental in coordinating operations in Ghana. In addition, the authors wish to thank Scotmas Limited for so kindly manufacturing and donating the mosquito net meshes. MGC received funding through an Association of Surgeons of Great Britain and Ireland (ASGBI) overseas fellowship.
Author information
Authors and Affiliations
Corresponding author
Additional information
An erratum to this article can be found at http://dx.doi.org/10.1007/s10029-009-0488-z
Rights and permissions
About this article
Cite this article
Clarke, M.G., Oppong, C., Simmermacher, R. et al. The use of sterilised polyester mosquito net mesh for inguinal hernia repair in Ghana. Hernia 13, 155–159 (2009). https://doi.org/10.1007/s10029-008-0460-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-008-0460-3