Low cost mesh for hernia repair is as good as commercial mesh, trial finds

Men undergoing hernia repair using a low cost mesh have a similar rate of hernia recurrence and postoperative complications as those treated with a commercial mesh, shows a randomised trial carried out in Uganda, where commercial meshes are generally unaffordable.

The trial randomly allocated 302 adult men with primary, unilateral, reducible groin hernias to undergo surgical hernia repair using either a low cost mesh or a commercial synthetic mesh.1

Commercial meshes are too expensive for most patients in low and middle income countries, costing US$125 (£86; €115) in Uganda. Researchers wanted to see whether they could be replaced with low cost mesh of 100% polyethylene, which is normally used for mosquito netting and costs less than $1. Both meshes used in the trial were lightweight and had a similar pore size.

All patients underwent hernia repair surgery carried out by four qualified surgeons at a hospital in eastern Uganda from February 2012 to October 2013. Results showed that the rate of hernia recurrence was very similar in those who had the low cost mesh (1 patient; 0.7%) to the rate in patients assigned to the commercial mesh (0 patients; absolute risk difference 0.7% (95% confidence interval –1.2% to 2.6%); P=1.0).

Postoperative complications, including haematoma or swelling in the groin or scrotum and superficial infection, occurred in 44 patients (30.8%) assigned to the low cost mesh and in 44 (29.7%) of those given the commercial mesh (1.0% (–9.5% to 11.6%); P=1.0).

“This study showed that a low cost mesh can be used in hernia repair with excellent clinical outcomes that do not differ significantly from those achieved with commercial mesh,” said the study authors, led by Jenny Löfgren, of the University Hospital of Umeå in Sweden.

They noted that haematoma or swelling in the groin or scrotum was documented more frequently than has been reported in high income countries (24.5% with low cost mesh and 23.6% with commercial mesh, versus 5.6-16%), but they thought that this was because one third of study participants had a scrotal hernia, which is associated with increased risk of diffuse bleeding and swelling.

“Results support the use of low cost mesh for hernia repair in resource scarce settings, after appropriate training of the staff performing the procedures,” the research group concluded, noting that the mesh requires correct preparation including sterilisation. Their study was funded by the Swedish Research Council and other research funding bodies.

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