title: Low-cost mesh for inguinal hernia repair in resource-limited settings.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Harvey 319, Baltimore, MD 21287-0005, USA.
authors: J
authors: J
authors: Yang
authors: D
authors: D
authors: Papandria
authors: D
authors: D
authors: Rhee
authors: H
authors: H
authors: Perry
authors: F
authors: F
authors: Abdullah
references: Hernia. 2004 May;8(2):121-6
references: 14625699
references: East Afr Med J. 2007 Aug;84(8):379-82
references: 17970006
references: Lancet. 2006 Apr 8;367(9517):1193-208
references: 16616562
references: Br J Surg. 1999 May;86(5):577-8
references: 10361171
references: Hernia. 2009 Apr;13(2):155-9
references: 19089526
references: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD001543
references: 19821279
references: Hernia. 2009 Oct;13(5):529-32
references: 19301084
references: Ann R Coll Surg Engl. 2007 Oct;89(7):722-4
references: 17959015
references: Hernia. 2008 Oct;12(5):527-9
references: 18404299
references: Eur Surg Res. 2007;39(5):312-7
references: 17595545
references: J Am Coll Surg. 1997 Oct;185(4):352-7
references: 9328383
references: World J Surg. 2009 Jun;33(6):1188-93
references: 19319593
references: Br J Surg. 2000 Jul;87(7):854-9
references: 10931018
references: Cochrane Database Syst Rev. 2002;(4):CD002197
references: 12519568
references: Trop Med Int Health. 2010 Sep;15(9):1109-15
references: 20636302
references: Trop Doct. 2006 Jul;36(3):147-9
references: 16884617
references: World J Surg. 2007 Jun;31(6):1356-9; discussion 1360-1
references: 17437156
references: West Afr J Med. 2003 Dec;22(4):310-3
references: 15008294
references: Am J Surg. 2001 Feb;181(2):101-4
references: 11425048
references: Int J Epidemiol. 1996 Aug;25(4):835-9
references: 8921464
references: Surg Clin North Am. 2003 Oct;83(5):1045-51, v-vi
references: 14533902
references: Ann Surg. 2006 Aug;244(2):167-73
references: 16858177
references: JAMA. 2006 Jan 18;295(3):285-92
references: 16418463
references: World J Surg. 2006 Oct;30(10):1784-9; dicussion 1790
references: 16983472
references: J Am Coll Surg. 2001 Aug;193(2):125-9
references: 11491441
references: World J Surg. 2008 Jun;32(6):1208-15
references: 18299920
references: Am J Surg. 2001 Nov;182(5):455-9
references: 11754850
references: Hernia. 2007 Oct;11(5):389-91
references: 17562124
references: Lancet. 2008 Jul 12;372(9633):139-44
references: 18582931
references: Arch Surg. 2010 Oct;145(10):954-61
references: 20956763
references: World J Surg. 2010 Mar;34(3):381-5
references: 19876689
references: Hernia. 2004 May;8(2):117-20
references: 14634843
references: Ann Surg. 2010 Aug;252(2):397-401
references: 20647921
references: Br J Surg. 1994 Feb;81(2):250
references: 8156349
references: Hernia. 2009 Jun;13(3):233-8
references: 19225858
references: Int J Surg. 2010;8(6):462-5
references: 20601250
references: J Fam Pract. 2007 Dec;56(12):1039-41
references: 18053445