In Africa, Surgeons use mosquito nets for cheap hernia operations

In Africa, prosthetic repair of inguinal hernias with commercially available mesh is often considered too expensive. A team of researchers investigated whether mosquito net mesh is a plausible alternative.

In many parts of the world the burden of untreated hernias, particularly inguinal, is high and those who work in advanced healthcare systems may believe that little can be done. In addition, many low income countries consider elective surgery to be a low priority. Indeed in parts of Africa many patients develop large inguinoscrotal herniation as a result of delayed presentation, and the need for emergency surgery with its attendant mortality is not uncommon.

Although those who work in developed countries fully appreciate the benefits of alloplastic (synthetic) mesh in the repair of inguinal hernias, this is still not commonly used in poorly resourced communities. Availability and cost of such meshes are generally prohibitive to both surgeons and patients.

Although the benefits of Lichtenstein tension-free repairs (earlier return to work and a lower long term recurrence rate) are well appreciated by African surgeons, a traditional sutured repair (Bassini technique) is still common. This can best be described as a low cost approach that has been clearly satisfactory in the past. Can this now be superseded by the introduction of a widely available and distinctly cheaper mesh to improve the results of repair and quality of life?

Hernioplasty using mosquito net mesh

The cost of life-changing hernia operations could be cut by using mosquito net mesh instead of expensive medical products, a study has found.

Hernias occur when an organ, usually the intestine, breaks free from the cavity which contains it. The condition affects one in every 1,000 people worldwide and not only causes extreme discomfort but, in many cases, restricts movement and prevents the sufferer from working.

Teaching the principles of tension-free mesh hernioplasty. Photo: British Medical Journal

Surgeons from Operation Hernia — an organisation that provides low-cost surgery in developing countries — found that one mosquito net, bought for around US$15, could be cut into enough meshes for 3,000 operations.

Each operation using the technique costs just US$13 for every disability-adjusted life year averted (a common metric used by the WHO and the World Bank to judge an intervention’s cost-effectiveness)  — even when including the costs associated with sterilisation and surgery.

This is around three times cheaper than conventional treatment, making it ideal for low income countries in the developing world.

“To provide an operation that can be truly life-changing is great — but at this price it is fantastic,” said Andrew Kingsnorth, a surgeon at the Plymouth Hospital, United Kingdom, head of Operation Hernia and an author of the study, published in the British Medical Journal (15 December).

Although mosquito net mesh has been used for several years in hernia operations, surgeons still had legitimate safety concerns over their cleanliness which needed to be answered if their use was to become more widespread, he told SciDev.Net.

“It is very important that we produce data that proves that [the technique] is safe. Combined with past studies, [the new study] does just that.”

Cutting a large sheet of mosquito net mesh to size before sterilisation. Photo: British Medical Journal

His team found that simple steam or chemical sterilisation — possible in all but the most basic rural clinics — produced mosquito net mesh that was as safe to use as expensive medical-grade products. Of the 2,000 people treated with mosquito mesh by Kingsnorth and his team, only two have suffered complications caused by the material.

But only particular nets, imported from India and untreated with insecticides, have been proven to work safely and effectively.

The potential impact of the technique in the developing world could be huge, argued Kingsnorth. He estimated that the incidence of hernias in Africa could be ten times higher than in developed nations, because they are left untreated. Providing cheap hernia procedures could drastically improve life for the patients — many of whom are unable to work.

Oluyombo Awojobi, a rural surgeon in Nigeria, told SciDev.Net that the latest study is further proof that using mosquito net mesh to mend hernias is “far superior” to conventional medical supplies. He hopes that the new research would encourage more surgeons to start using the cheap mesh.

But he added: “The biggest problem standing in the way in rural regions is training. We need more people who are capable of doing the procedure”.

Operation Hernia is aiming to plug this gap. Kingsnorth has helped train surgeons to use the technique in the 18 developing country locations that the organisation regularly visits.

-Africa Health News

Source: Link to full article in the British Medical Journal

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