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A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair
Jenny Löfgren1, Pär Nordin, Charles Ibingira
1From the Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund, Umeå University, Umeå (J.L., P.N.), and the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm (A.W.) - both in Sweden; and the Schools of Biomedical Sciences (C.I.) and Medicine (A.M.), Makerere University, and the Mulago National Referral Hospital (C.I.), Kampala, and the School of Public Health, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga (E.G.) - all in Uganda.
Background:
The most effective method for repair of a groin hernia involves the use of a synthetic mesh, but this type of mesh is unaffordable for many patients in low- and middle-income countries. Sterilized mosquito meshes have been used as a lower-cost alternative but have not been rigorously studied.
Methods:
We performed a double-blind, randomized, controlled trial comparing low-cost mesh with commercial mesh (both lightweight) for the repair of a groin hernia in adult men in eastern Uganda who had primary, unilateral, reducible groin hernias. Surgery was performed by four qualified surgeons. The primary outcomes were hernia recurrence at 1 year and postoperative complications.
Results:
A total of 302 patients were included in the study. The follow-up rate was 97.3% after 2 weeks and 95.6% after 1 year. Hernia recurred in 1 patient (0.7%) assigned to the low-cost mesh and in no patients assigned to the commercial mesh (absolute risk difference, 0.7 percentage points; 95% confidence interval [CI], -1.2 to 2.6; P=1.0). Postoperative complications occurred in 44 patients (30.8%) assigned to the low-cost mesh and in 44 patients (29.7%) assigned to the commercial mesh (absolute risk difference, 1.0 percentage point; 95% CI, -9.5 to 11.6; P=1.0).
Conclusions:
Rates of hernia recurrence and postoperative complications did not differ significantly between men undergoing hernia repair with low-cost mesh and those undergoing hernia repair with commercial mesh. (Funded by the Swedish Research Council and others; Current Controlled Trials number, ISRCTN20596933.).
