Meta‐analysis of the use of sterilized mosquito net mesh for inguinal hernia repair in less economically developed countries

M. H. Ahmad, S. Pathak, K. D. Clement, E. H. Aly (Corresponding Author)

Research output: Contribution to journalReview article

Abstract

Background
Inguinal hernias are common in less economically developed countries (LEDCs), and associated with significant morbidity and mortality. Tension‐free mesh repair is the standard treatment worldwide. Lack of resources combined with the high cost of commercial synthetic mesh (CSM) have limited its use in LEDCs. Sterilized mosquito net mesh (MNM) has emerged as a low‐cost, readily available alternative to CSM. The aim of this systematic review and meta‐analysis was to evaluate the safety and efficacy of MNM for the use in hernia repair in LEDCs.

Methods
A systematic review and data meta‐analysis of all published articles from inception to August 2018 was performed. Cochrane Central Register of Controlled Trials, MEDLINE and Embase databases were searched. The primary outcome measure was the overall postoperative complication rate of hernia repair when using MNM. Secondary outcome measures were comparisons between MNM and CSM with regard to overall complication rate, wound infection, chronic pain and haematoma formation.

Results
A total of nine studies were considered relevant (3 RCTs, 1 non‐randomized trial and 5 prospective studies), providing a total cohort of 1085 patients using MNM. The overall complication rate for hernia repair using MNM was 9·3 per cent. There was no significant difference between MNM and CSM regarding the overall postoperative complication rate (odds ratio 0·99, 95 per cent c.i. 0·65 to 1·53; P = 0·98), severe or chronic pain (OR 2·52, 0·36 to 17·42; P = 0·35), infection (OR 0·56, 0·19 to 1·61; P = 0·28) or haematoma (OR 1·05, 0·62 to 1·78; P = 0·86).

Conclusion
MNM has a low overall postoperative complication rate and is unlikely to be inferior to CSM in terms of safety and efficacy. MNM is a suitable low‐cost alternative to CSM in the presence of financial constraint.
Original languageEnglish
Pages (from-to)429-435
Number of pages7
JournalBJS Open
Volume3
Issue number4
Early online date27 Feb 2019
DOIs
Publication statusPublished - Aug 2019

Fingerprint

Mosquito Nets
Inguinal Hernia
Herniorrhaphy
Developing Countries
Chronic Pain
Hematoma
Outcome Assessment (Health Care)
Safety
Wound Infection
Hernia
MEDLINE
Odds Ratio
Databases
Prospective Studies
Morbidity
Costs and Cost Analysis

Cite this

Meta‐analysis of the use of sterilized mosquito net mesh for inguinal hernia repair in less economically developed countries. / Ahmad, M. H.; Pathak, S.; Clement, K. D.; Aly, E. H. (Corresponding Author).

In: BJS Open, Vol. 3, No. 4, 08.2019, p. 429-435.

Research output: Contribution to journalReview article

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title = "Meta‐analysis of the use of sterilized mosquito net mesh for inguinal hernia repair in less economically developed countries",
abstract = "BackgroundInguinal hernias are common in less economically developed countries (LEDCs), and associated with significant morbidity and mortality. Tension‐free mesh repair is the standard treatment worldwide. Lack of resources combined with the high cost of commercial synthetic mesh (CSM) have limited its use in LEDCs. Sterilized mosquito net mesh (MNM) has emerged as a low‐cost, readily available alternative to CSM. The aim of this systematic review and meta‐analysis was to evaluate the safety and efficacy of MNM for the use in hernia repair in LEDCs.MethodsA systematic review and data meta‐analysis of all published articles from inception to August 2018 was performed. Cochrane Central Register of Controlled Trials, MEDLINE and Embase databases were searched. The primary outcome measure was the overall postoperative complication rate of hernia repair when using MNM. Secondary outcome measures were comparisons between MNM and CSM with regard to overall complication rate, wound infection, chronic pain and haematoma formation.ResultsA total of nine studies were considered relevant (3 RCTs, 1 non‐randomized trial and 5 prospective studies), providing a total cohort of 1085 patients using MNM. The overall complication rate for hernia repair using MNM was 9·3 per cent. There was no significant difference between MNM and CSM regarding the overall postoperative complication rate (odds ratio 0·99, 95 per cent c.i. 0·65 to 1·53; P = 0·98), severe or chronic pain (OR 2·52, 0·36 to 17·42; P = 0·35), infection (OR 0·56, 0·19 to 1·61; P = 0·28) or haematoma (OR 1·05, 0·62 to 1·78; P = 0·86).ConclusionMNM has a low overall postoperative complication rate and is unlikely to be inferior to CSM in terms of safety and efficacy. MNM is a suitable low‐cost alternative to CSM in the presence of financial constraint.",
author = "Ahmad, {M. H.} and S. Pathak and Clement, {K. D.} and Aly, {E. H.}",
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AB - BackgroundInguinal hernias are common in less economically developed countries (LEDCs), and associated with significant morbidity and mortality. Tension‐free mesh repair is the standard treatment worldwide. Lack of resources combined with the high cost of commercial synthetic mesh (CSM) have limited its use in LEDCs. Sterilized mosquito net mesh (MNM) has emerged as a low‐cost, readily available alternative to CSM. The aim of this systematic review and meta‐analysis was to evaluate the safety and efficacy of MNM for the use in hernia repair in LEDCs.MethodsA systematic review and data meta‐analysis of all published articles from inception to August 2018 was performed. Cochrane Central Register of Controlled Trials, MEDLINE and Embase databases were searched. The primary outcome measure was the overall postoperative complication rate of hernia repair when using MNM. Secondary outcome measures were comparisons between MNM and CSM with regard to overall complication rate, wound infection, chronic pain and haematoma formation.ResultsA total of nine studies were considered relevant (3 RCTs, 1 non‐randomized trial and 5 prospective studies), providing a total cohort of 1085 patients using MNM. The overall complication rate for hernia repair using MNM was 9·3 per cent. There was no significant difference between MNM and CSM regarding the overall postoperative complication rate (odds ratio 0·99, 95 per cent c.i. 0·65 to 1·53; P = 0·98), severe or chronic pain (OR 2·52, 0·36 to 17·42; P = 0·35), infection (OR 0·56, 0·19 to 1·61; P = 0·28) or haematoma (OR 1·05, 0·62 to 1·78; P = 0·86).ConclusionMNM has a low overall postoperative complication rate and is unlikely to be inferior to CSM in terms of safety and efficacy. MNM is a suitable low‐cost alternative to CSM in the presence of financial constraint.

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