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Feature Christmas 2011: Surgery

Inguinal hernioplasty using mosquito net mesh in low income countries: an alternative and cost effective prosthesis

BMJ 2011; 343 doi: (Published 15 December 2011) Cite this as: BMJ 2011;343:d7448
  1. Brian M Stephenson, consultant general surgeon1,
  2. Andrew N Kingsnorth, professor2
  1. 1Department of Surgery, Royal Gwent Hospital, Newport, South Wales, NP20 2UB, UK
  2. 2Department of Surgery, Derriford Hospital, Plymouth, Devon, UK
  1. Correspondence to: B M Stephenson brian.stephenson{at}

In Africa, prosthetic repair of inguinal hernias with commercially available mesh is often considered too expensive. Brian Stephenson and Andrew Kingsnorth 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,1 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)2 are well appreciated by African surgeons, a traditional sutured repair (Bassini technique) is still common.3 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 Can this now be superseded by the introduction of a widely available and distinctly cheaper mesh to improve the results of repair and quality of life?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

Although commercial nylon (polyamide 6-6) has been used for over 60 years as suture material, in some low income countries sterilised nylon fishing line, bought locally, is still used as a cheaper alternative.4 Given that this has proved a safe option, the next logical step was the use of a net of similar material as a mesh in the repair of inguinal hernias.

The Indian surgeon Tongaonkar must be credited …

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