Mosquito net better for groin hernia at no extra cost

Using sterilised mosquito net instead of commercial mesh for repairing inguinal (groin) hernias opens the way for improved care without an increase in cost for low-income countries. This according to a study conducted in rural Uganda by researchers at Karolinska Institutet, Umeå University and Makerere University.

The results are presented in the British Journal of Surgery and are a follow-up on earlier studies that established that sterilised mosquito net is just as safe as commercial mesh for repairing inguinal hernia.

With a total of approximately 20 million cases a year, groin hernia surgery is one of the world’s most common operations. Commercial hernia mesh, which is used routinely in high-income countries, is very expensive in low-income countries, where they often cost over USD 100 each. For this reason, patients in these countries are not operated on using mesh.

Without surgery, an inguinal hernia can cause considerable suffering, particularly in terms of the pain it causes. Possible life-threatening complications claim the lives of some 40,000 people a year.

Health economy analysis

The results of this health economy analysis show not only that surgery for inguinal hernia using a sterilised mosquito net under local anaesthesia can be performed at a low cost, but also that it is highly cost-effective. Costs included in the analysis were those for staff, facilities, equipment, medicines, materials and overheads.

Depending on the choice of mesh, the difference is over USD 120 (SEK 1,000) per operation. Using mosquito net, the operation costs no more than the routine, sutured repair that is currently performed. This means that repair with mesh could be available for the millions of people suffering from inguinal hernia in low-income countries, which would bring considerable patient benefit.

Performed by local surgeons

The study was conducted by a team of Swedish and Ugandan researchers. When the surgery-related costs of the Swedish participants are taken into account in the health economical analysis, the per-operation cost rises dramatically. One conclusion to be drawn from this is that routine surgery should be performed by local surgeons; international collaborations should aim to provide surgical training and support where necessary.

“Now that we know that high-quality care for inguinal hernia surgery can be offered at a low cost in low-income countries, it’s time that we advanced our positions so that the many million of people suffering from inguinal hernias in these countries can get help,” says lead author Dr Jenny Löfgren, physician and researcher at Karolinska Institutet and Umeå University. “In the meantime, we must focus on implementation, patient safety, knowledge transfer and surgical training.”

The research was financed with grants from Region Jämtland Härjedalen’s R&D unit, the Swedish Research Council, the Capio Foundation, the Swedish Society of Medicine and Rotary.

Publication

Cost-effectiveness of groin hernia repair with commercial versus low-cost mesh in a low-income country
J. Löfgren, A. Matovu, A. Wladis, C. Ibingira, P. Nordin, E. Galiwango and B. Forsberg
Journal of British Surgery, online 16 February 2017, doi: 10.1002/bjs.10483