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 The result, reported in the New England Journal of Medicine, is
expected to cause a buzz in poor countries where people live on
under $2 a day, making conventional surgical mesh expensive.
The double-blind trial, conducted in Uganda, was the first rigorous
test of the mosquito netting.
"The mosquito mesh in groin hernia surgery is a frugal innovation
with great potential for millions," chief author Dr. Jenny Lofgren
of Umea University in Sweden told Reuters Health in an email. "The
study shows that high quality surgery (on par with western surgical
quality) can be provided to an underserved population at low cost in
a low income setting."
About 20 million such operations are done worldwide each year.
The researchers were able to get about 100 patches out of a mesh
sheet that cost $1.
Each sheet was first washed in mild detergent, cut into pieces and
then autoclaved for 20 minutes to sterilize them. The processing
cost about 20 cents, most of that cost was staff time, Lofgren said.
At the one-year mark, the low-cost mesh was performing as well as
the medical-grade mesh.
Hernias recurred in just one of the 150 men with the implanted
mosquito netting. There were no recurrences in the 149 men whose
hernias were repaired using the more expensive product.
Four surgeons at the Kamuli Mission Hospital did all the repairs.
The complication rate was just under 31 percent with the low cost
mesh; just under 30 percent with the commercial mesh.
Three men who received a conventional mesh repair died during the
two years following their surgeries, versus one man who got the
mosquito mesh. All the deaths were from unknown causes.
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"Nothing in our data suggests that the mosquito mesh is less durable
than the commercial mesh that we used," said Lofgren.
"Because groin hernia is a very common condition and its repair is
one of the most commonly performed surgical procedures worldwide and
because the cost of commercial mesh is prohibitive in many low- and
middle-income countries, the findings of this study could have broad
relevance for the care of these patients," the researchers said.
They cautioned, however, that the longer-term durability of the
mosquito mesh was not tested, the results may not apply to women or
to other parts of the world were more than 40 percent of repairs are
done on an emergency basis.
"Whether the mosquito mesh should be used in the West or not will be
for others to decide," said Lofgren. "It would not be dangerous or
compromise quality, but the cost saving is minimal when put in
relation to the much larger costs that we have for staff, space,
etc. in the West."
SOURCE: http://bit.ly/1VVffpJ New England Journal of Medicine,
online January 13, 2016.
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