Groin Hernia Surgery in Low-Resource Settings — A Problem Still Unsolved

Löfgren, Jenny; Beard, Jessica H.; Ashley, Thomas

doi:10.1056/nejmc1800621

Cited by 9 publications

(3 citation statements)

References 3 publications

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“…An important and critical issue appears to be the type of MM and sterilization. Sterilization may potentially alter both net surface and pore size, and sterilization > 121 °C may turn the mesh into poorly useable material, especially with certain types of mosquito nets [10]. Fortunately, steam sterilization, as used in our department does not appear to affect mesh tensile strength or tear force [11].…”

Section: Discussionmentioning

confidence: 92%

Prospective, randomized clinical trial of laparoscopic totally extraperitoneal inguinal hernia repair using conventional versus custom-made (mosquito) mesh performed in Cameroon: a short-term outcomes

et al. 2022

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Section: Discussionmentioning

confidence: 92%

Prospective, randomized clinical trial of laparoscopic totally extraperitoneal inguinal hernia repair using conventional versus custom-made (mosquito) mesh performed in Cameroon: a short-term outcomes

et al. 2022

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“…This is no problem for the producers of LCMs-they do not produce their nets for use as medical devices in humans! Löfgren et al have also recommended that the mesh used in a randomized prospective study should no longer be used in its current form [23]. A general use of LCMs, as recommended in the current HerniaSurge Guideline, is, despite all the known economic problems in LICs, only recommended with very severe limitations and should be critically reviewed.…”

Section: Discussionmentioning

confidence: 99%

“…Since only suture-based procedures are not always feasible for the very large inguinal hernia gaps, which are often very common, and thus meshes are urgently required, we also see, like Löfgren et. al., a possibility to solve the problem by establishing a manufacturing facility in Central Africa [23].…”

Section: Discussionmentioning

confidence: 99%

Alterations in the mechanical, chemical and biocompatibility properties of low-cost polyethylene and polyester meshes after steam sterilization

Wiessner¹,

Lorenz²,

Gehring³

et al. 2020

Hernia

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Introduction In Africa and other Low Resource Settings (LRS), the guideline-based and thus in most cases mesh-based treatment of inguinal hernias is only feasible to a very limited extent. This has led to an increased use of low cost meshes (LCMs, mostly mosquito meshes) for patients in LRS. Most of the LCMs used are made of polyethylene or polyester, which must be sterilized before use. The aim of our investigations was to determine changes in the biocompatibility of fibroblasts as well as mechanical and chemical properties of LCMs after steam sterilization. Material and methods Two large-pored LCMs made of polyester and polyethylene in a size of 11 x 6 cm were cut and steam sterilized at 100, 121 and 134 °C. These probes and non-sterile meshes were then subjected to mechanical tensile tests in vertical and horizontal tension, chemical analyses and biocompatibility tests with human fibroblasts. All meshes were examined by stereomicroscopy, scanning electron microscopy (SEM), LDH (cytotoxicity) measurement, viability testing, pH, lactate and glycolysis determination. Results Even macroscopically, polyethylene LCMs showed massive shrinkage after steam sterilization, especially at 121 and 134 °C. While polyester meshes showed no significant changes after sterilization with regard to deformation and damage as well as tensile force and stiffness, only the unsterile polyethylene mesh and the mesh sterilized at 100 °C could be tested mechanically due to the shrinkage of the other specimen. For these meshes the tensile forces were about four times higher than for polyester LCMs. Chemical analysis showed that the typical melting point of polyester LCMs was between 254 and 269 °C. Contrary to the specifications, the polyethylene LCM did not consist of low-density polyethylene, but rather high-density polyethylene and therefore had a melting point of 137 °C, so that the marked shrinkage described above occurred. Stereomicroscopy confirmed the shrinkage of polyethylene LCMs already after sterilization at 100 °C in contrast to polyester LCMs. Surprisingly, cytotoxicity (LDH measurement) was lowest for both non-sterile LCMs, while polyethylene LCMs sterilized at 100 and 121 °C in particular showed a significant increase in cytotoxicity 48 hours after incubation with fibroblasts. Glucose metabolism showed no significant changes between sterile and non-sterile polyethylene and polyester LCMs. Conclusion The process of steam sterilization significantly alters mechanical and structural properties of synthetic hernia mesh implants. Our findings do not support a use of low-cost meshes because of their unpredictable properties after steam sterilization.

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An in vitro study on the biocompatibility of fibroblasts in sterile and non-sterile low-cost and commercial meshes

Wiessner¹,

Gehring²,

Kleber

et al. 2019

Hernia

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Groin Hernia Surgery in Low-Resource Settings — A Problem Still Unsolved

Cited by 9 publications

References 3 publications

Prospective, randomized clinical trial of laparoscopic totally extraperitoneal inguinal hernia repair using conventional versus custom-made (mosquito) mesh performed in Cameroon: a short-term outcomes

Prospective, randomized clinical trial of laparoscopic totally extraperitoneal inguinal hernia repair using conventional versus custom-made (mosquito) mesh performed in Cameroon: a short-term outcomes

Alterations in the mechanical, chemical and biocompatibility properties of low-cost polyethylene and polyester meshes after steam sterilization

An in vitro study on the biocompatibility of fibroblasts in sterile and non-sterile low-cost and commercial meshes

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