Sterilized Mosquito Net versus Commercial Mesh for Hernia Repair

Abstract

Background: In industrialized countries alloplastic meshes are routinely used for hernia repair. However, in developing countries they are rarely available or affordable. This study compares textile properties and tissue response of commercial polypropylene mesh (PM) vs. sterilized nylon mosquito net (MN). Methods: Textile properties were examined in vitro. In 12 goats one MN and one PM (5.5 × 8 cm) were implanted onto the posterior layer of the rectus sheath. Wound healing was clinically assessed. Histology was assessed after 4 or 16 weeks. Results: MN was thinner and lighter, but weaker than PM. All wounds healed without complications. After 16 weeks foreign body granulomas in the MN group contained a higher proportion of inflammatory tissue (32.7 vs. 22.1%) and more giant cells (3.1 vs. 1.7/10 granulomas) with a significantly lower partial volume of foreign body (23.2 vs. 36.9%). Partial volume of fibrotic tissue was similar. MN was 1,000-fold cheaper than PM. Conclusions: PM was superior concerning strength and extent of inflammatory response. However, the findings indicate that MN might serve as a cheap substitute if an alloplastic mesh is needed but no commercial one is available or affordable. Further studies are justified which should include mosquito nets of different materials and long-term outcome.

A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair

“…[19][20][21][22][23] Previous studies on the use of mosquito mesh in groin hernia repair have shown promising results with respect to tissue reaction, outcome, and cost-effectiveness. 19,[21][22][23][24][25][26] However, data from randomized trials are lacking to inform the safety and long-term effectiveness of this practice. The aim of the current randomized trial was to assess the outcomes of groin hernia repair performed with the use of a low-cost lightweight mesh as compared with a commercial lightweight mesh in a low-income country in sub-Saharan Africa.…”

Prospective randomized controlled study using polyethylene mesh for inguinal hernia meshplasty as a safe and cost-effective alternative to polypropylene mesh

“…Hence long-term complications like chronic pain, foreign body reaction and bridging should be seen less frequently with polyethylene meshes [13]. In a comparative study of mosquito mesh with polypropylene mesh in goats, in spite of normal wound healing, a higher inflammatory response was seen in the mosquito mesh group [14]. However, since the polyethylene mesh is extremely inexpensive, commercial exploitation of this mesh will be economically unviable for multinational companies.…”

Interplay between physicochemical and mechanical properties of poly(ethylene terephthalate) meshes for hernia repair

“…Clinical trials of low‐cost nets on patients with inguinal, ventral, and incisional hernia showed good surgical outcomes, with no substantial difference from surgical meshes in the short‐term reliability …”

“…In relation to biochemical properties and prostheses interaction with host tissues, some studies are found concerning in vitro analysis or in vivo experiments in animal models. Wilhelm et al . carried out an experimental study in goats comparing a PP surgical mesh and non‐medical grade polyamide (PA) nets.…”