By Brian Camazine, MD

Mesh repair of groin hernias has become the standard of care throughout the world, but other methods are acceptable.

I recently read an article titled “Groin Hernia Surgery in Low-Resource Settings—A Problem Still Unsolved” (N Engl J Med 2018:378:1357-1358). The authors lament that there is no-low cost mesh available in resource-limited environments and that mesh is, in fact, more expensive in these environments. 

I am a missionary surgeon in Nigeria and currently spend six months per year overseas. Hernia repairs are one of our most common surgeries. I use a plug-and-patch method, with running 0-Prolene, with excellent results.

The unsolved problem the authors write about, namely low-cost mesh, has in fact been mostly resolved. I purchase commercial polypropylene mesh (equivalent to regular polypropylene mesh) for $40 per sheet (40 inches by 14 inches). This is then cut into pieces, 3 inches by 5 inches, yielding 24 pieces. The smaller pieces are then heat sterilized or solution sterilized with equivalent results. If a surgeon does just a patch, then each hernia costs $1.68. If he does a plug and patch, then each hernia costs $3.34. These are reasonable numbers even in an economically depressed area.

For surgeons concerned about heat or chemical sterilization, I should mention that I have had no wound infections or recurrences in over 1,000 clean cases. Occasionally, in a strangulated hernia requiring bowel resection, an infection occurs. Despite these occasional infections, I have not had to remove mesh.

In summary, mesh repairs of groin hernias is possible even in resource-limited environments, providing a little time is spent obtaining and sterilizing the mesh.

—Dr. Camazine is a missionary surgeon and president of Earthwide Surgical Foundation.