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Three different repair methods in sub-Saharan Africa
Here is an interesting abstract about a study of repair methods in sub-Saharan Africa. Basically a state-of-the-situation. Bassini, Shouldice, and Lichtenstein are the three methods.
It’s hard to see the need for a shift to more mesh.
https://link.springer.com/article/10.1007/s10029-022-02669-9
“Results
We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4–0.9). The pooled recurrence rate was 1.4% (95% CI 1.05–1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9–3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p???0.001; OR?=?47.7; 95 CI (27.2–83.47)].” -
6 Replies
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“This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low.”
That’s good and does suggest, to me, there is no real need for other methods.
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If you follow the logic defined in the “Guidelines” then you’ll see that these programs will spread mesh repair throughout low income regions of the world.
Guidelines say mesh is the preferred first choice > endorsed by Hernia societies > societies get involved in hernia repair training efforts > training in the “preferred” method happens in the low income regions > more mesh repairs > supported by big mesh-maker.
Marketing and sales promotion is defined as “giving back”.
Who will do the training for pain management and mesh removal?
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I might have confused Herniasurge with OperationHernia. They seem very similar.
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I might have mistaken Herniasurge for one of the other groups. Here is a typical training program, linked below. Medtronic seems involved, a big mesh-maker.
https://hernia2021.org/hernia-2021-charity-project/medtronic-operation-hernia-project
The reasoning behind it does not seem to fit the results of the abstract in the first post.
“Two significant factors form the background to this project:
1. The burden of hernias in Ghana is high. The rate of hernia repair is very low compared to the west. There is an urgent need to increase the rate of repair by increasing the number of trained surgeons to repair hernias to avoid a backlog of a million patients with hernias in 10 years
2. Most hernia repairs carried out in Ghana is by high tension Bassini repair which has a high recurrence rate. The programme trains in Mesh Repair.”
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p.s. my comment about Herniasurge being behind the program in Africa is based on past articles I’ve seen. I will try to find them and post them.
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The Herniasurge group has a program in place to train more surgeons in mesh techniques. The verbiage seems to be a bit mixed-message, the first reference is to the “International HerniaSurge Guidelines” (even though Herniasurge is not actually in the title of the Guidelines).
Herniasurge is the group that has an actual piece of mesh as their logo. Very strange how enamored they are of mesh. They have vacillated between being behind the scenes and being at the forefront. It looks like they are stepping out again as a force for promoting mesh.
https://pubmed.ncbi.nlm.nih.gov/32157505/
If a region is “Low Resource” and mesh is unaffordable how does training in mesh techniques help? The conclusion of “need for formal training” seems disconnected from the words that precede it. Seems like the need is not real. Maybe I am misinterpreting.
“Abstract
Introduction: Inguinal hernias are among the most common surgical diseases in Africa. The current International HerniaSurge Guidelines recommend mesh-based surgical techniques in Low Resource Settings (LRS). This recommendation is currently unachievable in large parts of Africa due to the unaffordability of mesh and lack of appropriate training of the few available surgeons. There is, therefore, a need for formal training in mesh surgery. There is an experience in Hernia Repair for the Underserved in Central and South America, however, inadequate evidence of structured training in Africa.”
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