Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Harvey 319, Baltimore, MD 21287-0005, USA.
Hernia. 2011 Oct;15(5):485-9. doi: 10.1007/s10029-011-0827-8. Epub 2011 May 24.
Hernia repair is one of the most frequently performed surgical procedures worldwide, yet more than half of hernias may be untreated in African countries that lack adequate and affordable surgical care. Although this disease burden can be effectively reduced by surgical repair, public health efforts to promote repair have been sparse because of the presumed high cost of surgery.
To review the epidemiology and treatment of hernias in African countries and to assess the efficacy and safety of using low-cost mesh for repair in resource-limited settings.
An extensive literature search was performed using PubMed and the Cochrane Library to locate pertinent background information and studies that used low-cost alternatives to commercial mesh.
Most hernia repairs in Africa are performed as high-risk emergency procedures. When treatment is provided, fewer than 5% are repaired using implanted mesh because of its high cost, despite the demonstrated improvement in clinical outcomes with tension-free repair. A total of four studies using low-cost mesh were reviewed. Three of the studies compared postoperative outcomes for repairs using sterile mosquito nets with those using commercial surgical mesh. The fourth study randomized patients to receive either an indigenous bilayer device or the Prolene Hernia System. No significant differences in recurrence or in incidence of wound complications between repairs using low-cost and commercial mesh were observed. The price of low-cost mesh was generally less than 1/1,000 the price of commercial mesh.
There were no significant differences in outcomes between repairs using low-cost and commercial mesh. While the size of the study populations and the limited time for follow-up preclude conclusive measures of effectiveness, recurrence, and long-term complications, these studies demonstrate that providing an improved standard of surgical care need not be prohibitively expensive.
疝修补术是全球范围内最常进行的手术之一，但在缺乏充足和负担得起的外科护理的非洲国家，超过一半的疝可能未得到治疗。尽管通过手术修复可以有效减轻这种疾病负担，但由于手术费用高，公共卫生部门促进修复的努力一直很少。
回顾非洲国家疝的流行病学和治疗方法，并评估在资源有限的环境中使用低成本网片进行修复的疗效和安全性。
通过使用 PubMed 和 Cochrane 图书馆进行广泛的文献检索，查找相关的背景信息和使用低成本替代商业网片的研究。
非洲的大多数疝修补术都是作为高风险的紧急手术进行的。当进行治疗时，由于成本高昂，只有不到 5%的疝使用植入网片进行修复，尽管无张力修复可显著改善临床结果。共审查了四项使用低成本网片的研究。其中三项研究比较了使用无菌蚊帐进行修补的术后结果与使用商业手术网片进行修补的结果。第四项研究将患者随机分配接受本土双层装置或 Prolene Hernia System。使用低成本和商业网片进行修补的复发率或伤口并发症发生率无显著差异。低成本网片的价格通常不到商业网片价格的千分之一。
使用低成本和商业网片进行修补的结果无显著差异。尽管研究人群的规模和随访时间有限，无法对有效性、复发率和长期并发症进行明确的衡量，但这些研究表明，提供改进的手术护理标准不一定代价高昂。
