14 Jan Lost-Cost Mesh Surgery for Groin Hernia Successful in Low Resource Setting
Dr. Jenny Löfgren
MedicalResearch.com Interview with:
Dr. Jenny Löfgren
Surgery and Perioperative Sciences
Faculty of Medicine,
University Hospital of Umeå
Umeå Sweden
Medical Research: What is the background for this study? What are the main findings?
Response: There are an estimated 220 million groin hernia patients in the World. 20 million are operated on annually making it one of the worlds most commonly performed surgeries. The surgical repair rate in low income settings is very low. Also, the quality of the surgery is lower than in high income settings. The superior technique that uses a synthetic mesh to reinforce the abdominal wall at the site of the hernia is not affordable due to the high cost of that mesh. Mosquito mesh, which is very similar to the expensive mesh, is already used in several settings but its safety and effectiveness had not previously been investigated in a randomized trial of sufficient size with follow up for as long as one year.
Medical Research: What are the main findings?
Response: The most important finding of the study is that it was not able to detect any differences in terms of safety, effectiveness and patient satisfaction when outcomes in the group receiving the low-cost (mosquito) mesh with the group receiving a commonly used commercial mesh. The study also shows that high quality surgery, on par with standards in high income settings, can be provided for an underserved population in rural Uganda, at an affordable cost. Finally, the study shows that it is possible to conduct high quality surgical (clinical) research with high follow up rates also in settings such as rural Uganda. This should encourage us and others to conduct other trials in the future.
Medical Research: What should clinicians and patients take away from your report?
Response: My hope is that the study will create a demand, both from patients and clinicians, for the mesh repair to be introduced in countries where it is not yet standard. From the clinician perspective, the demand should be directed towards authorities so that the mesh can be made available and so that the repair method can be taught during the training of doctors, surgeons and others who may be performing groin hernia surgery. Patients should feel confident that high quality surgery can also be performed even in low income settings.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: I and the research team have several plans for future research to build on this study. One planned study concerns the epidemiology of groin hernia in women and children (we have already undertaken a study on epidemiology of groin hernia in adult males in Uganda). It appears that groin hernia is more common in women in our Ugandan study setting than in, for instance, Sweden. Further on, groin hernia repair in women needs adjustment of the surgical method used and which method that should be used in low resource settings such as Uganda should be investigated. Before the mesh repair can be introduced on wide scale, an implementation study is also needed. We need to investigate how training of surgeons, doctors and others who are performing groin hernia repair should be carried out. We have plans for such a study and it will involve training as well as follow up of patients in a similar fashion as in the trial that we have just conducted.
Citation:
A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair
January 14, 2016
DOI: 10.1056/NEJMoa1505126
[wysija_form id=”5″]
More interviews with researchers from the NEJM
Dr. Jenny Löfgren (2016). Lost-Cost Mesh Surgery for Groin Hernia Successful in Low Resource Setting
Last Updated on January 14, 2016 by Marie Benz MD FAAD