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      Resterilized Polypropylene Mesh for Inguinal Hernia Repair

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          Abstract

          Purpose:

          The use of prosthetic biomaterials for reconstructing and reinforcing the posterior wall of the inguinal canal reduces the incidence of hernia recurrence. Cost, availability of mesh, and perhaps reluctance to adopt a new technique are factors which prevent widespread practice of hernioplasty in low-resource settings. Use of resterilized mesh significantly reduces the cost of hernioplasty and is safe.

          Patients and Methods:

          Sheets of 30 cm × 30 cm polypropylene mesh were cut into 16 cm × 8 cm to produce mesh strips which were repackaged into SELFSEAL ® (Medical Action Industries Inc., USA) sterilizing pouches measuring 90 mm × 230 mm and autoclaved. At repair, the strips are shaped to fit the anatomy of the posterior wall of the inguinal canal, a slit created at one end and applied in Lichtenstein repair of inguinal hernias. Patients were monitored for seroma collection and wound infection up to 2 weeks postoperative period.

          Results:

          Sixty inguinal hernia repairs were done in 58 patients using the resterilized mesh; two cases being bilateral. One patient (1.7%) had seroma collection at 2 weeks which was aseptically aspirated. We did not record any case of wound infection.

          Conclusion:

          The use of sterilized polypropylene mesh for the repair of inguinal hernias is safe and reduced the cost of hernioplasty by reducing the cost of polypropylene mesh. This technique is recommended in low-resource settings.

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          Most cited references16

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          Surgical care in low and middle-income countries: burden and barriers.

          Surgically correctable pathology accounts for a sizeable proportion of the overall global burden of disease. Over the last decade the role of surgery in the public health agenda has increased in prominence and attempts to quantify surgical capacity suggest that it is a significant public health issue, with a great disparity between high-income, and low- and middle-income countries (LMICs). Although barriers such as accessibility, availability, affordability and acceptability of surgical care hinder improvements in LMICs, evidence suggests that interventions to improve surgical care in these settings can be cost-effective. Currently, efforts to improve surgical care are mainly coordinated by academia and intuitions with strong surgical and global health interests. However, with the involvement of various international organisations, policy makers, healthcare managers and other stakeholders, a collaborative approach can be achieved in order to accelerate progress towards improved and sustainable surgical care. In this article, we discuss the current burden of global surgical disease and explore some of the barriers that may be encountered in improving surgical capacity in LMICs. We go on to consider the role that international organisations can have in improving surgical care globally. We conclude by discussing surgery as a global health priority and possible solutions to improving surgical care globally.
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            Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa.

            Little is known about the burden of surgical disease in rural sub-Saharan Africa, where district and rural hospitals are the main providers of care. The present study sought to analyze what is known about the met and unmet need of surgical disease. The PubMed and EMBASE databases were searched for studies of surveys in rural areas, information on surgical admissions, and operations performed within rural and district hospitals. Data were extrapolated to calculate the amount of surgical disease per 100,000 population and the number of operations performed per 100,000 population. These extrapolations were used to estimate the total, the met, and the unmet need of surgical disease. The estimated overall incidence of nonfatal injury is at least 1,690/100,000 population per year. Morbidity as a result of injury is up to 190/100,000 population per year, and the annual mortality from injury is 53-92/100,000. District hospitals perform 6 fracture reductions (95% CI: 0.1-12)/100,000 population per year and 14 laparotomies (95% CI: 7-21)/100,000 per year. The incidence of peritonitis and bowel obstruction is unknown, although it may be as high as 1,364/100,000 population for the acute abdomen. The annual total need for inguinal hernia repair is estimated to be a minimum of 205/100,000 population. The average district hospital performs 30 hernia repairs (95% CI: 18-41)/100,000 population per year, leaving an unmet need of 175/100,000 population annually. District hospitals are not meeting the surgical needs of the populations they serve. Urgent intervention is required to build up their capacity, to train healthcare personnel in safe surgery and anesthesia, and to overcome obstacles to timely emergency care.
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              Hernia repair: the search for ideal meshes

              Background Effective repair of hernia is a difficult task. There have been many advances in hernia repair techniques over the past 50 years, but new strategies must be considered to enhance the success of herniorrhaphy. Discussion At the 30th International Congress of the European Hernia Society, nine experts in hernia repair and experimental mesh evaluation participated in a roundtable discussion about today’s unmet needs in hernia repair, including what constitutes an “ideal” hernia repair and the portfolio of “ideal” mesh prostheses. Defining characteristics of lightweight mesh, mesh alternatives, the surgeon’s role in hernia repair, adverse events, the unmet requirements for today’s hernia repair, and optimized animal models were among the topics discussed. Conclusion The ideal mesh’s construction is still in progress, but greater understanding of its critical characteristics was explored. It is hoped that these suggestions will lead to the development of improved hernia treatments and a maximally effective portfolio of hernia mesh prostheses.
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                Author and article information

                Journal
                Niger J Surg
                Niger J Surg
                NJS
                Nigerian Journal of Surgery : Official Publication of the Nigerian Surgical Research Society
                Medknow Publications & Media Pvt Ltd (India )
                1117-6806
                2278-7100
                Jan-Jun 2018
                : 24
                : 1
                : 19-22
                Affiliations
                [1]Department of Surgery, University of Uyo, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
                [1 ]Department of Medical Microbiology, University of Uyo, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
                Author notes
                Address for correspondence: Dr. Isaac Assam Udo, Department of Surgery, University of Uyo, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria. E-mail: isaacudo@ 123456uniuyo.edu.ng
                Article
                NJS-24-19
                10.4103/njs.NJS_21_17
                5883845
                273d2fc0-289e-43fe-aa7e-c2b09450488f
                Copyright: © 2018 Nigerian Journal of Surgery

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                inguinal hernia,lichtenstein repair,low-cost,sterilized mesh

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