Comment to: The use of sterilized mosquito nets for hernioplasty: a systematic review. Sørensen CG, Rosenberg J. Hernia 2012; 16: 621–625

Abstract

We feel this review falls somewhat short of an unambiguous opinion as to the value of such an innovative approach to hernioplasty given the wealth of evidence demonstrating the worth of mosquito nets in low-income and resourcepoor countries [1]. The cost of an individual sterilized mosquito-mesh patch for inguinal hernioplasty is negligible and estimated at $US 2 which is significantly lower than the price we all pay in the developed world. We recently visited The Gambia which is a densely populated country in western sub-Saharan Africa where over 80 % of the population live on less than $US 2 a day. As in many similar countries, the burden of surgical disease [2] in combination with the lack of human resources (qualified surgeons) and health care facilities (an equipped and functioning operating room) is difficult to appreciate unless experienced first hand. More importantly and irrespective of the purpose of surgical ‘‘humanitarian missions’’ can the use of mosquito net meshes be quantified or validated for those who might remain skeptical? The Global Burden of Disease study [3] introduced the concept of disability-adjusted life-years (DALY) as a time-based measure of health that enables commensurable measurement of years of life lost due to premature mortality (YLLs) with years lived in less than ideal health [years lived with disability (YLDs)]. A mosquito net hernioplasty clearly lowers the patients’ YLD but more importantly can be achieved at a very low DALY rate as recently demonstrated in an analysis of 113 patients treated in Ghana [4]. Not only are mosquito net meshes safe but also they are truly cost-effective. It is some time since Lichtenstein described his innovative method, to the dismay of many in the surgical fraternity, to groin hernia repair. No doubt he would be delighted that his concept now reaches so many underprivileged patients. While mosquito net mesh ‘‘technology’’ seems to have been tested to the satisfaction of both surgeons and patients [1], we understand that further careful African rural audit is required. While we appreciate this may be difficult to achieve, we hope we can continue to rely on the help of profit-making companies in developed countries. Irrespective of this last comment and as stated by Dr Read in his editorial [5], Hernia is now a World Journal, so enthusiasm must be encouraged rather than possibly dampened as we have much more to accomplish as stressed by Chevrel [6] so many years ago when he said ‘‘Numerous problems are still without solutions today.’’