Mechanical properties of mosquito nets in the context of hernia repair

In vitro characterisation of low-cost synthetic meshes intended for hernia repair in the UK

Purpose

Low-cost meshes (LCM) were repurposed for the repair of hernias in the developing world. In vivo studies have shown LCM to have comparable results to commercial meshes (CM) at a fraction of the cost. However, little has been done to characterise the mechanical and biocompatible properties of LCM, preventing its clinical use in the UK. The objectives of the research are to assess mechanical and ultrastructural properties of two UK-sourced low-cost meshes (LCM) and the characterisation of the LCMs in vitro biocompatibility.

Methods

Mechanical properties of the two LCM were measured through uniaxial tensile test and ultrastructure was evaluated with Scanning Electron Microscopy. LIVE/DEAD^® Viability/Cytotoxicity Assay kit and alamarBlue were used to assess cellular viability and proliferation, respectively. Images were acquired with a fluorescence microscope and analysed using ImageJ (NIH, USA).

Results

LCM1 and LCM2 were both multifilament meshes, with the first having smaller pores than the latter. LCM1 exhibited significantly higher tensile strength (p < 0.05) than LCM2 but significantly lower extensibility (p < 0.0001), while Young’s Modulus of the two samples was not significantly different. No significant difference was found in the cellular viability and morphology cultured in LCM1 and LCM2 conditioned media. Metabolic assay and fluorescence imaging showed cellular attachment and proliferation on both LCMs over 14 days.

Conclusion

The characterisation of the two UK-sourced LCMs showed in vitro biocompatibility and mechanical and ultrastructural properties comparable to the equivalent CM. This in vitro data represents a step forward for the feasibility of adopting LCM for surgical repair of hernias in the UK.

Hernioplasty using low-cost mesh compared to surgical mesh in low- and middle-income countries: a systematic review protocol

OBJECTIVE

This review aims to assess the differences in surgical outcomes between hernioplasty using low-cost mesh and surgical mesh in adults undergoing elective hernioplasty in low- and middle-income countries.

INTRODUCTION

The use of untreated mosquito netting in inguinal hernioplasty in low- and middle-income countries has been well described in the literature, with two recent limited systematic reviews finding equivalent postoperative surgical outcomes. This comprehensive review, across a wider set of databases and gray literature, will assess a broader set of outcomes including patient and surgeon preference and sterility, report more granular complication outcomes, and include other low-cost mesh alternatives such as resterilized surgical mesh and indigenous products, alongside mosquito net mesh.

INCLUSION CRITERIA

Adult patients undergoing elective inguinal hernioplasty with mesh in low- and middle-income countries.

METHODS

Electronic bibliographic databases (PubMed, Embase, Scopus, Web of Science and the Cochrane Library) and gray literature databases and trial registers will be searched for experimental studies, either randomized or quasi-randomized controlled trials, comparing hernioplasty with surgical mesh versus low-cost mesh, published in any language from 2000 to the present. Two independent reviewers will conduct the literature search, screen titles and abstracts, assess full-text studies for inclusion, assess methodological quality using the Cochrane Risk of Bias 2 tool, and extract data using a custom extraction tool. Synthesis will involve pooling for statistical meta-analysis with either a random-effects or fixed-effects model, as appropriate, and where this is not possible, findings will be presented in narrative form.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019136028.