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The Socio-Economic aspects of Laparoscopic Approach in the Treatment of Inguinal Hernia by Mesh in Cameroon

Author(s): Basile Essola, Jacques Himpens, Jean Paul Engbang, Augustin Limgba, Jacques Landenne, Esdras Ngaroua, Yves Hako, Emile Telesphore Mboudou, Michel P Hermans, Pierre Lingier, Felix Engonga Otounga, Marcelin Ngowe Ngowe, Jacob Souopgui, Patrizia Loi

Background: In Sub-Saharan Africa (SSA), economic conditions often do not always permit the use of modern surgical techniques, especially for hernia treatment. Aim of the study: To demonstrate that a modern technique such as Laparoscopic Total Extraperitoneal inguinal hernioplasty (TEP) can be performed at a significantly lower cost thanks to the use of a less expensive mesh material.

Settings: The study was performed in Douala at the Gynaecology-Obstetric and Paediatric University Hospital and at governmental Regional Hospitals of Ayos and Edéa in Cameroon.

Material and methods: Prospective, randomised, double-blind, controlled trial (RCT) including consecutive adult patients presenting with primary inguinal hernia treated by TEP, with implantation of either sterilised mosquito net mesh (MNM) or conventional polypropylene mesh (CPM).

Results: 62 patients were enrolled; randomization allocated 32 to MNM and 30 to CPM. Both groups were comparable for age and professional activities. Significant perioperative differences pertained to conversion rate (2/32 MNM), due to external (electrical power) factors and mesh removal for early obstruction (1/30 CPM). Hospital stay was less than 2 days in both groups. All patients resumed their activities after 3 weeks. Costs were significantly lower in the MNM group. No recurrences were noted with a follow-up of median 21(12-30) months.

Conclusion: This RCT shows that TEP with MNM is feasible, cost-effective with good outcomes in SSA hospital setting.

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