The innovative use of sterilized mosquito net as a cheaper alternative to commercial mesh for hernia repair has gained increasing recognition. Developing health care systems have inherently higher surgical site infection rates, and concerns regarding the introduction of untested prosthetic hernia meshes have been raised. This in vitro study assesses the infection risk of polyethylene (PE) mosquito net mesh compared with commercial hernia prosthetics by assessing the essential (first) step in the pathogenesis of mesh infections.
Materials and methods
Individual meshes were inoculated with Staphylococcus epidermidis and Staphylococcus aureus with a bacterial inoculum of 102 bacteria. Inoculated meshes were incubated for 18 h in tryptone soy broth and then analyzed using scanning electron microcopy. The final fraction of the bacteria adherent to each of the meshes was compared. One-way analysis of variance was performed on the bacterial counts. The Tukey test was used to determine the difference between the different biomaterials in the event the one-way analysis of variance was significant.
There was no significant difference in the mean number of adherent bacteria to PE mosquito net compared with the monofilament polypropylene-based meshes (Prolene and Bard Soft Mesh). Multifilament Vypro mesh had significantly greater mean bacterial adherence compared with PE mosquito net (P < 0.001 with S aureus and P = 0.003 with S epidermidis).
In vitro infection risk of PE mosquito net is not significantly different from commonly used monofilament polypropylene commercial prosthetics and is in fact lower than a commonly used commercial multifilament mesh. This study adds to the growing body of evidence that indicates that these meshes can be safely deployed.
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- Public health and policy issues of hernia surgery in Africa.World J Surg. 2009; 33: 1188
- Technologies for global health.Lancet. 2012; 380: 507
- Cost-effectiveness of groin hernia surgery in the Western Region of Ghana.Arch Surg. 2010; 145: 954
- Low-cost mesh for inguinal hernia repair in resource-limited settings.Hernia. 2011; 15: 485
- Randomized clinical trial of Lichtenstein's operation versus mesh plug for inguinal hernia repair.Br J Surg. 2007; 94: 36
- Randomized clinical trial of Lichtenstein patch or Prolene Hernia System for inguinal hernia repair.Br J Surg. 2006; 93: 33
- Risk factors for long-term pain after hernia surgery.Ann Surg. 2006; 244: 212
- Anaesthesia for elective inguinal hernia repair in rural Ghana - appeal for local anaesthesia in resource-poor countries.Tropical doctor. 2006; 36: 147
- The use of sterilised polyester mosquito net mesh for inguinal hernia repair in Ghana.Hernia. 2009; 13: 155
- Sterilized mosquito net versus commercial mesh for hernia repair. an experimental study in goats in Mbarara/Uganda.Eur Surg Res. 2007; 39: 312
- Commercial mesh vs. nylon mosquito net for hernia repair.World J Surg. 2007; 31: 859
- Commercial mesh versus Nylon mosquito net for hernia repair. A randomized double-blind study in Burkina Faso.World J Surg. 2006; 30 (dicussion 1790): 1784
- Prospective randomized controlled study using polyethylene mesh for inguinal hernia meshplasty as a safe and cost-effective alternative to polypropylene mesh.Updates Surg. 2012; 64: 37
- Inguinal hernioplasty using mosquito net mesh in low income countries: an alternative and cost effective prosthesis.BMJ. 2011; 343: d7448
- Design and validation of a novel quantitative method for rapid bacterial enumeration using programmed stage movement scanning electron microscopy.J Microbiol Methods. 2012; 91: 544
- Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis.Lancet. 2011; 377: 228
- Chronic groin sepsis following tension-free inguinal hernioplasty.Br J Surg. 1999; 86: 1482
- Mesh-related infections after hernia repair surgery.Clin Microbiol Infect. 2005; 11: 3
- An experimental study exploring the relationship between the size of bacterial inoculum and bacterial adherence to prosthetic mesh.Surg Endosc. 2013; 27: 978
Collins, CH., Collins and Lyne's microbiological methods. 8th ed. CH Collins ed. 2004, London, England: Arnold. vi, 456.
- Statistical study of the spot-plate technique for viable-cell counts.Appl Microbiol. 1963; 11: 305
- Handbook of bacterial adhesion: principles, methods, and applications.Humana, Totowa, NJ2000
- In vivo evaluation of bacterial infection involving morphologically different surgical meshes.Ann Surg. 2010; 251: 133
- Morphological aspects of surgical meshes as a risk factor for bacterial colonization.Br J Surg. 2008; 95: 1051
- Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model.J Biomed Mater Res. 2002; 63: 765
- Infection control as a major World Health Organization priority for developing countries.J Hosp Infect. 2008; 68: 285
- Health-care-associated infection in Africa: a systematic review.Bulletin of the World Health Organization. 2011; 89: 757
- Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index.Clin Infect Dis. 2001; 33 Suppl 2: S69
- SSI statistical report: surgical site infections. Hospital in Europe Link for Infection Control through Surveillance, Lyon, France2004
- A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs.Surg Endosc. 2003; 17: 1778
- The treatment of complicated groin and incisional hernias.World J Surg. 1989; 13: 545
- Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: the randomized, double-blind, prospective trial.Ann Surg. 2001; 233: 26
- Surgeon, do you know where your DALYs are?: (Can you fix a hernia with a mosquito net?): Comment on “Cost-effectiveness of groin hernia surgery in the Western Region of Ghana”.Arch Surg. 2010; 145: 961
- Commercial mesh versus nylon mosquito net for hernia repair. A randomized double-blind study in Burkina Faso.World J Surg. 2007; 31: 858
- Preliminary multicentric trial of cheap indigenous mosquito-net cloth for tension-free hernia repair.Indian J Surg. 2003; 65: 89
- Mosquito net mesh for abdominal wall hernioplasty: a comparison of material characteristics with commercial prosthetics.World J Surg. 2013; ([e-pub ahead of print])
- Safety and sterilization of mosquito net mesh for humanitarian inguinal hernioplasty.World J Surg. 2011; 35: 1957
Published online: February 18, 2013
Accepted: January 24, 2013
Received in revised form: December 27, 2012
Received: December 27, 2012
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