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From the Journals

Modified Mesh Repair Effective in Women’s Hernias

Randomized trial results showed that modified open mesh repair was as safe and effective as standard mesh repair for treating groin hernias in women, with similar recurrence and complication rates after 1 year.

Conexiant

A randomized clinical trial in Uganda found that a modified open anterior mesh (MOAM) technique for groin hernia repair in women was as safe and effective as the standard open anterior mesh (OAM) method, with no significant differences in recurrence or complication rates at 1 year.

The study enrolled 200 women aged 18 years or older with primary groin hernias at 2 public hospitals in Northern Uganda between October 2019 and February 2023. Participants were randomly assigned to receive either OAM repair (99 women) or MOAM repair (101 women). The MOAM procedure involved opening the transversalis fascia and placing a mesh flap over the femoral canal.

At 1-year follow-up, hernia recurrence occurred in 4 of 97 women (4.1%) in the OAM group and 7 of 98 women (7.1%) in the MOAM group. The absolute difference was −3%, indicating no statistical significance.

Femoral hernias were identified in 89 of 200 women (44.5%). Among those assigned to OAM repair, 35 of 99 (35.4%) received the MOAM procedure instead due to intraoperative detection of femoral hernias. The modified approach allowed visualization of the femoral canal, which standard OAM may overlook.

Wound complications were reported in 20 of 198 patients (10%) at 2-week follow-up—12 of 99 (12%) in the OAM group and 8 of 99 (8) in the MOAM group.  One patient developed a deep infection requiring drainage, and another had postoperative bleeding that required surgical control.

Pain symptoms improved in both groups. The mean Inguinal Pain Questionnaire (IPQ) score at 1 year was 1.53 in the OAM group and 1.56 in the MOAM group. One patient reported severe chronic groin pain (IPQ score = 7).

At 1 year, 90 of 97 patients (93%) in the OAM group and 93 of 98 (95%) in the MOAM group reported satisfaction with the surgical outcome. Self-assessed health scores improved from baseline by +30.2 in the OAM group and +32.3 in the MOAM group.

All procedures were performed under local anesthesia by four trained surgeons. The study was originally designed for 440 participants but ended after 200 due to logistical constraints and early data trends.

“Femoral hernias were very common in the study population, and exposure of the femoral canal was essential to detect these hernias,” said lead author Alphonsus Matovu, MD, of the Department of Surgery at Mubende Regional Referral Hospital, Uganda.

Full disclosures can be found in the published study.

Source: JAMA Surgery