Sunday, December 11, 2005

Reheating the Leftovers

I always appreciate nicely designed, well-executed studies that address a common problem in a sensible manner. Such is the case with a report in this month's Journal of the American College of Surgeons (subscription required, but abstract available). It comes from Turkey (hardly a major contributor to American surgical literature), and is the lead article this month --- "Use of Resterilized Polypropylene Mesh in Inguinal Hernia Repair: A Prospective, Randomized Study," by Asim Cingi, M.D., et al.

The article addresses the resterilization of polypropylene mesh, such as when only a portion of a larger sheet of mesh needs to be used for a given operation. The authors initially evaluated mesh that was manually manipulated, divided into smaller pieces, and resterilized. Sort of like reheating leftovers.Subsequent cultures proved to be negative, and tensile strength was only minimally altered. They then embarked on a double-blinded, randomized study, placing either "virgin" or divided and resterilized polypropylene mesh in patients undergoing first-time inguinal hernia repair. No differences were noted in either group (total 184 patients) with a median follow-up of two years.

OK, so what's the big deal? Actually, we're talking about a significant amount of cash, particularly in poor countries. Inguinal hernias are extremely common, and it has been very well-established that the recurrence rate for non-mesh repairs is unacceptably high (in adults), leading to lost work and productivity.....an even bigger problem in poor countries. If larger sheets of mesh can be "tailored" to be used in several operations, the costs to the health system in developing countries will be significantly lower. This might allow increased mesh use in those regions, lowering recurrence rates to about 2%. As my daughter would say, "cool beans."

What about here in the good old USA? Actually, this was done routinely back in the dark ages (when I was but a wee intern), but was subsequently abandoned, primarily over theoretical concerns with HIV infection. I would love to see a much larger similar study done here, with standardization of how the mesh is handled and sterilized, potentially to include resterilization of large sheets that are cut to size on the "back table." The specter of prion disease is also one that would have to be dealt with. I suspect the results would be similar; I also suspect that study will never be done here, due to potential liability issues (can you imagine the consent form that your local IRB would come up with?).

Disclaimer : I'm not just the president of The Mesh Club For Men; I'm also a client! I got my mesh in 2004!