Comparative Study of Suture-Anchored Bi-Layer Mosquito Net Mesh with Standard Lichtenstein’s Prolene Mesh Inguinal Hernioplasty

Abstract

Background: Tension-free mesh hernioplasty is the standard of care for inguinal hernia repair, but the cost of commercial polypropylene mesh limits access in resource-poor settings. Sterilized mosquito-net mesh has been proposed as a low-cost alternative. Objective: To compare a self-fabricated, suture-anchored bi-layer mosquito-net mesh with standard Lichtenstein polypropylene mesh hernioplasty. Methods: A prospective comparative study of 60 adult patients with primary unilateral inguinal hernia was conducted, with alternate allocation to mosquito-net mesh (Group A, n=30) or standard Lichtenstein mesh (Group B, n=30). Operating time, hospital stay, postoperative pain (VAS), wound healing, surgical site infection, seroma/hematoma, recurrence at 6 months, return to daily activity, and procedure cost were compared. Results: The groups were comparable at baseline for age, sex, symptom duration, hernia laterality, and anesthesia type. Operating time was significantly shorter with mosquito-net mesh (56.70±9.49 vs. 65.40±10.51 minutes, p=0.001), and cost was approximately 71% lower (Rs. 2558.83±348.37 vs. Rs. 8758.43±896.42, p<0.001). No significant difference was found in postoperative pain at any time point, hospital stay, infection, seroma/hematoma, recurrence, or return to activity. A borderline, non-significant trend toward delayed wound healing was observed with mosquito-net mesh (23.3% vs. 3.3%, p=0.052). Conclusion: Suture-anchored bi-layer mosquito-net mesh offers a safe, effective, and markedly cheaper alternative to standard polypropylene mesh for inguinal hernioplasty, with a shorter operating time and comparable complication and recurrence profile, though the wound-healing trend merits confirmation in larger trials.