Hernioplasty using low-cost mesh compared to surgical mesh in low- and middle-income countries: a systematic review protocol.

Objective: This review aims to assess the differences in surgical outcomes between hernioplasty using low-cost mesh and surgical mesh in adults undergoing elective hernioplasty in low- and middle-income countries.

Introduction: The use of untreated mosquito netting in inguinal hernioplasty in low- and middle-income countries has been well described in the literature, with two recent limited systematic reviews finding equivalent postoperative surgical outcomes. This comprehensive review, across a wider set of databases and gray literature, will assess a broader set of outcomes including patient and surgeon preference and sterility, report more granular complication outcomes, and include other low-cost mesh alternatives such as resterilized surgical mesh and indigenous products, alongside mosquito net mesh.

Inclusion criteria: Adult patients undergoing elective inguinal hernioplasty with mesh in low- and middle-income countries.

Methods: Electronic bibliographic databases (PubMed, Embase, Scopus, Web of Science and the Cochrane Library) and gray literature databases and trial registers will be searched for experimental studies, either randomized or quasi-randomized controlled trials, comparing hernioplasty with surgical mesh versus low-cost mesh, published in any language from 2000 to the present. Two independent reviewers will conduct the literature search, screen titles and abstracts, assess full-text studies for inclusion, assess methodological quality using the Cochrane Risk of Bias 2 tool, and extract data using a custom extraction tool. Synthesis will involve pooling for statistical meta-analysis with either a random-effects or fixed-effects model, as appropriate, and where this is not possible, findings will be presented in narrative form.

Systematic review registration number: PROSPERO CRD42019136028.