Mesh versus suture repair of primary inguinal hernia in Ghana

Research output: Contribution to journalArticle


  • S. Tabiri
  • F. Owusu
  • F. Atindaana Abantanga
  • A. Moten
  • D. Nepogodiev

External organisations

  • Tamale Teaching Hospital; Tamale Ghana
  • St Patrick Hospital; Offinso Ghana
  • Department of Surgery; Temple University Hospital; Philadelphia Pennsylvania USA
  • National Institute for Health Research Global Health Research Unit on Global Surgery, Institute of Translational Medicine; University of Birmingham; Birmingham UK
  • School of Medicine and Health Sciences; University for Development Studies; Tamale Ghana


Background: Most patients in Ghana undergo suture repair for primary inguinal hernia. Although there is strong evidence from high-income country settings to indicate superiority of mesh repair for inguinal hernia, the evidence to support the safety and effectiveness of mesh repair in the Ghanaian setting is limited. This study aimed to compare hernia recurrence rates following suture versus mesh repair in Ghana.

Methods: Men aged 18 years or over presenting with symptomatic, reducible inguinal hernias were included. Over the first 6 months all consecutive patients were enrolled prospectively and underwent a standardized suture repair; an equal number of patients were subsequently enrolled to undergo mesh repair. The primary outcome was hernia recurrence within 3 years of the index operation. Multivariable analysis was adjusted for age and right or left side. Adjusted odds ratios (ORs) with 95 per cent confidence intervals are reported.

Results: A total of 116 sutured and 116 mesh inguinal hernia repairs were performed. Three years after surgery, follow-up data were available for 206 of the 232 patients (88·8 per cent). Recurrence occurred significantly more frequently in the suture repair group (23 of 103, 22·3 per cent) than in the mesh group (7 of 103, 6·8 per cent) ( P = 0·002). In multivariable analysis, suture repair was independently associated with an increased risk of recurrence (OR 4·51, 95 per cent c.i. 1·76 to 11·52; P = 0·002).

Conclusion: In Ghana, mesh inguinal hernia repair was associated with reduced 3-year recurrence compared with sutured repair. Controlled dissemination across Ghana should now be assessed.

Bibliographic note

© 2019 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.


Original languageEnglish
Pages (from-to)629-633
Number of pages5
JournalBJGP Open
Issue number5
Early online date25 Jun 2019
Publication statusPublished - Oct 2019