Abstract
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 center dot 8 per cent). Recurrence occurred significantly more frequently in the suture repair group (23 of 103, 22 center dot 3 per cent) than in the mesh group (7 of 103, 6 center dot 8 per cent) (P = 0 center dot 002). In multivariable analysis, suture repair was independently associated with an increased risk of recurrence (OR 4 center dot 51, 95 per cent c.i. 1 center dot 76 to 11 center dot 52; P = 0 center dot 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.