##article.abstract##
Background: Globally, mesh repair of abdominal wall
hernias has become the gold standard due to lower
recurrence and earlier return to normal activities. The
aim of this study is to document the spectrum and
factors that determine mesh acceptance for
abdominal wall hernias in our institution.
Patients and Method: This was a prospective study
of adult patients with adverse hernia characteristics
like voluminous sizes > 4cm, recurrence or multiple
hernias of any sizes recruited over a period of seven
years. Emergency cases, those with advanced
abdominal malignancies or who declined inclusion in
the study were excluded.
Results: A total of 440 patients with hernias that have
one or more of the following characteristics:
voluminous, recurrent, bilateral or incisional hernias
were recruited and comprised 298 (67.7%) males and
142 (32.3%) females. Majority (203, 46.1%) had inguinal
hernia, followed by incisional hernia (112, 25.5%).
Overall acceptance rate was 57.0%. The relative rate
of mesh acceptance was highest among patients with
incisional hernia (90, 80.4%) followed by inguinal hernia
(122, 60.1%). Indeed, 71.1% of the 142 females
counseled for mesh implant accepted it compared to
50.3% recorded for males. The main independent factors
that influenced mesh acceptance rates were hernia
recurrence (p=0.002), hernia defect > 5cm (p=0.001),
hernia being incisional or inguinoscrotal/inguinolabial in
type (0.006), financial impediments (p=0.031) and socio
cultural barriers (p=0.020).
Conclusion: Despite hernia complexity with increased
risk of repair failure after suture-based repair, a
significant proportion (43.0%) of patients with the above
hernia types still do not accept mesh implants in our
environment. Acceptance of mesh was predicated on
sex, hernia type and size, previous recurrence, financial
capacity and socio-cultural barriers.
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