Humanitarian hernia surgery: innovative repairs with “mosquito-net” mesh by renowned surgeon Mr Brian Stephenson

In rural Africa and other resource-poor areas, elective hernia surgery is often neglected as hospitals are ‘far and few’ and attending surgeons ‘difficult to find’.  

With people living on less than £2 a day treatment is unaffordable and as such their hernias increase in size and often limit a person’s daily activities and livelihoods, especially if the patient is the ’bread-winner’ of the family.  Untreated hernias can have a serious economic impact and may cause unnecessary morbidity/mortality.

Consultant General Surgeon, Brian Stephenson has recently returned from a charitable groin hernia clinic in rural north India, at the base of the Himalayas where he treated underprivileged patients in resource-poor areas. Patients had their symptomatic groin hernias repaired under local anaesthesia using sterilised mosquito-net mesh which is qualitatively similar to the mesh used in our modern Western health care systems.

Whilst there remains debate and some controversy as to the optimal approach to the repair of groin hernias, patients are looking for a speedy recovery and minimal chance of recurrence.  This is true wherever in the world the patient lives.

Brian Stephenson has for many years travelled to areas of the world where the need is the greatest. Having trained in London he spent a year as a missionary surgeon in deprived rural South Africa before returning to the UK to complete his higher surgical training in London, Leeds and South Wales where he is now a well-known Consultant in General and Colorectal Surgery.

Since that time Brian has been fortunate to be able to continue operating in many foreign countries on a charitable/humanitarian basis, primarily on groin hernia patients through the charity Hernia International. This charity addresses the global problem of hernia by delivering modern techniques of hernia surgery in low-income /resource settings.

The use of synthetic mesh to augment the repair of groin hernias is now well-established as the ‘gold’ standard in the Western World as it reduces the chance of later recurrence which no patient wants. However, the cost of commercial mesh prohibits its use where incomes are so low. This dilemma was overcome by an Indian Surgeon, Ravi Tongaonkar who used mosquito-net mesh instead. The results meant that the under-privileged could be managed in a similar fashion to those from wealthier societies.

Such qualitatively similar mesh can be purchased in large sheets at very low cost, cut into appropriate size(s) and then sterilised (often with steam at high pressure).

An easy read as to the value of this approach can be found at “Inguinal hernioplasty using mosquito net mesh in low-income countries: an alternative and cost-effective prosthesis”. Stephenson BM, Kingsnorth AN. British Medical Journal 2011; 343: d7448

Since 2005 the charity Hernia International has provided surgery and anaesthesia (usually a local) to many communities mainly in sub-Saharan Africa. To date volunteer surgeons from around the world have worked in over 23 different countries with great success and enormous patient satisfaction; that is something money can’t buy.

Brian Stephenson explains, “The operating theatres are sometimes very challenging and the work rather hot but always rewarding. I have personally enjoyed all the ‘missions’ that I have contributed to including my most recent visit to high rural India at the base of the Himalayas in November 2019 and I am most grateful to my NHS Trust in allowing me time to carry out this work.”

Brian Stephenson lectures on this topic and other topics of interest to audiences at a number of hospitals. If you would like to contribute to this charity or find out more please visit the website: www.herniainternational.org.uk

To discover more about Brian Stephenson visit: https://www.stjosephshospital.co.uk/consultants/mr-brian-stephenson/