Muheza approach: a sustainable mesh hernia service in a resource-poor setting and developing a national methodology to hernia surgery in Tanzania

Background: Hernias are amongst the most common general surgical problems worldwide. In 2019, an estimated 800 000 inguinal hernias remain untreated in Tanzania. Furthermore, only 5% of hernias in Africa are repaired with mesh due to costs, resulting in high recurrence rates. We describe the establishment of a safe, sustainable and affordable mesh hernia programme in Tanzania. Methods: Hernia repairs were performed by a UK Consultant General Surgeon and two Tanzanian Surgical Assistant Medical Officers between November 2018 and April 2019. Tanzanian Assistant Medical Officers were taught in a modular fashion. Polyethylene ‘mosquito net’ mesh was sterilized using a steam autoclave on site. A standardized approach to intraoperative technique and perioperative care was adopted. Patients were followed up and a registry maintained. Results: A total of 50 mesh hernia repairs were performed on all-comers between November 2018 and April 2019. One additional hernia repair was carried out without mesh as the hernia contained perforated bowel with faecal contamination. Of the 50 patients, 47 were followed up. At 2 weeks, none were found to have recurrence, none had evidence of infection and none reported numbness. Of the 47 patients, nine reported low-grade discomfort. On further follow-up, the pain resolved in seven of the nine patients, and the remaining two reported persistent low-grade discomfort (both recurrent hernias with the reported pain less than preoperatively). Conclusion: Proposals have been accepted for a Tanzania National Hernia Project, which aims to establish mesh repair as the gold-standard approach to inguinal hernia surgery across Tanzania. Through education and collaboration, this project hopes to address the major outstanding health issue of untreated hernias in Tanzania.