Commercial mesh versus Nylon mosquito net for hernia repair. A randomized double-blind study in Burkina Faso.

PURPOSE: The goal of this study was to investigate whether locally available Nylon mosquito net might be a useful alternative to expensive commercial mesh implants for hernia repair, a clinical randomized double-blind study was performed. MATERIALS AND METHODS: Over a period of 3 months 35 patients with a total of 40 inguinal hernias were randomized for hernia repair with either a commercial graft (Ultrapro) or a piece of sterilized 100% Nylon mesh available as mosquito net in most African village markets. The surgeons' comfort in handling the meshes, the incidence of complications, and the patients' quality of life before and 30 days after hernia repair were evaluated. In addition, the costs of the two materials were compared. RESULTS: There was no significant difference in the clinical short-term outcome of the hernia treatment or the surgeons' comfort in handling the two different materials. The price of the locally bought Nylon mesh was 0.0043 US dollars as compared to 108 US dollars for the commercial mesh. CONCLUSIONS: In situations where superior results of hernia repair depend on the use of a mesh prosthesis but where commercial material is not available or affordable, the use of Nylon mosquito net may be an alternative. Further studies with a larger number of patients and longer follow-up are justified and recommended.

HIV-related and Epstein-Barr virus-associated anal Burkitt's lymphoma: report of a case.

PURPOSE: This article describes and discusses primary Burkitt's lymphoma of the anus which is an extremely rare site of origin. METHODS AND RESULTS: A 38-year-old HIV+ Rwandan farmer had an 8-cm x 13-cm anal tumor. Histopathology and immunohistology provided evidence of an Epstein-Barr virus-associated Burkitt's lymphoma. Chemotherapy in combination of virostatic therapy is the gold standard for treatment, but because of economic constraints surgical treatment was the only practicable intervention and an abdominoperineal resection of the anorectum was performed. CONCLUSIONS: Because of the AIDS epidemic and the increase of anal malignant pathologies, anal Burkitt's lymphoma may appear more frequently. Adequate treatment is available for only a small percentage of patients.

Fishing line suture: cost-saving alternative for atraumatic intracutaneous skin closure--randomized clinical trial in Rwanda.

Experience with the use of nylon fishing line for surgical sutures has been reported from several African countries. A recent publication suggested that fishing line and an injection needle may provide an atraumatic suture that is especially suitable for intracutaneous skin closures. This article provides further empirical support for such alternative technology. We describe a randomized, blinded clinical trial conducted in Butare (Rwanda) with 220 cutaneous wounds closed by intracutaneous sutures, with either the homemade suture or a commercial nylon thread (Ethilon). We compared the clinical outcomes as well as the costs of those two materials. There are no significant differences between the two sutures in terms of clinical findings or in the reported ease of use by the surgeons. The cost of a homemade atraumatic suture is US $0.07, which is less than one-thirtieth the cost of the commercial thread. The advantage of the commercial thread is the assurance of quality. We consider whether this quality assurance justifies the large price difference, and if the homemade suture should be recommended to surgeons in countries where the costs of surgical material often remain an obstacle for life-saving operations.