Evolution of a cost‐effective self‐tailored mesh for extraperitoneal inguinal hernia repair

Aim:  A study was conducted to develop a cost‐effective self‐tailored mesh for extraperitoneal hernia repair. Method:  Our prototype was rooted in the original idea that folding up the lower flap of a slit‐mesh (along the horizontal slit) behind its upper patch and simultaneously shifting the whole mesh down the embraced spermatic vessels would provide complete coverage of the deep inguinal ring, whilst still taking advantage of anchorage on cord structures. A succession of improvements soon followed, which were all variants on this theme. Results:  Our work has come to fruition: the current mesh proves simple to construct, easy and quick to deploy and position accurately, cost‐effective and, most importantly, very safe in terms of minimal recurrence and low chronic pain. Briefly, the tailor‐made mesh consists of an intact patch of 15 × 10 cm 2 and a heart‐shaped flap; the flap is affixed to the lower back of the patch with two stitches just lateral to its deep notch made for accommodating the vas and spermatic vessels, which finally lie between the flap and the patch. The strategic disposition of the cord structures prevents lateral displacement and rotation of the mesh, as well as superior migration of the lower edge and exposure of the internal ring, the usual cause of indirect recurrences. Whilst the distinctive ‘open heart’ pattern commands easy memory, self‐tailoring lends itself to greater adaptability in individual cases. The prosthetic is concertinaed to ease deployment. Without using consumables for fixation, our design potentially saves our hospital $HK1500–2000 for every repair. Conclusion:  A continuum of design improvement has transformed a square sheet of polypropylene into a highly cost‐effective mesh.