LAUSR

OBJECTIVE This review aims to assess the differences in surgical outcomes between hernioplasty using low cost mesh and surgical mesh in adults undergoing elective hernioplasty in low- and middle-income countries. INTRODUCTION The use of untreated mosquito netting in inguinal hernioplasty in low- and middle-income countries has been well described in the literature, with two recent limited systematic reviews finding equivalent postoperative surgical outcomes. This comprehensive review, across a wider set of databases and gray literature, will assess a broader set of outcomes including patient and surgeon preference and sterility, report more granular complication outcomes, and include other low cost mesh alternatives such as resterilized surgical mesh and indigenous products, alongside mosquito net mesh. INCLUSION CRITERIA Adult patients undergoing elective inguinal hernioplasty with mesh in low- and middle-income countries. METHODS Electronic bibliographic databases (PubMed, Embase, Scopus, Web of Science and the Cochrane Library) and gray literature databases and trial registers will be searched for experimental studies, either randomized or quasi-randomized controlled trials, comparing hernioplasty with surgical mesh versus low cost mesh, published in any language from 2000 to the present. Two independent reviewers will conduct the literature search, screen titles and abstracts, assess full texts for inclusion, assess methodological quality using the Cochrane Risk of Bias 2 tool, and extract data using a custom extraction tool. Synthesis will involve pooling for statistical meta-analysis with either a random-effects or fixed-effects model, as appropriate, and where this is not possible, findings will be presented in narrative form. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019136028.