Quality and reliability evaluation of current Internet information regarding mesh use in inguinal hernia surgery using HONcode and the DISCERN instrument.

INTRODUCTION Mesh-related complications following pelvic prolapse surgery has potentiated societal fear and led to increased investigation into mesh use in inguinal hernia repair (IHR) surgery online. However concern exists regarding the quality of Internet health informatics. The DISCERN Instrument and HONcode  tool can be used to assess the quality and reliability of online health information. The aim of this study is to investigate the reliability and quality of online information pertaining to mesh use in IHR surgery using the DISCERN instrument and HONcode tool. METHODS An Internet search using the keywords: 'mesh', 'inguinal hernia' and 'surgery' was carried out via Google, Yahoo, Bing, Facebook and Twitter. The HONcode and DISCERN scores were generated for each of the first ten search engine result pages (SERPs). RESULTS Google provided the most reliable [Median HONcode score 77% (IQR 25.5%)] and highest quality information [Median DISCERN score; 61.5 (IQR 18.25)]. Social media yielded both the most unreliable and lowest quality information. Facebook was the most unreliable [Median HONcode score 21% (IQR 14.25%)], while Twitter imparted the lowest quality information [Median DISCERN score of 18.5 (IQR 25.25)]. DISCUSSION A 2018 Cochrane review concluded the use of mesh in IHR to be safe and associated with superior outcomes. However, numerous SERPs present results contradicting this, based solely upon Level 5 evidence. Commercialisation of the Internet has resulted in search engine optimisation, which can permit lesser quality sites to obtain higher SERP ranking. Alarmingly  if only a limited search is carried out by patients [4], lower quality, sensationalist evidence may be the only information they are exposed to. As such this may negatively influence the patient decision-making process detrimentally. However utilisation of social media by healthcare professionals may offer a solution to bridge the gap between the public and high quality medical information. CONCLUSIONS Online information regarding mesh repair of inguinal herniae is of variable quality and reliability. Enhanced quality assurance of online health information is necessary. However, increased presence by hernia societies on social media may help to disseminate high quality information to patients, thus enabling pre-hospital education to set the scene prior to formal hospital consultation.