Inguinal Hernia Repairs in a Rural Setting in East Africa: A Clinical Approach

Background: Inguinal hernias are a major cause of morbidity and mortality in the developing world. In resource limited settings in rural Africa the clinical management of inguinal hernias may pose a therapeutic challenge to the surgeon due to the late presentation of this condition and lack of availability and affordability of mesh and laparoscopy. In our environment there is a lack of data and literature regarding the surgical management of inguinal hernias. The life time prevalence of inguinal hernia is 3% in women and 27% in men and this tend to drop after 45 years of age. The purpose of this study was to outline the clinical profile and outcomes among patients undergoing inguinal hernia repairs in our hospital. Methods: A descriptive retrospective study was carried out between 1st April 2008 to the 31st July 2012 on all patients 15 years of age that underwent an inguinal hernia repair were eligible in this study. The patients were reviewed on the surgical ward postoperatively and in the surgical out-patients clinic 3 months post-operatively. Data was collected using a pretested questionnaire on the following variables: age, sex, recurrence of hernia, post-operative pain and post-operative complications. Physical examination was used to determine post-operative recurrence and evidence of haematomas, seromas or severe wound sepsis requiring operative intervention. Results: One hundred and fifty eight patients following repair of inguinal hernia using the Modified Bassini technique were analyzed. Mean age was 44.84 years. The male: female ratio was 3.65:1 with male predominance. Emergency inguinal hernia repairs were carried out in 4(2.53%) and the majority of patients, 154(97.47%) were elective inguinal hernia repairs. One (0.63%) mortality and the morbidity included 1(0.63%) seroma, 1(0.63%) haematoma, 1(0.63%) necrotizing fasciitis and 1(0.63%) enterocutaneous fistula. The overall complication rate was 3.16%. Conclusions: In rural Africa patients with inguinal hernias should be encouraged to present early with signs and symptoms of inguinal hernia. Elective hernia repair of inguinal hernias, irrespective of the type of repair, will reduce the morbidity and mortality from this common problem in East Africa.