Indirect inguinal hernia: the implication of occupation in a semi-urban centre

Abstract

Inguinal hernia is the commonest anterior abdominal wall hernia and increased intra-abdominal pressure is one of the risk factors of inguinal hernia formation. The objective of this study was to determine the effect of occupation on types of indirect inguinal hernia and its associated posterior wall defect in adult male patients in a semi-urban hospital. This was a prospective descriptive hospital based study conducted between February 2004 and February 2006 among ninety-two adult male patients. Patients were classified into three work groups based on their exposure to heavy lifting: the unskilled, the artisan and the professional. Types of indirect inguinal hernia were classified intra-operatively based on distal extent of fundus of the hernia sac into: bobunocoele, funicular and inguinoscrotal and their associated posterior wall defects was classified using Nyhus classification. All data were analysed using SPSS version 15 for windows with level of significance put at p < 0.05 for nonparametric tests. There were 38 Unskilled, 18 Artisan and 36 Professional. Comparing levels of occupation with types of indirect inguinal hernia was not statistically significant (x² = 1.09, df = 2; p = 0.580). However, comparing levels of occupation with the posterior wall defect was statistically significant (x² = 7.48; df = 2; p = 0.024); follow-up tests evaluating pairwise differences between the three levels of occupation and the posterior wall defect only show significant difference between the Unskilled and the Professional (p = 0.008). Levels of occupation in our environment appears unrelated to the types of indirect inguinal hernia, however, it has an influence on the degree of posterior wall defect in the Unskilled. There is a need to evaluate the optimal convalescent period in this group of workers post surgery, to allow for adequate wound healing before returning to active work; especially, where tension repair is still the main modality of treatment.