Complicated inguinal hernia in rural southeast Nigeria: A multicentre observational study on epidemiology and treatment outcomes

Abstract

[Accepted Research Article]

Background: There is enormous pool of unmet need for inguinal hernia (IH) repair in our environment due to numerous factors against elective repair. This has led to a large number of patients presenting emergently with complications. The aim of this study is to document the epidemiology and outcome of surgical management of complicated inguinal hernia (CIH) in a low income rural southeast Nigeria.

Methods: This was a multi-centre, retrospective cross-sectional analytical study of patients who received surgical treatment for CIH over eight years period (January 2013- December 2020) at three selected district hospitals in Southeast Nigeria. The trend over time and outcome of surgical treatment were evaluated. The main outcome measures analyzed were morbidity, mortality and length of hospital stay (LOHS). The various clinical, demographic and perioperative indices that impacted on morbidity and mortality were evaluated.

Results: Of the 540 patients evaluated, there were 89 (16.5%) bilateral and 451 (83.5%) unilateral IHs. Majority (78.5%) were inguinoscrotal/inguinolabial hernias. Nearly a third (30.4%) presented after 72hours of complications. At presentation, all (540,100.0%) had irreducible groin swellings and abdominal pain, but 68.95 had abdominal swelling. Comorbidities were present in 26.3% of patients. Strangulation, obstruction and incarceration were present in 46.5%, 42.0% and 11.5% respectively. Morbidity was increased in cases of laparotomy and bowel resection(p=0.000), emergency repair (p<0.001), large hernias (p=0.004) and operations performed by lower rank of surgeon (p=0.001). Bowel resection rate was 28.5%. Overall, morbidity and mortality rates were 47.4% and 8.1% respectively. Mortality was significantly higher in patients with delayed presentation > 24hours (OR:13.42;C.I:6.74-29.44;p=0.001), strangulated cases (OR:3.34;C.I:2.85-11.16;p=0.02), comorbidity (OR:6.72;C.I:10.42-37.55;p=0.01) and advanced age (OR:14.38;C.I:13.46-47.72;p=0.03).

Conclusions: Majority of the patients had voluminous hernias and presented late with attendant high morbidity and mortality. Bowel resection, delayed presentation, advanced age, comorbidity and lower rank of surgeon executing the repair were responsible for high adverse postoperative outcomes.