Inguinal herniorrhaphy in the elderly in a low resource setting- A multicentre prospective study

Abstract

Objectives: Generally, the incidence of inguinal hernias is high in the elderly as a result of progressive musculo-aponeurotic weakness and numerous causes of increase in intraabdominal pressure like bladder outlet obstruction, chronic obstructive pulmonary disease, obesity and intra-abdominal tumors. The purpose of this study is to evaluate the prognostic indicators of outcomes after surgical repair of inguinal hernias in the elderly. Materials and Methods: A prospective multicenter study between January 2013 to December 2017 was done. Elderly patients (both elective and emergency cases) with inguinal hernias treated surgically within the study period formed the study population. Moribund patients and those with advanced malignancy were excluded.

Results: There were 86 patients presented as emergency cases while 262 patients were elective cases. Of the emergency group, 59 (68.6%) presented with strangulation, 21 (24.4%) had obstruction while six (7.0%) had incarceration. Fifty four of the 86 emergency cases (62.8%) had intestinal resection. Overall, the resection rate for the entire 348 cases was 15.5%. In the emergency group, 12 patients (14.0%) presented within 24hours following onset of acute complications, the rest, 74 patients (84.0%) waited beyond 24 hours before presentation at the emergency unit. In the elective cases, 61 (23.3%) patients received mesh implants. Post-operative morbidity was 83.1% in the emergency arm and 19.5% in the elective group. Similarly, mortality rates were 15.1% and 0.8% for emergency and elective repairs respectively.

Conclusion: Inguinal hernias are common in the elderly population and often coexist with comorbidities. It is clinically gainful when the hernias are repaired electively to avoid the attendant high morbidity and mortality rates associated with emergency operations.