Retrospective audit of laparoscopic inguinal hernia repair at a South African tertiary academic hospital

Abstract

Background: Adoption of laparoscopic inguinal hernia repair (LIHR) in sub-Saharan Africa is poor. The aim of this study was to describe our experience of  the feasibility and short-term efficacy of the LIHR service at a South African tertiary academic hospital.

Methods: A retrospective audit of all the adult, elective, laparoscopic inguinal hernia cases that were done between November 2011 and 31 October  2016. Data were collected regarding the patient demographics, index side of hernia, type of repair, conversion rate, peri- and postoperative  complications, postoperative hernia recurrence, persistent groin pain for more than three months and procedure-related mortality.

Results: One hundred and eighty-six patients were evaluated. One hundred and twenty-six (68%) patients were followed up for a mean of 38 months (3.1  years; range 9–67 months). Sixty (32%) patients were lost to follow-up. Early hernia recurrence (onset in < 7 days) occurred in one case after a totally  extra-peritoneal (TEP) repair had required conversion to a trans-abdominal pre-peritoneal (TAPP) repair. Late recurrence (onset in > 7 days) occurred in  seven TEP repair cases (5.6%). Four recurrences (57%) occurred within the first two years. Recurrences in the next three years showed a 59% reduction  giving a recurrence rate of 2.9%. At follow-up, six TEP cases (4.8%) had persistent groin pain persisting for 3–6 months in two cases and for more than  one year in four cases. Five cases had seroma, six scrotal haematoma and one port-site sepsis. No death occurred.

Conclusion: LIHR could be safely  offered in a South African tertiary academic centre with acceptable results that are comparable with the South African private sector setting. LIHR could  be implemented in other surgical training centres within a resource-limited environment.