Pattern and early surgical outcomes of inguinal hernia repair in adults at the Moi teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Inguinal hernia is a bulge of the peritoneum through a congenital or acquired defect in the muscular and fascial structures of the anterior abdominal wall. It is at risk of incarceration, strangulation and obstruction. The current gold standard treatment is the open tension free mesh repair but, in most resource, limited African countries the popular treatment is Bassini’s repair. There are limited statistics from Kenya and Africa as a whole for the number of annual hernial repairs, prevalence, demographic patterns, clinical presentation and surgical management outcomes. Objective: To describe pattern and early surgical outcomes of inguinal hernia repairs among adult patients at the Moi Teaching and Referral Hospital (MTRH). Methods: This was a descriptive prospective study employing consecutive sampling. Prior Ethical approval was obtained. Adult patients with inguinal hernia (IH) operated for the first time at MTRH were included. A total of 103 adult patients were studied. Patients were recruited from surgical clinics, wards and accident and emergency department. Their demographic characteristics, clinical presentation, hernia characteristics, repair techniques and short-term surgical outcomes were recorded and patients followed up for one month after discharge. Data was collected using an interviewer administered structured questionnaire. Data analysis was done using STATA version 15. Descriptive statistics such as frequencies and percentages were used for categorical variables while mean, median and interquartile range were used for continuous variables. Results: The age range was 18 to 93 years, a mean of 49.6 years and standard deviation of ±19.6 years. The male to female ratio was 33:1 with majority of patients admitted as emergencies 58(56.3%). The leading signs found in IH complications included irreducibility 58(56.3%), tenderness 50(48.5%) and, abdominal pain 48(46.6%). Majority of the IH at MTRH were irreducible at 56.3%. Among the irreducible IH, 55.2% were strangulated IH surgical repair techniques included open mesh repair (90.3%), laparoscopic mesh repair (3.9%) and tissue repair (5.8%). The overall morbidity and mortality rates were 35.9% and 2.9% respectively. The top three complications were prolonged ileus 9(8.7%), urinary retention 8(7.8%) and seroma formation 6(5.8%). Emergency cases were associated with longer hospital stay (p= <0.0001) and more complications postoperatively (p= <0.001) than elective cases. At one month of follow up, pain was the key parameter assessed. Mild, moderate, and severe pain was reported in 36%, 45% and 19% of patients respectively. Conclusion: Majority of IH cases seen at MTRH presented as incarcerated emergencies in males and were mainly done open mesh repair. The morbidity and mortality rates were 35.9% and 2.9% respectively Recommendation: Community health education on IH should be done to prevent late presentations, complications and poor outcomes.