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.