ADULT ABDOMINAL WALL HERNIA IN IBADAN.

O.O Ayandipo1, O.O Afuwape1, D.O Irabor1 and A.I. Abdurrazzaaq2

  1. Dept. of Surgery, University College Hospital, Ibadan and College of Medicine, Univ. of Ibadan, Nigeria.
  2. Department of Surgery, University College Hospital, Ibadan, Nigeria.

Abstract

Background: Abdominal wall hernias are very common diseases encountered in surgical practice. Groin hernia is the commonest type of abdominal wall hernias. There are several methods of hernia repair but tension-free repair (usually with mesh) offers the least recurrent rate.

Aim: To describe the clinical profile of anterior abdominal wall hernias and our
experience in the surgical management of identified hernias

Methods: The project was a retrospective study of all patients with abdominal wall hernia presenting into surgical divisions of University College Hospital Ibadan during a 6 year period (January 2008 to December 2013). Relevant information was retrieved from their case notes and analysed.

Result: The case records of 1215 (84.7%) patients out of 1435 were retrieved. Elective surgery was done in 981(80.7%) patients while 234 (19.3%) patients had emergency surgery. There were 922 (84.8%) groin hernias and post-operative incisional hernia accounted for 9.1% (111) of the patients. About half (49.1%) of those with incisional hernia were post obstetric and gynaecologic procedure followed by post laparotomy incisional hernias 16 (14%) and others (23.5%). The ratio of inguinal hernia to other types in this study is 3:1. Hollow viscus resection and emergency surgery were predictors of wound infection statistically significant in predicting wound infection (P < 0.001). Peri-operative morbidity/mortality at 28 days post operation was documented in 113 patients (12.1%). One year recurrence rate of groin hernia was 2.1%.

Conclusion: The pattern of presentation and management of anterior wall hernias are still the same compared with the earlier study in this hospital. New modality of treatment should be adopted as the standard choice of care. Abdominal wall hernias are very common clinical presentation. Modified Bassini repair was the preferred method of repair due to its simplicity. Mesh repair is becoming more common in recent time but high cost and initial non-availability of the mesh limit its use in our centre

Keywords: Hernia, Mesh, Bassini, Ibadan

Correspondence:

Dr. O.O. Ayandipo
Department of Surgery,
College of Medicine,
University of Ibadan and
University College Hospital,
Ibadan, Nigeria.
E-mail: yokebukola@yahoo.com

Introduction

Abdominal wall hernia repair accounts, in the average surgical unit, for 15-18% of all surgical procedures1,2. Indeed hernias are a leading cause of morbidity and mortality in various parts of Africa1,3,4,5,6. Approximately 7 in 10 cases of all abdominal wall hernias occur in the groin, thus making inguinal hernias the commonest type of hernia2, 7, 8. Inguinal hernia has an incidence of 175 per 100,000.9, 10 However, only a third of these are repaired surgically.

Although there are several methods of repair, the absence of recurrence is a marker for determining the most ideal method of repair. In this light, mesh repair with well demonstrated low recurrence rates in the current era is now a much favoured method for this surgical procedure.11,12 Laparoscopic mesh repair of hernias, with a lower recurrence rate, is becoming more attractive because of earlier return to normal activities

Challenges in surgical practice in developing countries include delayed clinical presentation of patients10,14 and very inadequate privately-funded health care financing. This necessitates the need to ultimately strike a balance between expensive cutting-edge and an affordable surgical practice. It is also necessary to ensure adequate training for surgical trainees. The overall aim is a repair with a low peri-operative complication profile. This will enable the largely predominant male population15 early return to normal life style and work.

The aim of this study was to describe the clinical profile of anterior abdominal wall hernias and our experience in the surgical management of identified hernias.

MATERIALS AND METHODS
This was a retrospective study conducted at the University College Hospital, Ibadan-a tertiary health institution situated in Ibadan, Nigeria. All cases of adult external abdominal wall hernias seen in the hospital during a 6 year period (January 2008 to December 2013) by the surgical teams were included. Paediatric cases were excluded from this study. We retrieved the case folders of all the adult patients with the clinical diagnosis of an external abdominal wall hernia seen in our surgical services during the study period.

Relevant data including the patients’ socio-demographic information, clinical presentation, anaesthetic and surgical treatments along with outcomes and followup were retrieved from the case records. The data were analysed using the SPSS Version 16.0. The findings were presented using frequency distribution, percentages, range, mean, tables and charts as appropriate. Statistical tests of associations were performed, and an alpha value of <0.05 was deemed significant.