ABSTRACT
Background: Hernia is defined as
the protrusion of an organ or part of an organ or any other structure
through the wall of the cavity that normally contains it.
Goal: To determine the prevalence, pattern
and the immediate outcome of groin hernia surgery in Kibogora hospital.
Methodology: This was a retrospective
descriptive study for all patients treated for groin hernias in the period of
18 months from 01/01/2007 to 30/06 2008 at Kibogora hospital in the western
province. Data was collected using a structured data collection form from
patients' clinical files, computerized and analyzed using Epidata and SPSS
computer soft wares. The text was written using Microsoft word. Graphs, tables
and pie charts were drawn with the help of Microsoft excel. Results were
cross-tabulated to examine relationships and association between the variables.
Statistical analysis was performed using Q 2 for test of
association. P value of less than 0.05 was considered significant in all the
statistical tests performed.
Results: The Prevalence of GH in the surgical
department of Kibogora Hospital during the period of study was 121 (16%) among
the total of 765 cases. The Male: Female ratio occurrence was 6:1. In a total
of 121 cases, 105 (87%) were males and only 16 (13%) were females. Modified
Bassini was the most commonly applied technique in Groin Hernia repair (68%),
with spinal anesthesia being predominant (77%). Post-operative complications occurred in 25% of all
the cases and hematoma wound was the predominant (14%), scrotal edema followed
(7%) and wound sepsis came last with only a 4%. The majority of patients (78%)
were discharged in good condition
Conclusion: GH is a public health hazard at
large as revealed by the above results at Kibogora Hospital. Although the
majority of patients operated on for groin hernia are discharged in good
condition some post-operative complications (25%) were revealed, wound hematoma
and scrotal edema at 14% and 7% respectively were the common . Modified Bassini
technique and spinal anesthesia are commonly employed, though in our settings
local anesthesia is highly recommended.
Key words: groin hernia,
post-operative complications, evolution.
CHAPTER 1: INTRODUCTION
Hernia is the protrusion of an organ or part of an organ or
any other structure through the wall of the cavity that normally contains
it. 1,2Hernias (incorrectly known as rupture) are qualified by the
name of the part that protrudes or the area through which protrusion occurs.
Thus, an inguinal hernia, perhaps the most common form, is one that passes
through the abdominal wall in the groin area [1, 2].
There are two main types of groin hernias, inguinal and
femoral hernias.
Groin hernia may be either congenital or acquired. Congenital
hernias are preformed hernial openings caused by incomplete closure of the
abdominal wall (e.g., persistent processus vaginalis), while, in acquired
hernias, the cause is increasing dehiscence of fascial structure with
accompanying loss of abdominal wall strength. They develop typically in
locations where larger blood vessels or the spermatic cord lie, or where
previous incisions were made.
Different factors contribute to the etiology of groin hernias
such as increased intra-abdominal pressure (in pregnancy, heavy lifting,
chronic cough as in COPD, ascites, straining to pass stool, obesity)
[3] .
Symptoms of inguinal hernia may include a lump in the groin
near the thigh; pain in the groin; and, in severe cases, partial or complete
blockage of the intestine.
Blood may be unable to enter or leave the organs in a hernia,
so that they strangulate. This is more likely to happen in a hernia with a
narrow neck. Most strangulated hernias are therefore either inguinal or
femoral, because these hernias have narrow necks and they both require
immediate surgery. The main treatment for inguinal hernia in adults is surgery
to repair the weakness in the posterior wall. This surgery is called
herniorrhaphy. Sometimes the weak area is reinforced with prosthetic mesh. This
operation is called hernioplasty. In children usually the hernia sac is ligated
after reducing the hernia contents. If the protruding intestine becomes twisted
or traps stool, part of the intestine might need to be removed if
strangulated.
Femoral hernia is a variety of groin hernia. It usually
presents as a defect in the fascia transversalis that is exploited by a
peritoneal sac similar to the patent processus vaginalis in an indirect
inguinal hernia exploiting the deep ring in the fascia transversalis of the
posterior wall of the inguinal canal. Femoral hernias are not as common as
inguinal hernias. Femoral hernias are more common in women, usually elderly and
frail. They typically present as a groin lump. They may or may not be
associated with pain. Often, they present with a varying degree of complication
ranging from irreducibility through intestinal obstruction to strangulation of
contained bowel. The incidence of strangulation in femoral hernias is high. A
femoral hernia has often been found to be the cause of unexplained small bowel
obstruction [4].
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