Concurrent hydrocelectomy during inguinal herniorrhaphy is a risk factor for complications and reoperation: data from rural Haiti.

Abstract

Series of conventional inguinal herniorrhaphy from low and middle income countries (LMICs) suggest elevated rates of morbidity, mortality, and recurrence, although the reasons remain incompletely understood. We sought to identify risk factors for adverse outcomes from inguinal herniorrhaphy performed in a resource-limited LMIC setting. We performed mesh-free modified Bassini inguinal herniorrhaphies on 141 consecutive patients with 156 inguinal hernias over 10 months in rural Haiti. We prospectively followed these patients for complications. No intraoperative or perioperative deaths occurred. Follow-up was poor, with 20 patients (14%) returning after discharge. 14 complications were identified in 11 patients, yielding an identified complication rate per herniorrhaphy of 9%. Five complications required reoperation, for an overall reoperative complication rate per herniorrhaphy of 3%. Reoperative complications included one postoperative hemorrhage, one persistent painful cord mass, and three infected hematomas or seromas. On univariate analysis, trends towards complication and need for reoperation were noted with concurrent repair of an ipsilateral hydrocele (OR 4.5, p=0.300, for complication; OR 9.0, p=0.115, for reoperative complication). In rural Haiti, we found that adding ipsilateral hydrocele repair to inguinal herniorrhaphy may elevate the risk of both complications and need for reoperation. This previously unreported association is of high relevance to surgical practice across tropical LMICs, where concurrent inguinal hernia and hydrocele is common.