Determinants of outcome of inguinal herniorrhaphy in Nigerian patients

Abstract

Objective: To determine the clinical, operative and postoperative factors influencing the outcome of inguinal herniorrhaphy for inguinal and iguinoscrotal hernia. A protocol was drafted to carry out a prospective study of all patients who had herniorrhaphy for inguinal or inguinoscrortal hernia within a period of 7 years (February 1995–January 2002). The present study took place in a Teaching Hospital Complex Unit that serves a rural and semiurban Nigerian community.Patients and methods: A total of 425 consecutive patients who had inguinal herniorrhaphy were recruited for the current study. Only adult male and female patients were recruited and operated on either as emergency or elective status. Demographic, clinical, operative and postoperative patterns of the patients were documented and analysed using SPSS 7.5 for Window.Results: There were 391 (92%) male patients and the patients age ranged from 16 to 90 years, with a mean of 51.8 years. Duration of symptoms ranged 1 day−25 years, median of 1 years. There were 169 patients (39.8%) with 175 (37.6%) cases of inguinoscrotal hernia, 256 patients (60.2%) with 290 (62.4%) cases of inguinal hernia and 15 (3.5%) patients presented with recurrent hernia. Emergency operation was carried out in 112 (26%) patients, with a high incidence of scrotal complications, wound failure, mortality and a prolonged period of hospitalization. There were more scrotal complications among the elderly patients, with a high rate of inguinoscrotal hernia and those patients with systemic pathology. Wound infection and wound dehiscence were more common in patients with obstructive uropathy, longer duration of symptoms, inguinoscrotal hernia, presence of other hernia type and such operative findings as sliding hernia. Postoperative hernia recurrence and scrotal complications were associated with a high wound infection rate, while mortality rate was associated with age, hernia incarceration, inguinoscrotal hernia, suboptimal clinical status and operative findings of gangrenous intestinal segment.Conclusion: There were many preoperative, operative and postoperative factors that significantly influence the outcome of inguinal herniorrhaphy at the Teaching Hospital Complex. High postoperative morbidity and mortality were associated with old age, inguinoscrotal hernia and preoperative hernia complications.