Inguinal Hernias in Adults: Epidemiological, Clinical and Therapeutic Aspects in the City of Douala

Abstract

Background: Inguinal hernia is defined as the subcutaneous passage of a portion of the peritoneum containing abdominal viscera through the inguinal canal or directly through the abdominal wall. Its diagnosis is essentially clinical and strangulation is the most important of complications. Many surgical techniques have been described update. The aim of the present study was to highlight the epidemiological, clinical and therapeutic aspects of inguinal hernias in adults in Douala city. Methodology: we conducted a retrospective study from January 01, 2010 to December 31, 2019. The study concerned medical records of patients aged from 18 and above, who were followed and or operated for inguinal hernia in the surgical wards of five hospitals in Douala city. Files with no content of: age, sex, type of hernia and the therapeutic method used have been excluded in the study. Variables were recorded on data collection sheets. Data were analysed using the software Sphinx plus² version 5.0. Results: One thousand and twenty-four cases answered the inclusion criteria (925 males and 99 females). The mean age was 45.6 years (in-between: 18-94). Labourers category were about 56.4% of the cases (n = 578). 84.0% of cases (n=865) were simple hernia, 7.0% of cases (n=74) were recurrences and 16.0% of cases (n=159) were complications. Strangulation with 85.5% of cases (n=136) was the most common complication. The factors in relation to these complications were the length progression of the hernia and patients professions. The predominant site of the hernia was the right side with 53.9% of cases of simple hernia and 65.2% of cases of complicated hernia. The diagnosis was clinical in 99.0% of cases and ultrasound (10 cases) was the only imaging test used for cases with doubtful diagnosis. Therapeutically the most widely used non-prosthetic treatment was that of Bassini in 47.8% of cases with simple hernias and in 46.7% of cases with complicated hernias. Lichtenstein technique was the most used prosthetic treatment with 90.5% of cases of simple hernias and 100% of cases of complicated hernias. The hernia was mainly through the external oblique in 66.0% of simple hernias and 76.9% of complicated hernias. Bowel resection and anastomosis were performed in 43 (27.0%) patients with intestinal necrosis. Recurrent hernia was mostly treated by the Shouldice technique in 25 cases (33.8%). The mean length of hospital stay was 3 to 4 days. The mortality and morbidity rate were respectively null and 1.4 (n=12) for simple hernias and 6.2 (n=10) for complicated hernias. The factors identified in relation to this morbidity were sex and the length of hospital stay. Conclusion: inguinal hernia was the most common hernia of the abdominal wall (85.4%). It was predominant in the male sex (90.0%) and mostly present on the right side. Bassini surgical repair was the most used operating technique. Prosthetic cures (gold standard of the surgical management) were little or not well practiced in our setting and could be a tool to improve needed results.