Hernia In South Southern Nigeria: Five Year Retrospective Study.

Abstract

Background: Hernia occurs commonly in surgical practice. Common hernia cases include Aims and Objectives: The purpose of this study is to determine the pattern of hernia diseases which were surgically treated in University of Port Harcourt Teaching Hospital. Patients And Methods: This is a 4 year retrospective study of all adult patients with hernia diseases who were admitted into the surgical wards of University of Port Harcourt Teaching Hospital. Relevant data were retrieved and analyzed. Results: A total of 386 patients had hernia between January 2009 to December 2012. In 2009 the highest number of patients were recorded 118 (30.6%). This was followed by 2011 with 106 (27.5%) of patients and subsequently, 2010 and 2012 with 89 (21.8%) and 78 (20.2%) respectively. There was male preponderance, males were 253 (65.5%) and female were 133 (34.5%) with a male to female ratio of 1.9:1. Most of these patients were aged 30-39 years 93 (24.1%) followed by 20-29 years 91 (23.6%), 40-49 years 73 (18.9%), 50-59 years 49 (12.7%), 60-69 years 36 (9.3%), 70-79 years 20 (5.2%), 10-19 years 16 (4.1%), 80-89 years and less than 10 years with 4 (1.0%) each respectively. Most of the cases were done by Senior Registrars 221 (57.3%) then Consultants 105 (27.2%), while Registrars did 60 (15.5%). The hernias were mostly inguinal with reducible right inguinal hernia constituting the highest 121(31.1%), Reducible left inguinal hernias 81 (21.0%), Obstructed right inguinal hernias were 44 (11.4%), incisional hernia were 38 (9.8%), umbilical hernia 27 (7.0%), Bilateral inguinal hernias were 26 (6.7%), epigastric hernias were 25 (6.5%), obstructed supra-umbilical hernias were 9 (2.3%), left femoral hernias were 5 (1.3%), obstructed left femoral and obstructed epigastric were both 4 (1.0%) each and right femoral and bilateral femoral hernias were 1 (0.3%) each respectively. The type of hernia repair done was nylon darn in 313 (81.1%), those requiring both exploratory laparotomy and herniorrhaphy were 36 (9.3%), bilateral herniorrhaphy was done in 15 (3.9%). Mayo's type of repair was done in 9 (2.3%) and repair with mesh was done in 4 (1.0%) as well as in herniotomy. Primary repair in layers was in 3 (0.8%). Herniorrhaphy with orchidectomy was 2 (0.5%). The anaestheia done was mostly sub arachnoid block 297 (76.9%), general anaesthesia was done in 69 (17.9%), local infilteration was 18 (4.7%), total intravenous anaesthesia (TIVA) and field block 1 (0.3%) each. Most of the surgery lasted between 50-99 minutes 214 (55.4%), then followed by less than 50 minutes 78 (20.2%), 100-149 minutes 66 (17.1%), 150-199 minutes 19 (4.9%), 200-249 minutes 4 (1.0%), 250-299 minutes 2 (0.5%), 300-349, 350-399 and greater than 400 minutes with 1 (0.3%) respectively. Conclusion: Hernia in South Southern Nigeria has quite a large magnitude of clinical impact in our environment. The indirect inguinal hernia being the most common with male sex preponderace. Sub-aracnoid block is the most common form of anaesthesia utilized with most herniorrhaphies done by the senior registrars.