| Popis: |
In developing nations, abdominal wall hernias constitute a very common cause of considerable morbidity and mortality especially in rural communities. In many communities across Africa, the shift towards elective repair is far from desired and many cases still present late with complications. This study aimed to determine the severity, morbidity and mortality of abdominal wall hernias and outcomes of surgical repair in rural Southeast Nigeria. It was a cross-sectional study of adult patients surgically treated for abdominal wall hernia in rural southeast Nigeria between June 2015 to May 2018. A total of 794 patients were recruited; 629 (79.2%) had uncomplicated hernias while 165 (20.8%) presented acutely. Inguinal hernias comprised 76.1% of the hernias, followed by umbilical hernia (8.1%). Patients with Inguino-scrotal / inguino-labial hernia represent 64.2% of all cases. Over a quarter (189, 23.8%) had comorbidities, 13.6% harbored recurrent hernias while 53.7% had hernias with defect sizes 5cm or more. Morbidity rates were 40.0% in emergency repairs, 40.4% in the elderly and 31.2% in those with comorbidities. The major determinants of morbidity were emergency presentation (p=0.000), advancing age (p=0.000), procedures performed by lower rank of surgeon (p=0.000), extent of hernia (p=0.029) and voluminous sizes (p=0.000). Overall, mortality rate was 2.0%, but 8.5% in those with emergency presentation. The independent predictors of mortality were intestinal resection (p=0.000) and comorbidities (p=0.002). A surgeon in the rural setting encounters high proportion of complex hernias and patients often present in emergency with coexisting medical diseases leading to high morbidity and mortality rates |
