Early Outcome of Ambulatory Hernia Surgery in a Low-resource Setting: Experience from a Voluntary Surgical Outreach Program

Abstract

Abstract Background: Progress in hernia surgery in Nigeria is hampered by poor health-seeking behavior, poverty, and ignorance. The disparity in the quality of health care deliveries between urban and rural areas led to the greater proportions of rural dwellers being grossly underserved. Medical aid programs offer ample opportunities to reduce the burden of hernias in Nigeria. This study aimed to analyze the early outcomes of elective hernia repairs performed during medical outreach programs. Methods: This is a retrospective study of 186 patients who had hernia repair between September and November 2019. Patients were recruited from six consecutive medical aid programs held in Niger Delta (Southern) region of Nigeria. Results: Overall, 186 patients were evaluated: 159 (855%) males and 27 (14.5%) females. Approximately three-fourths (141, 75.8%) harbored inguinal hernia. Nylon-darn was utilized to repair all inguinal hernias while a simple closure technique was used for all midline hernias. Majority (180, 96.8%) were discharged within 24 h of repair. Spinal anesthesia accounted for 51.6% of all anesthetic techniques used. The overall postoperative complication rate was 17.2%. The most common postoperative morbidity was scrotal edema (8.1%) followed by seroma (4.3%). Age >64 years ( P < 0.001), large hernias >3 cm defect ( P < 0.001), lower cadre of surgeon ( P < 0.001), local anesthesia ( P < 0.001) and comorbidity ( P < 0.001) were significantly associated with raised morbidity. No mortality was recorded. All complications were managed conservatively. Conclusion: Majority of the hernias were of inguinal origin. Scrotal edema was the most frequent postoperative complication, followed by seroma. Advanced age, large hernias, lower cadre of surgeon, comorbidity and local anesthesia were associated with raised morbidity rates.