Recurrent inguinal hernia: Epidemiology and outcomes of surgical repair in a resource-limited setting

Abstract

Objective: Worldwide, recurrence after inguinal hernia surgery is the most important reference standard against which hernia  surgeons judge the effectiveness of a repair technique. This study aimed to document some aspects of the epidemiology and the outcomes of surgical repair of recurrent inguinal hernia in our institution.

Design: This was an analytical cross-sectional study carried out from January 2013 to December 2017 .

Setting: Surgery department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.

Subjects: Adult patients with recurrent inguinal hernia aged 16 years and above were included.

Intervention: Mesh and non-mesh repairs

Main outcomes measures: Recurrence, wound infection, length of hospital stay and mortality

Results: There were 81 males and five females giving male:female ratio of 16:1. Majority (62, 72.1 %) of the patients were aged 45 years  and above. Nearly half (41, 47.7%) were either obese or overweight. Sixteen (18.6%) patients presented in emergency; the rest (70, 81.4%) presented electively. Thirty-four (39.5%) patients had comorbidities and 69 (80.2%) received prosthetic mesh implants. Four (4.7%) patients had intestinal resection. The overall postoperative morbidity and mortality rates were 40.7% and 2.3% respectively. The recurrence rate was 2.3%. Obesity (p=0.033), wound infection (p=0.003), prolonged length of hospital stays (p=0.036) and suture-based repair (p=0.048) were independently and significantly associated with hernia recurrence.

Conclusion: Many patients with recurrent inguinal hernia have associated comorbidities. Repair was associated with high postoperative adverse outcomes. The main predictors of recurrence after repair were obesity, wound infection and non-mesh repair method.