Evaluation of External Abdominal Wall Hernia Surgery in a Secondary Level Facility in Kumasi, Ghana

Abstract

Aims: We aimed at auditing hernia surgeries performed at a secondary care center and determine the outcome of surgery based on the grade of operating surgeon. Study Design: A single center retrospective study. Place and Duration of Study: Department of Surgery of Ashanti regional Hospital between October 2015 to September 2018. Methodology: We included 259 patients, age ranging between 1 and 84 years, who underwent external hernia surgeries. Information retrieved included patient demographics, type of hernia, duration of hernia, whether hernia was emergency or elective, method of repair, whether surgery was performed by a surgeon or non-surgeon and early post-operative complications. Data was analyzed using PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc SPSS. Bivariate analysis was done to ascertain relationship between complications and operating doctor. Results: A total of 259 hernia surgeries were performed over the study period. There were 186 (71.8 %) males and 73 (28.2 %) females, age range of 1 to 84 years. There were 66 (25.5%) children and 193(74.5%) adults. Children in their first decade were the majority (22.4%) age group followed by adults in their 5th decade (17%).  Inguinal hernia was the most common (75.7%) type of hernia, 49 (18.9%) children and 147(56.6%) adults. There were 32 (12.4%) emergencies. Small bowel (20) was the most common content found in the hernia sac with 6 of them being gangrenous. Hematoma was the most common early complication. The majority (63.7%) of the cases were performed by the general surgeon and (20.1%) by house officers (interns) under supervision. Complications like haematoma, surgical site infection and acute urinary retention were more likely to occur in the non-surgeon operators. There was no statistically significant relation between the grade of operating surgeon and Haematoma (p = 0.28) and surgical site infection (p= 0.76). Conclusion: Hernias are common in children in the first decade and in adults in the 5th decade. With a well-structured training programme non-surgeon physicians can be trained to perform hernia surgeries with relatively low complication.