Abstract
Background Abdominal wall hernia is a common surgical entity worldwide with groin hernias having
the most common presentation among them. They are a cause of morbidity and mortality
if not addressed in time. A variety of surgical methods are available for the repair
of hernias. The tension-free repair using synthetic mesh has the least recurrence
and is the most accepted.
Aim To describe the surgical burden and clinical profile of abdominal wall hernias as
well as experiences in their management in a rural setup.
Methods This was a retrospective observational study of all the cases of abdominal wall hernias
presenting to various surgical divisions of Mahatma Gandhi Institute of Medical Sciences,
Sevagram, during a two-year period from December 2011 to November 2013. Relevant details
were collected from the hospital information statistics and patient file records and
analysis of obtained data was done.
Result A total of 910 out of 90,056 surgical outpatients (10.10%) seen during this period
had abdominal wall hernias; 816 (89.67%) got operated. A total of 163 (20%) of 816
were operated in an emergency. Groin hernias were the most common 653 (80%), followed
by incisional 82 (10%), umbilical and paraumbilical 41 (5%), epigastric 33 (4%), and
rarer hernias in 8 (1%). Of 816 operations, 24 (2.9%) had recurrent hernias and 83
(10.17%) were pediatric patients. Male to female ratio was 9:1 in adults and 4:1 in
children. The median age among adults was 49 years (range: 14–95 years), and among
the pediatric age group, it was 7 years (range: 3 months–14 years). The majority of
the adult patients were from a low-income group and presented more than 2 years after
symptoms appeared. Comorbid conditions encountered were hypertension in 212 (26%),
diabetes in 155 (19%), chronic airway disorders in 449 (55%), cardiac problems in
163 (20%), obesity in 10 (1.2%), and chronic renal failure and liver disorder in 82
(1%). Predisposing factors in the majority of the patients were chronic cough 449
(55%), prostatic problems in 187 (23%), chronic constipation in 163 (20%), previous
surgeries in 82 (10%), obesity in 10 (1.2%), and ascites in 9 (0.1%). Hernia surgery
was performed laparoscopically in 51 (6.25%) patients. Simultaneous other surgeries
were performed in 130 (16%) patients. Mortality occurred in 2 (0.24%) patients operated
in emergency, and chief morbidity was due to wound infection in 25 (3%) and chronic
pain in 30 (3.9%) patients.
Conclusion Abdominal wall hernias are common clinical entities. Although the pattern of presentation
and management is similar, the challenges faced in a rural setup are due to ignorance,
social inhibitions, and financial restraints, leading to delayed presentations which
increase their morbidity and mortality. Health programs and surveys to increase awareness
in rural areas as well as cutting down on expenses could help these patients.
Keywords
abdominal wall - hernias - hernia surgery - rural setup - India
