Adult groin hernia surgery in sub-Saharan Africa: a 20-year systematic review and meta-analysis

Safety and effectiveness of laparoscopic adult groin hernia repair in Africa: a systematic review and meta-analysis

BACKGROUND

Surgery is the recommended treatment of groin hernia, and laparoscopic approach is increasingly accepted due to lower risk of chronic pain. This systematic review aims to evaluate results of laparoscopic groin hernia repair (LGHR) in Africa.

METHODS

We performed a literature search of published studies using electronic databases. Included African articles reported at least one of outcomes after LGHR in adult population. Newcastle-Ottawa Scale was used for quality assessment. A quantitative meta-analysis was performed to estimate the pooled prevalence of the post-operative outcomes.

RESULTS

We included 19 studies from 6 countries which totalized 2329 hernia cases. Mean age was 44.5 years and male patients were predominant (sex-ratio 19.8). The mean operative time was 69.1 min. The pooled prevalence of conversion to open procedure was 2.578% (95% IC: 1.209-4.443). The pooled prevalence of surgical site infection and Hematoma/Seroma was respectively 0.626% (95%IC: 0.332-1.071) and 4.617% (95% IC: 2.990-6.577). The pooled prevalence of recurrence and chronic pain was respectively 2.410% (95% IC: 1.334-3.792) and 3.180% (95% IC: 1.435-5.580). We found that total morbidity for TAPP procedure was higher than TEP procedure (p = 0.0006; OR 1.8443).

CONCLUSION

These results confirm that LGHR is safe and feasible and would be recommended in our African context.

Evaluating the complications of adult groin hernia where there is no hernia registry: a systematic review of Nigerian literature

BACKGROUND

Enumerating the complications of groin hernia repair might help to highlight the need for improvement in the quality of care. This is imperative in a country without a strong post-operative complication surveillance mechanism. Hence, this review aims to determine the complications encountered during the surgical treatment of groin hernias among Nigerian subjects.

METHODS

Databases like Google Scholar, Scopus, and PubMed were searched. Out of the 140 papers found during the search, only 20 were included in this review. Bassini repair was the most common type of hernia repair used, and neither laparoscopic repair nor posterior approach was utilized in any of the patients. Emergency presentations constituted about 18.5% of the cases. Meta-analysis of the studies showed that more prevalent complications were wound/scrotal edema (derived from four studies), surgical site infections (derived from 17 studies), and hematoma (from 19 studies). The rates were 23% (CI 0-46%; I2 = 80.9%), 6% (CI 3-10%; I2 = 87.7%), and 5% (CI 2-8%; I2 = 83.7%), respectively. The rate of complication in giant hernias was higher than the non-giant hernias and was statistically significant [p < 0.05; OR 1.5 (CI 0.9-2.4)]. Although the recurrence rate is low, there was insufficient follow-up of patients.

CONCLUSION

This review has shown that one-fifth of the patients had emergency repair of hernias and giant groin hernias have higher odds of complications after repair compared to normal-sized ones. The most common complication noted was wound/scrotal edema. None of the hernias was repaired with laparoscopy. Perhaps, establishing a registry might improve the detection of late complications in patients who had groin hernia repair.

Feasibility of tension-free repair of inguinal hernia in senile patients under ultrasound-guided local nerve block

The clinical characteristics of open hernia repair under local nerve block guided by ultrasound and epidural anesthesia under daytime surgery mode were compared and analyzed, and the safety, rationality and effectiveness of tension-free repair of inguinal hernia in elderly patients under local nerve block guided by ultrasound were discussed. The clinical data of 200 patients who underwent inguinal hernia day surgery in Liaocheng People's Hospital Affiliated to Shandong First Medical University from January 2022 to October 2022 were retrospectively analyzed, including 150 patients who underwent local anesthesia block surgery and 50 patients who underwent epidural surgery. The visual analog score of the ultrasound local anesthesia group was lower than that of the epidural surgery group at 4 h after operation. The time of getting out of bed and postoperative exhaust were shorter than those of epidural operation group. The recovery rate of unrestricted activity 2 weeks after surgery was higher than that in epidural surgery group (P < 0.05). The incidence of postoperative acute urinary retention between the two groups was lower in local ultrasound anesthesia group, and the difference was statistically significant (P < 0.05). The median follow-up time was 4(1-6) months, and the follow-up rate was 100%. Postoperative complications were seroma, wound infection, chronic pain and recurrence, and there was no statistical significance between the two groups (P > 0.05). No serious complications occurred in both groups. Compared with open epidural surgery, ultrasound-guided local nerve block tension-free day surgery in the elderly has the advantages of less pain, faster recovery, and is safe and feasible.

Assessing knowledge and confidence of surgical residents in inguinal hernia repair using a low-cost synthetic model

PURPOSE

Open repair of groin hernia is an essential skill for the general surgeon. This study aimed to develop a low-cost hernia model based on a validated high-fidelity model and assess its effectiveness in teaching inguinal hernia repair to surgical trainees from many institutions throughout Africa.

METHODS

Using inexpensive, locally available materials, a low-cost hernia model was created. Six models were constructed, and a workshop was conducted for surgical residents. Pre- and post-workshop surveys were administered to assess knowledge, confidence, and understanding. Statistical analyses were performed using paired t tests and the Wilcoxon signed-rank test.

RESULTS

The low-cost hernia model consisted of various readily available materials and cost an average of $5.07. Sixty-eight trainees participated in the workshop, and 59 completed the post-workshop survey. Participants reported a significant increase in confidence for both mesh and non-mesh repairs and an improved understanding of hernia anatomy after the workshop. Trainees scored an average of 5.6 (SD 1.9) out of 10 questions on the pre-workshop quiz and 7.9 (SD 1.4) out of 10 on the post-workshop quiz (p < 0.001), indicating improved knowledge. All trainees supported the use of the model for education.

CONCLUSION

The low-cost hernia model demonstrated its effectiveness in enhancing trainees' understanding of hernia anatomy and increasing their confidence in hernia repair. Integrating low-cost hernia models into training programs can help improve trainees' knowledge and confidence in a safe and affordable environment.