Abdominal Wall Hernias: An Epidemiological Profile and Surgical Experience from a Rural Medical College in Central India

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.

Ventral hernia repair in India: a Delphi consensus

“…Preferred approach in a patient with symptomatic hernia, BMI > 40 kg/m 2 In an algorithm that was published in 2020, the recommendation suggested if there is an abdominal or an incisional hernia, for symptomatic cases and all defect sizes, a hernia repair should be followed by bariatric surgery. If the hernia is < 4 cm (W1) and asymptomatic, then concomitant bariatric surgery should be done with hernia repair.…”

“…The prevalence of abdominal wall hernias is 1.7% for all ages and 4% for those over 45 years, making them a relatively common condition. Worldwide, an estimated 20 million patients with hernias are treated each year [2]. A ventral (abdominal wall) hernia is surgically repaired.…”

“…Thus, standardizing the practice of LVHR is the need of the hour. A panel of experts assembled (1) To support and enhance the decision-making process for laparoscopic VHR; (2), to drive a consensus and standardize the practice of laparoscopic VHR; and (3) to identify limitations and unmet needs that affect optimal safety and clinical outcomes.…”

Anatomical and Surgical Principles of Ventral Hernia Repairs

“…Of note, the vast majority of the umbilical hernia defects that can be seen in infancy, will self-obliterate by the 5th year of age in more than three quarters of the patients [16]. With respect to those hernias arising during adult life, any factor which can increase the intra-abdominal pressure (obesity, ascites, chronic cough, pregnancy, chronic straining due to constipation) or weaken the strength of the anterior abdominal wall (connective tissue diseases, smoking, auto-immune disorders), could be implicated in their pathogenesis [17].…”

Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia.

“…[1][2][3] Patients who have cirrhosis, obesity or multiparous women are the groups most likely to experience PUH. [1][2][3][4] The most popular approach over the past century for the resolution of PUH has been herniorrhaphy with simple suture or Mayo's repair (vest over pants). 5 However, numerous retrospective studies have shown that these procedures have an abnormally high recurrence (10-30%).…”