Strangulated External Hernias in Kumasi

Background: In our hospital, Komfo Anokye, Kumasi theatre records show that more than 65 per cent of hernia repairs are performed for strangulation. The low level of elective repair may be linked to poverty, ignorance and fear, factors commonly found in a rapidly expanding young city like Kumasi with ever increasing population. This paper highlights the morbidity and mortality associated with surgery for strangulated external hernias.

Method: The details of consecutive adult patients admitted to our emergency ward with a diagnosis of strangulated hernia were recorded. In addition the mode of presentation, hernia type, treatment and the outcome were recorded for each case.

Results: Out of 120 strangulated external hernias 76 were indirect, 6 recurrent and 4 direct a total of 86 (71.7%) inguinal hernias. Strangulated femoral hernias were diagnosed in 12 (10 percent)) of the cases. These were all females. Other hernias included 13 (10.8%) para-umbilical and 9 (7.5%) of incisional hernias. Strangulation occurred in more men (80) than women (40) and 75% of these patients were aged 50 years or below. The most common physical sign for the diagnosis of strangulation was a tender lump at a previous hernia site. One hundred and seventeen patients were operated upon with an over all bowel resection rate of 24.1%. The over-all mortality was 11.8%. For the inguinal hernias, mortality was lower at 6.2% but higher for the incisional hernia at 33%. Apart from hernia type delayed operation after 72 hours increased the need for bowel resection.

Conclusion: The significant and unacceptable morbidity and mortality associated with surgery for strangulated hernias may be avoided by advocating for mass elective repair of these hernias before strangulation occurred.