Indirect inguinal hernia in Nigerian older children and young adults: is herniorrhaphy necessary?

In many centers in sub-Saharan Africa, adults and children aged over 12 years with indirect inguinal hernias are treated with Bassini's herniorrhaphy with many avoidable complications. The objective of this study was to determine the applicability of herniotomy in patients aged between 12 and 45 years.

A prospective study was carried out on patients aged between 12 and 45 years with indirect inguinal hernias who were treated with herniotomy at the Leadeks Medical Center, Benin City, Nigeria, between January 2002 and December 2007.

A total of 316 patients aged between 12 and 45 years (mean 25 +/- 5.3 years), comprising 305 males and 11 females with a male:female ratio of 27.7:1, had 326 herniotomies, which accounted for 27.5% of pediatric operations during the study period. Two hundred and eighty-three (86.8%) patients had elective while 43 (13.2%) had emergency surgery following features of obstruction and strangulation, with a mean duration of surgery of 30 min (range 20-40 min). All of the patients were operated on day case with a mean observation period of 8 +/- 3.5 h (range 2-24 h), and no significant immediate postoperative complication was recorded. Postoperative pain was extremely statistically significant in those cases that had strangulation before operation (P < 0.0001), but paracetamol was an adequate analgesia. The patients resumed normal duties between 5 and 14 days after repair and have been followed up for 1-5 years, with one (0.3%) patient, who was also being treated for chronic cough, who had recurrence 3 years after operation.

Herniotomy was found to be safe, applicable, beneficial, and cost-effective in this age group, with many advantages over Bassini's herniorrhaphy.