Technical aspects of inguino scrotal hernia surgery in developing countries

Area of Science:

• Surgical Techniques
• Hernia Repair
• Global Surgery

Background:

• Inguinoscrotal hernias in low- and middle-income countries (LMICs) present unique challenges due to larger size, chronicity, and limited resources.
• Operative complications in LMICs can have severe consequences, necessitating specialized surgical approaches.
• Existing literature often lacks specific guidance for surgeons operating in austere environments.

Purpose of the Study:

• To describe technical aspects of inguinoscrotal herniorrhaphy for surgeons in LMICs.
• To provide practical guidance for managing challenging hernias in resource-limited settings.
• To emphasize strategies for avoiding and managing complications in this specific patient population.

Main Methods:

• Consensus-based technical considerations from 7 experienced surgeons in LMIC inguinoscrotal hernia repair.
• Detailed operative steps and illustrations tailored for limited-resource settings.
• Inclusion of pre-operative evaluation, anesthetic considerations, and technical guidelines.

Main Results:

• The Lichtenstein repair technique was performed over 1775 times in LMICs by the authors.
• A 5-year follow-up registry study (HerniaMed) on 90 patients showed one recurrence (1.1%).
• Low rates of chronic pain (2.2% at rest, 4.4% with activity) and reintervention (1.1%) were reported.

Conclusions:

• Inguinoscrotal hernias in LMICs are often more complex than those in high-income countries.
• Specific technical adaptations are crucial for improving outcomes and managing complications in LMICs.
• The described techniques aim to optimize care for patients undergoing hernia repair in challenging environments.