CHAPTER 2: PROBLEM STATEMENT
Hernia repair is one of the most common operations performed
worldwide. However, the hernia burden in Rwanda remains unknown as does the
outcome of hernia repair surgery in our hospitals.
According to the National Centre for Health Statistics, about
700,000 inguinal hernia repairs are performed each year in the United States.
Surgery for hernias represents a significant social expenditure, particularly
when lost days of work are factored in. Direct annual costs of hernia surgery
alone have been estimated at (2.5 billion dollars). The indirect costs of
hernia surgery are difficult to determine, but clearly add substantially to the
overall costs [4].
In 2000 a prospective descriptive study was conducted at
Mulago National Referral and Teaching Hospital in Kampala Uganda for 12 months
and 208 patients under went surgical repair for groin hernia. There were 195
(93.7%) inguinal hernias of which 159 (81.5%) were indirect inguinal hernias
and 34 (17.4%) were of the direct inguinal variety. Busoga hernias were
diagnosed in only 4 (2.05%) of inguinal hernias. There were only 13 (6.2%)
femoral hernias. The pantaloon hernias were diagnosed in two patients
(1.1%).
One hundred and fifty (76.9%) of the inguinal hernia
presented as emergencies and 45 (23.1%) as elective. Post-operative
complications occurred in 41.8% of the cases. There was one death. (0.48%)
[5].
Femoral hernias are not as common as inguinal hernias. Femoral
hernias account for about 1.2% to 10% of all groin hernias. In British practice
50% of femoral hernias are admitted as emergencies with
strangulation2. In Nigeria, in a 5-year study done at a teaching
hospital, only 5 patients presented with femoral hernias out of a total of 111
groin hernias seen. In a 14-year period Miller, while working in different
parts of Kenya, saw only 3 cases of femoral hernias. He further noted that by
1961, no operation for femoral hernia appeared on the operation lists at
Kenyatta National Hospital in Nairobi[4].
A review of intestinal obstruction at Mulago Hospital between
1958 to 1960 showed that femoral hernias accounted for 12% of the strangulated
hernias. Whereas in Kampala, for every one man with a femoral hernia there are
nine women [5] the male to female ratio is 1.2 to 1 in the West
African Hausa [7] .
Untreated or recurrent groin hernias are responsible for an
incalculable loss of productivity and revenue. Postoperative convalescence also
contributes to absence from the work force.
Currently the epidemiology of groin hernias in Rwanda is not
well understood. This study aimed to evaluate the prevalence and possible
complications following surgery and gather baseline data for further clinical
and basic research on groin hernias in Rwanda. The study was also used to pass
on recommendations to different levels of decision making in government like
the ministry of health, Non-Government organizations, medical and paramedical
staff on better management and possible preventive measures for complications
encountered after groin hernia repair.
2.1 RESEARCH QUESTION AND OBJECTIVES
2.1.1. Research question
What is the prevalence and possible complications following
groin hernia surgery at Kibogora Hospital?
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