4.2. DISCUSSION
Here the results obtained in our study at Kibogora hospital
are compared with findings from other studies and we draft some conclusions and
recommendations.
A. Prevalence of Groin hernia
in Kibogora Hospital (Department of surgery)
At the end of our study we found
that the total of patients who underwent major surgical interventions in the
department of surgery at Kibogora Hospital from 01/01/2007 to 30/06/2008 i.e.
(in 18 months) was 765 patients of which 121 patients were operated for groin
hernia making a local hospital prevalence for GH 16%. Although the literature
does not prevail a reliable regional or international prevalence for GH, a
study carried out by Karuranga Ernest in March 2007 in Kanombe Military
Hospital came up with a prevalence of 14.7% in 59 cases recorded among a total
of 397 cases involved during the period of 12 months [8]. The
prevalence of Groin hernia is difficult to determine and the possible reasons
for this difficulty being; the inconsistency of data sources used and also lack
of standard differentiation of Groin hernia studies from abdominal wall hernia
in general.
B. Characteristics of patients
according to age
In total this study had a male population of 105 (87%) and
females at 16 (13%) and M: F ratio of 6.5:1. This shows a clear agreement with
the study conducted by Karuranga [8] which came up with a M: F ratio of 6.1:1.
Another study done by Kakande I and Odula P.O about Groin hernia in Mulago
Hospital Kampala also confirmed a male predominance [5]. The female
population in both studies was quite low. This may reflect the role of
increased abdominal pressure commonly seen in male sex especially with
advancing age.
C. Characteristics according to
clinical presentation and type/site of hernia
In Kibogora Hospital (Western province in Rwanda), most
patients 95/121 (79%) presented with uncomplicated reducible hernias, 2/121
(2%) presented as strangulated or obstructed hernias, others 12/121 (10%) and
9/121 (7%) presented as non reducible and incarcerated hernias. Basing on the
type/site of groin hernia our study revealed that most patients had inguinal
hernia i.e. 65/121 (54%), femoral hernia was only seen in 5% of all the cases.
Ohene-Yeboah [9] in Ghana reported that 71% of cases in his study
were inguinal hernias, 10% femoral hernias. In yet another study, by McConkey
[10] from Sierra Leone, had strangulated hernias representing 25% of
all emergency operations. Adesunkanmi in Nigeria, [11] in his study
of 250 consecutive patients, the incarceration rate was 25%, obstructed hernias
were said to represent 26% of all abdominal hernias.
D. Characteristics of patients
according to type of operation
In our study at Kibogora hospital we revealed a high tendency
to practising the Modified Bassini technique during hernia repair making up
68%. Other techniques included Herniotomy 20%, Non specifified repairs 7%,
figure of eight for femoral hernia repair at 3%, Simple closure of defect at
2%. Our study findings were very much consistent with various study findings.
In Karuranga's study at KMH in Kigali [8], Modified Bassini
technique took 52% of cases, followed by Herniotomy 15%. Comparatively to
another study by Odula and Kakande in Mulago Hospital, Kampala Uganda
[5], Modified Bassini technique constituted 68.2% of all cases,
Herniotomy at 16.9%, Simple closure of defect 1%. In all the above studies
Modified Bassini was the mostly employed technique during hernia repair.
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