INGUINAL HERNUIA
Inguinal hernia is the protrusion which occurs when a piece of the intestine or part of a membrane lining the abdominal cavity bulges through a weak spot in the abdominal muscles of the groin. This could be a serious health problem and so should be prevented. Males and females and even children suffer this health condition where they undergo a simple surgical procedure of hernia repair. Smokers, farmers and people who do strenuous work which require carrying heavy objects and children who were born with weak abdominal wall are at risk of inguinal hernia. Complications of inguinal hernia include: strangulation, incarceration and obstruction
Though there is little data on the prevalence of inguinal hernia, it is thought to be common in Ghana, especially, rural parts of the nation (Ohene-Yeboah et al., 2016). The word hernia is a derivative of the Greek language which suggests a shoot or a bud. Many years ago, it was the Hippocratic School which distinguished hernia from hydrocele with hernia being reducible and hydrocele being transiluminable (Read, 1984). The protrusion of an organ through a muscle or a tissue is simply termed as hernia. Hernia is commonly realized in the regions of the abdomen. This is as a result of a deficiency in the innermost layer of the muscle or tissue. Hernia which occurs in the abdominal regions have specific areas it may occur. Muscular atrophy, surgery or trauma are some of the means by which hernia may be produced (Rao el at., 2015). Hernias can be either acute or chronic in their manifestation.
As mentioned earlier one of the popular types of hernia is called inguinal hernia which occurs as a result of the protrusion of fatty tissues from the abdominal cavity through the inguinal canal or the inner thigh (Chiow et al., 2010). It is on top of chart of types of hernia and mostly affect men (Chiow et al., 2010). It is often associated with aging and stressors on the muscles of the abdominal wall. It has been estimated that inguinal hernia stands at 75% of all types of abdominal hernias with risk level of 27% and 3% in males and females respectively (Kingsnorth et al., 2003). This high prevalence has given it a place in traditional surgical management (Rao et al., 2015).
In estimation, over 20million hernia repairs are performed each year with paediatric inguinal hernia repairs leading the chart, as inguinal hernia is commonly found in infants (Lao et al., 2012). One of the foreseen adverse effects of inguinal hernia if not actively treated is incarcerated hernia and this is a common emergency situations in infants also (Chang, et al., 2016; Van Heurn, et al., 2014). In 2003, reports from USA showed that one in every four men will need hernia repair in a life time with about 800,000 hernia repairs being carried out throughout that year and beyond (Ruhl & Everhart, 2007; Rutkow, 2003).
In a related literature, it was revealed that increase in life expectancy directly can affect the development of inguinal hernia (Zendejas et al., 2013).In choosing the proper remedy for inguinal hernia, assortment of ideal surgical techniques may go a long way to reduce the health care costs of the nation (Bittner & Schwarz, 2012). For the purposes of improving the outcome and reduce adverse effects of inguinal hernia repair, the European Hernia Society (EHS), the International Endohernia Society (IEHS), and the European Association for Endoscopic Surgery (EAES) issued some guidelines (Bittner et al., 2011: Simons et al., 2009). From the time when the historic input of Bassini in 1888 (Bendavid, 1989), more than 100 diverse modus operandi for the repair of inguinal hernia have been detailed, chiefly categorized as, tissue, open, mesh and laparo-endoscopic mesh repair techniques (Köckerling & Simons, 2018). In the Sub-Saharan regions, the clinical and epidemiological evidence of inguinal hernia stands out a little different.
In 1970s, about 7.7% adult men in certain parts of the southern rural parts of Ghana were found to be with inguinal hernia. In certain parts of Ghana, many people with cases of inguinal hernia live and work with them, with no surgical intervention resulting in complications such as immense pain (Kingsnorth et al., 2009; Shillcutt et al., 2010). Mostly, this is as a result of poverty. In Ghana, recent literature has shown that close to two - thirds of inguinal hernias are repaired only under emergency conditions, subsequently resulting in high health cost for patients and health care systems (Beard et al., 2013). One key fact that must be noted is that, in Ghana, almost all the inguinal hernia repairs are performed by medical officers who do not have any professional training in surgery but simply learnt the technique on the field (Beard et al., 2019).
Inguinal hernia is one of the most common types of hernia as there are other forms of hernia in Ghana. If left untreated, inguinal hernia can lead to incarceration, obstruction, or strangulation, resulting in increased morbidity, mortality, and an added burden on the healthcare system (Tabiri et al., 2018). A greater part of those living in Ghana with elective inguinal hernia repair indicated limitations in their daily activities including occupation (Shillcutt et al., 2010).
In the northern part of Ghana, research has shown that most repairs of inguinal hernia are done without the use of mesh (a very important ingredient in surgical repair of inguinal hernia). This is likely the result of high cost of surgery and unavailability (Service, 2015). Although some level of information can be found on inguinal hernia, there is still little research done on the prevalence in Ghana and other parts of Africa (Beard et al., 2013).
Inguinal hernia is a common surgical condition encountered in Ghana, especially rural areas (Beard et al., 2013). To better appreciate hernias, they must be characterized epidemiologically. However, little research has been done on this area to better appreciate the prevalence rate in various parts of Ghana (Tabiri et al., 2018). Research on prevalence will help health professionals understand the seriousness of this condition. A condition as serious as inguinal hernia should be handled by a professional surgeon. Notwithstanding, inguinal hernia repair and other forms of hernia are repaired by medical officers who are not professional surgeons (Beard et al., 2019). In order to draw the attention of Ghana’s health systems and leaders, several researches done on the incidence of inguinal hernia just as this current study must be set out.
One of the commonest surgical conditions mostly found in adult males is inguinal hernia. An estimated percentage of about twenty-five percent of adult males residing in the United States of America are expected in a lifetime to have experienced inguinal hernia (Ruhl & Everhart, 2007). Risk of inguinal hernia for a whole lifetime is around twenty-seven percent for men which is far greater than in women which stands at three percent (Helgstrand et al., 2013).
Apart from the presence of patent processsus vaginalis and altered metabolism of collagen connective tissue and the extracellular matrix which are some risk factors for the development of primary inguinal hernia, intra-abdominal pressure remains one common risk factors for inguinal hernia (Balamaddaiah et al, 2017). Other factors which are associated with patients which are seen as risk factors for the development of inguinal hernia include aging, smoking, male as a gender, diabetes, physical activities and family history ( Halgas et al., 2018; Sørensen et al., 2010).
Very common in men, inguinal hernia is seen to have a direct proportional relationship with aging, mostly being realized through fifty to seventy years (Balamaddaiah & Reddy, 2016; Ravanbakhsh et al., 2015). Another common risk factor of inguinal hernia is obesity. It is actually believed to increase the intra-abdominal pressure which can cause wear and tear (Öberg et al., 2017). Notwithstanding, this assertion still stands as a hypothesis and has not been fully observed to be one of the underlining causes. Finally, in a related study, risk factors for inguinal hernia were seen to be increased abdominal pressure, pre-existing weakness of abdominal muscles, straining during defecation, heavy lifting of weights, obesity and pregnancy (Balamaddaiah & Reddy, 2016).
Written by: Alex Dela Dwomoh
