Date of Publication: 30-Nov--0001
National Study on the Surgical Treatment of Inguinal Hernia in Morocco
Author: Imad Marzak, Mohammed Anass Majbar, Kholoud Houssaini, Amine Benkabbou, Amine Souadka, Raouf Mohsine, Mohamed Raiss, Abdelmalek Hrora
Category: JMSR Surgery
Background: Over 20 million inguinal hernia repairs are performed in the world every year. These repairs require the use of various techniques. In Morocco, there is a prominent disparity in terms of types of structure, human assets and available equipment, patient selection, and perioperative management protocols. The goal of this study was to audit the results of the surgical treatment of inguinal hernia repairs in adults in Morocco.
Methods: This nationwide cross-sectional prospective study has been conducted by the Moroccan Society of Surgery (la Soci__ampersandsigneacute;t__ampersandsigneacute; Marocaine de Chirurgie) and the Moroccan Society of Digestive Surgery (la Soci__ampersandsigneacute;t__ampersandsigneacute; Marocaine de Chirurgie Digestive). It included male patients aged 18 and above, with an inguinal hernia that has been clinically diagnosed by a surgeon and repaired during the recruitment phase that extends over a period of 30 days. The measured variables consist of the anesthesia type, preoperative antibiotic treatment, surgical technique, length of in-hospital stay and intraoperative and postoperative complications up to 30 days.
Results: The response rate of the survey was 88.78% which led to the study of 95 cases. 12 patients (12.6%) received general anesthesia , 82 patients (86,3%) regional anesthesia , and 1 patient (1.1%) local anesthesia. No prophylactic antibiotics were prescribed to 14.7% of the patients while they were systematically administered to 84.2% of the patients at the induction, and a few days prior to surgery for one patient. Various approaches were used to repair the inguinal hernia. 83.2% of the patients were operated with the Lichtenstein technique. Laparoscopic transabdominal preperitoneal approach (TAPP) was performed on 11.6% of the patients. Outpatient surgery was performed on 2.1% of the patients. 12 patients developed a postoperative seroma, of which 5 patients were operated using laparoscopic TAPP. Only 2 patients previously operated using the Lichtenstein open mesh repairs have developed a postoperative hematoma. 1 patient (1.1%) died postoperatively.
Conclusion: This study showed disparities in the perioperative management of inguinal hernia in Morocco. Potential improvement opportunities were determined through the conducted nationwide study. In this regard, scholarly societies could play a significant role by programming ongoing training sessions, with the aim of sensitizing surgeons to the best practice of inguinal hernia repair.
Keywords: Inguinal Hernia, laparoscopic Repair, Lichtenstein Repair, Morocco, Surgical Audit
1. Koch A, Edwards A, Haapaniemi S, Nordin P, Kald A. Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg. 2005 Dec;92(12):1553–8.
2. Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996 Aug;25(4):835–9.
3. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1–165.
4. Bay-Nielsen M, Kehlet H. Anaesthesia and post-operative morbidity after elective groin hernia repair: a nation-wide study. Acta Anaesthesiol Scand. 2008 Feb;52(2):169–74.
5. Das D. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair (Br J Surg 2004; 91: 253. Br J Surg. 2004 May;91(5):647.
6. Kehlet H, Kingsnorth A. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair (Br J Surg 2003; 90: 1479-1492). Br J Surg. 2004 Apr;91(4):509.
7. Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg. 2003 Dec;90(12):1479–92.
8. Pisanu A, Podda M, Saba A, Porceddu G, Uccheddu A. Meta-analysis and review of prospective randomized trials comparing laparoscopic and Lichtenstein techniques in recurrent inguinal hernia repair. Hernia. 2015 Jun;19(3):355–66.
9. Farquharson EL. Early ambulation; with special reference to herniorrhaphy as an outpatient procedure. Lancet. 1955 Sep 10;269(6889):517–9.
10.Lau H, Patil NG, Yuen WK. Day-case endoscopic totally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males. Vol. 20, Surgical Endoscopy. 2006. p. 76–81. Available from: http://dx.doi.org/10.1007/s00464-005-0203-9
11.Majholm B, Engbaek J, Bartholdy J, Oerding H, Ahlburg P, Ulrik A-MG, et al. Is day surgery safe? A Danish multicentre study of morbidity after 57,709 day surgery procedures [Internet]. Vol. 56, Acta Anaesthesiologica Scandinavica. 2012. p. 323–31. Available from: http://dx.doi.org/10.1111/j.1399-6576.2011.02631.x
12. Murphy KP, O’Connor OJ, Maher MM. Adult abdominal hernias. AJR Am J Roentgenol. 2014 Jun;202(6):W506–11.
13. Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, et al. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull. 2011 Feb;58(2):C4243.
14.Lorenzini C, Sofia L, Pergolizzi FP, Trovato M. [The value of diagnostic ultrasound for detecting occult inguinal hernia in patients with groin pain]. Chir Ital. 2008 Nov;60(6):813–7.
15.Orchard JW, Read JW, Neophyton J, Garlick D. Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian Rules footballers. Br J Sports Med. 1998 Jun;32(2):134–9.
16.Koie T, Yoneyama T, Kamimura N, Imai A, Okamoto A, Ohyama C. Frequency of postoperative inguinal hernia after endoscope-assisted mini-laparotomy and conventional retropubic radical prostatectomies. Int J Urol. 2008 Mar;15(3):226–9.
17.INCA Trialists Collaboration. Operation compared with watchful waiting in elderly male inguinal hernia patients: a review and data analysis. J Am Coll Surg. 2011 Feb;212(2):251–9.e1–4.