A study of complications of various types of hernias in our institution

Vijayabhasker, V (2014) A study of complications of various types of hernias in our institution. Masters thesis, Chengalpattu Medical College, Chengalpattu.

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Abstract

INTRODUCTION: Inguinal hernia repair is one of the most commonly performed in every general surgery department . In our hospital about 300 to 400 inguinal hernia repairs are performed every year. Majority of the hernia repairs are performed electively and few are done as an emergency procedure. The complications associated with inguinal hernias and the post operative complications are not uncommon. In our study most of the pre-operative complications are associated with long standing hernias and recurrent hernias. Post operative complications like seroma and hematoma commonly occurred in patients with BMI more than 30. Smokers are associated with increased rate complications than the non smoking counterparts. Long standing inguino-scrotal hernias are associated with complications like seroma, funiculitis, orchitis, testicular atrophy. Both pre-operative and postoperative complications are more frequent in indirect inguinal hernias than the direct inguinal hernias. METHODS: A prospective clinical study of 200 inguinal hernia patients are selected randomly was done. They are stratified and followed up for a duration of two years. Their associated co-morbidities and social habits and anthropometry and the associated complication at diagnosis are recorded. The intra-operative complications and the short term complications are recorded. RESULTS: In our study patients with inguinal hernias are grouped into three categories based on the age group. In patients belonging to the < 40 years group 6 patients had direct inguinal hernia, 46 patients had indirect inguinal hernias, 1 patient had recurrent inguinal hernia, 2 patients had bilateral inguinal hernias, 4 patients had pantaloons hernia. In patients belonging to the age group of 40 to 60 years, 27 patients had direct inguinal hernia, 72 patients had indirect inguinal hernia, 5 patients had recurrent inguinal hernia, 4 patients had bilateral inguinal hernia, and 14 patients had pantaloons hernia. In patients belonging to the group > 60 years, 21 patients had direct inguinal hernia 28 patients had indirect inguinal hernias, 6 patients had recurrent inguinal hernias, 8 patients had bilateral hernias, 3 patients had pantaloons hernia. In our study a total of 200 inguinal hernia patients were included. 52 patients (26%) were in the age group of less than 40 years. 99 patients (49.5%) were in the age group of 40 to 60 years. 49 patients (24.5%) of the patients were in the age group of more than 60 years. In our study 54(27%) patients had direct inguinal hernia, 146 (68%) patients had indirect inguinal hernia. 12 (6%) patients had recurrent inguinal hernia. 139 (69.5%) patients had right inguinal hernia and 61 (30.5%) patients had left inguinal hernias, 16 (8%) patients had bilateral inguinal hernia. In our study out of 200 patients 196 (98%) patients were males and 4 (2%) patients were females. out of the 4 female patients 1 (25%) patient had direct inguinal hernia and 3(75%) patients had indirect inguinal hernias, all the female patients had right inguinal hernia (100%). In our study 92 (46%) out of 200 patients presented with symptoms for less than one year, 108 patients (54%) had symptoms for more than one year in our study. 86 patients (43%) had inguinal swelling. 117 patients (58.5%) had inguino scrotal swelling . 67% (37) of the patients with direct hernia had inguinal swelling and 33 % (18) of the patients with direct hernia had inguino scrotal swelling. 34% (49) of the patients with indirect hernias has inguinal swelling. 66% (96) of the patients with indirect inguinal hernias has inguino scrotal hernias. 32% of the patients had BMI 20 – 25. 56% of the patients had BMI 25-30. 12% of the patients had BMI 30 – 35. In our study 32% of the patients are smokers, 27% are alcoholics. 22% are both smoker and alcoholic and 19% of the patients are nonalcoholic and nonsmokers. 18% (36) of the patients had diabetes mellitus. 22% (43) of the patients had systemic hypertension. 14% (28) of the patients had coronary artery heart disease. 26% (52) of the patients had chronic obstructive pulmonary disease. 20% (40)of the patients had benign prostatic hypertrophy. 50% (12) of the pre-operative complications was due to incarceration. 33%(8) of the pre-operative complications was due to obstruction. 17% (4) of the complications was due to strangulation. 17% (4) of the patients are less than 40 years old. 54% (13) of the patients are in the age group of 40 – 60 years. 29% (7) of the complications are in the age group of more than 60 years. 75% (9) of the incarcerated hernia are right inguinal hernia . 25% (3) of the incarcerated hernia are left inguinal hernia . 87.5% (7) of the obstructed hernias are right inguinal hernia. 12.5% (1) of the obstructed inguinal hernia are left inguinal hernia. 75% (3) of the strangulated hernias are right and 25% (1) of the strangulated hernias are left. 58% (14) of the complicated hernias had hernias for more than one year. 42% (10) of the complicated hernias had hernia for less than one year. 83% (10) of the incarcerated hernias had hernia for more than one year. 17% (2) of the incarcerated hernias had hernia for less than one year. 75% (6) of the obstructed hernias had hernia for less than one year, and 25% (2) of the obstructed hernias had hernia for more than one year. 100% (4) of the strangulated hernia patients had hernia for less than one year. 96% (23) of the complicated inguinal hernias are inguino scrotal. 4% (1) of the pre-operative complications had bubonocele. 0.7% (1) of the complications are vas injury. 11% (15) of the complications are vessel injury. 9% (13) of the complications are nerve injury. 8% (11) of the complications are due to urinary retention. 7% (10) of the complications are due to hematoma. 14% (20) of the complications are due to seroma. 6% (8) of the complications are due to wound infection. 16% (22) of the complications are to funiculitis. 1% (2) of the patients are due to orchitis. 3.6% (5) of the complications are due to seroma. 2% (3) of the complications are due to hematoma. 0.7% (1) of the complication are due to infection. 10% (14) of the complications are due to inguinodynia. 19.4% (27) of the complications are due to sensory disturbance. 1.4% (2) of the complications are due to recurrence. Orchitis, testicular atrophy, hydrocele, entero-cutaneous fistula each contribute to 0.7% of the complications each. 9% of the complications are intra operative, 57% of the complications are short term complications. 34% of the complications are long term complications. 71% of the complications occurred in patients with hernia more than one year. 29% of the complications occurred in patients with hernia less than one year. 67% of the complications occurred following repair of inguino scrotal hernias. 33% of the complications occurred following bubonocele repair. 20% (23) of the complications occurred in patients with BMI 20 -25. 58% (80) of the complications occurred in patients with BMI 25 – 30. 22% (31) of the complications occurred in patients with BMI 30 -35. 56% (78) of complications occurred in smokers. 39% (54) of the complications occurred in alcoholic . 26% (36) of the complications occurred in patients who do not smoke or drink. 19% (26) of the complications occurred in patients less than 40 years of age. 49% (68) of the complications occurred in patients who are 40 -60 years of age. 32% (44) of the complications occurred in patients more than 60 years. 59% (81) of the complications occurred in indirect hernias. 31% (43) of the complications occurred in patients with recurrent inguinal hernia. 10% (14) of the complications occurred in patients with direct inguinal hernia. 15% (21) of the complications occurred in patients with diabetes mellitus. 11% (15) of the complications occurred in hypertensive patients. 8% (11) of the complications occurred in patients with coronary artery heart disease. 13% (18) of the complications occurred in patients with chronic obstructive pulmonary disease. 14% (20) of the complications occurred in patients with Benign prostatic hypertrophy. 5% (7) of the complications occurred in patients with other comorbidities. 33% (139) of the complications occurred in patients without any comorbid illness. CONCLUSION: • 31% (62) of the patients developed complications. • Totally 139 complications are reported on follow up of 200 patients for a period of 2 years. • Nerve injury is the most common intra operative complication. • Vascular injury is the 2nd common intra operative complication. • Funiculitis is the most common short term complication in our study. • Funiculitis commonly occurred in patients with inguino- scrotal hernias and in hernias of longer duration. • Seroma is the 2nd common short term complication in our study. • Seroma is common in patients with BMI > 25. • Wound infection is common in diabetic patients and in patients with BMI > 25. • Haemotoma is common in hypertensive patients and in patients with BMI > 25. • Orchitis, nerve injury, vessel injury are common in recurrent inguinal hernias had in patiets with large inguino scrotal hernias. • Chronic groin pain is common in the age group 40- 60 years. • Patients with intra operative nerve injury had post operative sensory disturbances in the groin region. • Smokers had increased incidence of complications than non smokers. • 1% of the patients had inguinal hernia recurrence. • Under weight and smoking are important risk factors in the development of recurrence. • Patients with strangulation or obstruction had hernias for less than one year. • Patients with incarceration had inguinal hernia for more than one year Duration. • Incarceration was the most common pre operative complication. • 12% of the patients had pre operative complications. • Incarceration is the most common pre operative complication. • Right inguinal hernias contribute to 80 % of all pre operative complications. • 96 %of the pre operative complications occurred in inguino sctotal hernias. • Incarcerated hernias commonly occurred in patients with chronic cough and Benigh Prostratic Hypertrophy with significant urinary tract obstruction. • Pre operative complications commonly occurred in patients in the age group of 40 to 60 years.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Inguinal hernia ; body mass index ; seroma ; hematoma ; orchitis ; funiculitis ; testicular atrophy.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 06 Jul 2018 16:25
Last Modified: 07 Jul 2018 17:12
URI: http://repository-tnmgrmu.ac.in/id/eprint/8669

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