Outcomes of the Management of Giant Inguinoscrotal Hernias in Rural Areas in Cameroon

Abstract

Introduction: Inguinal hernia is one of the most common surgical operations world-wide accounting for 10% - 15% of all surgical procedures. Giant inguinoscrotal hernias (GISH) have been defined as those that extend below the midpoint of the inner thigh when the patient is in the standing position. Its management represents a challenge due to the risk of developing abdominal compartment syndrome (ACS). This study is set out to describe the experience of ASCOVIME in the management of GISH in the rural areas of Cameroon. Materials and Methods: We conducted a descriptive cross-sectional study in the rural areas of the ten regions of Cameroon within 13 years (February 2011 to August 2024). Sampling included patients operated for GISH. The patients were recruited during ASCOVIME health campaigns and operated in a local health centre/district hospital by the ASCOVIME team and the local team. Postoperative follow up was done by the local team. Patients were follow up for at least 3 years following the surgery. End points to stop follow up were defined as a recurrence or at least 5 years, whichever occurs first. Results: GISH represented 0.39% of the surgical activities and 0.69% of groin hernias. We included 62 cases with a male predominance; sex ratio 11:1. The average age was 54.7 ± 1.1 [34 - 79] years. Majority of the participants were farmers (66%). Those with the sac between the midthigh and supra-patellar line were the most frequent 30 (48.3%). All declared having an altered quality of life with more than 38 (58%) feeling rejected by their communities. More than half of the participants, 55 (88.7%) had a hernia that was spontaneously or manually reducible. This was a major criterion to determine operability in rural zones to avoid complications. Lichtenstein was the most practised technique 56.5% (35). Bowel resection in 22.6% (14 cases) related to partially reducible or irreducible cases where tough adhesions and oedematous viscera caused inevitable bowel injury during surgery and bleeding with sometimes the need for blood transfusion. We recorded 2 cases (3.2%) of ACS with a case fatality rate of 3.2%. Conclusion: GISH is a reality in our community. It is frequent in rural areas where populations are involved mainly in land ploughing activities. This condition impacts heavily social integration which can go right up to rejection. Its treatment relies on surgery, depending on the reducibility; the corner stone in determining the possibility of surgery in rural areas with minimal risk of complication. Application of appropriate management orientation for the individual patients is the key to successful treatment.