Department of Surgery, University of North Carolina, Chapel Hill, NC, 27599, USA.
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
Hernia. 2021 Oct;25(5):1339-1344. doi: 10.1007/s10029-020-02337-w. Epub 2020 Nov 21.
Inguinal hernias are one of the most common surgical conditions worldwide. Due to limited surgical access in low- and middle-income countries, many hernias present emergently; however, data on the resultant outcome disparities is limited. We, therefore, sought to describe the epidemiology, clinical features, and outcomes of incarcerated inguinal hernias at a tertiary center in Malawi.
This is a retrospective analysis of the acute care surgery registry at Kamuzu Central Hospital in Lilongwe, Malawi. All patients > 13 years admitted with a non-reducible inguinal hernia from 2013 to 2019 were included. The primary outcome was in-hospital mortality. A Poisson multivariable regression determined factors associated with increased risk of mortality.
A total of 297 patients presented with non-reducible inguinal hernias, the majority of which were young (median age 38), male (93.6%), farmers (47.8%). Of the 81% who underwent surgery, 55% were delayed ≥ 24 h. 19.5% of hernias were strangulated. Overall mortality was 5.4%. Increased age (RR 1.06, 95% CI 1.01-1.12), shock index ≥ 1 (RR 4.82, 95% CI 1.45-16.09), and delay ≥ 24 h from presentation to operative intervention (RR 11.24, 95% CI 1.55-81.34) resulted in an increase in relative risk of mortality.
Non-reducible inguinal hernias largely affect young male farmers in Malawi. Delays to care can limit economic productivity for this rural population, as well as, yield considerable risk of mortality. While specific patient and institutional factors must be further elucidated, increased awareness, public health prioritization, and surgical capacity building is needed to reduce further hernia-related morbidity and mortality.
腹股沟疝是全球最常见的外科疾病之一。由于中低收入国家手术途径有限，许多疝会紧急出现；然而，关于由此导致的结果差异的数据有限。因此，我们试图描述马拉维一家三级中心嵌顿性腹股沟疝的流行病学、临床特征和结局。
这是对马拉维利隆圭卡姆祖中央医院急性护理手术登记处的回顾性分析。纳入 2013 年至 2019 年间因不可复性腹股沟疝入院的所有年龄 > 13 岁的患者。主要结局是住院死亡率。泊松多变量回归确定了与死亡率增加相关的因素。
共有 297 例患者出现不可复性腹股沟疝，其中大多数为年轻人（中位年龄 38 岁），男性（93.6%），农民（47.8%）。在接受手术的患者中，有 55%的人延迟了 ≥ 24 小时。19.5%的疝发生绞窄。总死亡率为 5.4%。年龄增加（RR 1.06，95%CI 1.01-1.12）、休克指数 ≥ 1（RR 4.82，95%CI 1.45-16.09）和从就诊到手术干预的延迟 ≥ 24 小时（RR 11.24，95%CI 1.55-81.34）均导致死亡率的相对风险增加。
不可复性腹股沟疝主要影响马拉维的年轻男性农民。医疗延迟会限制这一农村人群的经济生产力，并带来相当大的死亡风险。虽然需要进一步阐明具体的患者和机构因素，但需要提高认识、优先考虑公共卫生和加强手术能力建设，以减少进一步的疝相关发病率和死亡率。
