Background: The purpose of this study was to describe the etiologic factors and therapeutic modalities of incisional hernias in the department of surgery at the regional hospital of Tenkodogo, in Burkina Faso.
Methods: It is a cross sectional study covering the period from 2010 to 2012. Sampling was comprehensive, including all the patients operated for incisional hernias during this period.
Results: Fifty-four patients were included. Their average age was 22.3 years. There were 35 (64.8%) males and 19 (35.2%) female patients. We counted 28 large-size incisional hernias, 14 medium-size incisional hernias and 12 incisional hernias of small size. The average time from the first surgery to the diagnosis of incisional hernias was 8 months. Generalized acute peritonitis (44.4%) and acute intestinal obstructions (22.2%) were the main indications of initial surgical interventions. Vertical midline incisions have been involved in 37 cases (68.5%). Therapeutically, two surgical techniques have been used: open suture repair and open mesh repair. Forty-two patients (77.8%) were treated by open suture repair. Twelve patients (22.2%) benefited from open mesh repair. Post-operative complications were noted in 2 patients. Nine patients (16.7%) presented a recurrence after 12 months.
Conclusion: In the rural area of Burkina Faso, incisional hernias occur in young patients. Emergencies with abdominal Infections are the main operative indications. Prostheses are relatively high cost and less accessible. The recidivism rate is high.
Incisional hernias constitute one of the most common complications of open abdominal surgery. Their impact varies from 3% to 20% depending on studies [1] [2] . They are responsible for significant morbidity [3] . Several risk factors have been identified. The most frequent are wound infections observed after the first surgery, intra-abdominal hyperpression and failing parietal closing techniques [4] . The treatment of incisional hernias is surgical. Two main surgical techniques are used. The open suture repair is the less costly technique, but it seems to be the origin of a high rate of recidivism [4] [5] . The best technique uses synthetic prostheses [6] [7] . These prostheses are relatively high cost and less accessible in rural Africa. In this environment, there is therefore a major interest for prevention. This study is aimed at identifying the risk factors and describing the therapeutic modalities of incisional hernias in a secondary hospital in Burkina Faso, in order to improve strategies of treatment and prevention.
2. Patients and Methods
This study is aimed at identifying the risk factors and describing the therapeutic modalities of incisional hernias in a secondary hospital in Burkina Faso.
We retrospectively reviewed the medical records of all the patients who underwent surgery for incisional hernia in the general surgery ward of the regional hospital of Tenkodogo (Burkina Faso) between 1 January 2010 and 31 December 2012. We listed the records of all patients operated for incisional hernia during the study period. However, recurrent incisional hernias, post traumatic hernias and records containing incomplete data were excluded from the study. Patients were monitored for 3 years after incisional hernia surgery. For each patient, we collected the epidemiological, clinical, therapeutic and evolutionary data. We also collected data to classify the incisional hernias in conformity with the “European Hernia Society”. This classification distinguishes 3 classes depending on the width of the incisional hernia: small size hernia (less than 5 cm), medium size hernia (5 - 10 cm) and large size hernia (more than 10 cm).
3. Results
A total of 54 patients were included in the study. Their average age was 22.3 years (standard deviation: 11.4 years). We counted 19 female patients (35.2%) and 35 male patients (64.8). Sociodemographic and clinical characteristics of the participants are summarized in Table 1.
The average time from the first surgery to the diagnosis of incisional hernias was 8 months (SD 2.6 months). The incisional hernias were classified according to the criteria of the “European Hernia Society”. This classification is reported in Figure 1.
According to the first surgery, acute generalized peritonitis was involved in 24 cases (44.4%). The distribution of patients according to the indication of the first surgery is reported in Table 2.
Regarding the type of incision of the first surgery, vertical midline incisions were the most providers of incisional hernias with 37 cases (68.5%). The distribution of patients according to the type of initial incision in the first surgery is reported in Table 3.
Sociodemographic and clinical characteristics of patients
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