Page 111 - International guidelines for groin hernia management

Hernia

KQ28.g What is the best way to educate surgeons in a Africa paint a very different clinical picture. A 1978 study
sustainable manner in LRSs? of rural Ghanaian men estimated that 7.7% had an IH. 203
KQ28.h How can the internet and other technologies be However, a 1969 study showed that the prevalence of IH
used to teach physicians in LRSs? was as high as 30% on Pemba Island in East Africa. 204

Evidence in literature A prospective cohort study compared IHs in Ghana and
KQ28.a What is the epidemiology of inguinal hernia in the UK and revealed that two-thirds of Ghanaian hernias
LRSs? extended into the scrotum. This was the case in only 7% of
IH epidemiology literature is limited, from both the UK IHs. 205 The majority of these were longstanding right-
developed world and particularly from LRSs. IH inci- sided indirect hernias. Ghanaian subjects had an average
dence—measure of probability of IH occurrence in a age of 34 versus 62 years in the UK cohort.
population within a specified time—is difficult to firmly Inguinal hernias, occurring in the young, have a major
establish although it seems unlikely that incidence varies impact on fragile economies. In the Ghanaian study, 64%
much between countries. In contradistinction, IH preva- of subjects experienced daily activity limitations and
lence—population proportion with IH at a given time— 16.3% of these individuals were unable to work.
appears to be significantly higher in countries with poor A truly startling percentage of IH repairs are done on an
healthcare access. 194, 198–202 The assumption is that most emergent basis in sub-Saharan Africa—65% in Ghana,
cases go untreated in resource-poor settings. The discrep- 76% in Uganda, 33% in Sierra Leone and 25% in Nige-
ancy in incidence versus repair rate results in high preva- ria. 200, 206–209 In contrast, 6% of IH repairs are performed
lence. This in turn has a huge economic impact on as emergency in the EU. 210 A 2007 Nigerian study reported
countries least able to shoulder that burden. 197 that 20% of emergent IH repair patients died. 211
A 1996 United Kingdom (UK) study found a lifetime In 2012, data from the National Health and Nutrition
risk of IH repair of 27% for men and 3% for women, an Examination Survey prospective cohort study of IHs were
immense IH disease burden. 186 Data from sub-Saharan used to estimate IH disease burden in Ghana. 199 Per this

123