Abdominal wall hernia management in a second level hospital of Senegal: a cross-sectional study

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Introduction: Hernias represent a common pathology worldwide. In low-income settings, there is difficulty in implementing existing guidelines, and a lack of research funding prevents the development of local guidelines. This article aims to describe the current management of abdominal wall hernias in a secondary centre in Senegal. Method: We conducted a cross-sectional study over a six-month period in the surgical department of a second-level centre hospital based in a semi-urban area of Senegal. Results: Among 199 surgeries performed at our centre during this period, hernia repairs accounted for 34.2% of surgical activity. Inguinal hernias accounted for 25.6% and midline ventral hernias for 8.5% of all procedures, with inguinal hernias constituting 75% of the hernias operated on. All inguinal hernias were primary, and 82.3% were primary midline ventral hernias. Procedures performed on an emergency basis were 19.1% of repair. A mesh was used for 51.5% of hernias and tissue repair for 48.5%. Treatment of inguinal hernias was performed under spinal anaesthesia in 90.2% of cases and under general anaesthesia in 9.8% of cases. The treatment techniques used were Lichtenstein in 64.8% of cases, Desarda in 33.3% of cases and Bassini in 2% of cases. Complications included pain at the surgical site in 17.7%, lower urinary tract obstructive disorders in 11.8% including acute urinary retention in 5.9%; headache in 7.8% and spermatic cord induration in 9.8%. Treatment of midline ventral hernias was performed under general anaesthesia in 100% of cases. This involved Primary aponeurotic closure in 88.2% of cases and Onlay repair in 17.7 of cases. Complications included pain at the surgical site in 5.9%, infection at the surgical site in 5.9% and post-operative ileus in 5.9%. Conclusion: The management of abdominal wall hernias has advanced in our region. However, efforts are needed to raise awareness among the population and encourage consultation before complications arise. Complications related to spinal anaesthesia are numerous. Guidelines adapted to Africa need to be developed in order to standardise the treatment and follow-up of patients with abdominal wall hernias.

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