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Abstract
BACKGROUND:
Hernia is a very common type abdominal wall complication encountered in surgical practice. Irreducibility, obstruction and strangulation are its commonest complications which usually present as acute emergencies. Emergency repair of obstructed hernias is associated with poor prognosis and a high rate of post operative complications even with better care, improved anaesthetic management and advanced surgical techniques. The aim of study was to determine the various modes of presentation, clinical features, diagnostic and therapeutic strategies and to evaluate the post operative outcome in obstructed hernia surgeries in our setup.
OBJECTIVES:
To study age and sex distribution, location, type, predisposing factors, presentation and duration of illness of obstructed inguinal hernia and to compare between types of repair namely Lichtenstein repair and Modified Bassinis repair and following parameters: post operative complications, morbidity and mortality.
METHODS
53 patients of obstructed inguinal hernia admitted in general surgical wards in the Dept. of General Surgery government General Hospital Guntur for a period of 2 yrs from December 2015 to November 2017 who met both the inclusion and exclusion criteria were studied A prospective clinical study was performed on obstructed inguinal hernia. Type of surgery, clinical presentation, post operative complications analysed and compared with other similar studies with 1 year of follow up done.
RESULTS AND ANALYSIS:
A total of 53 inguinal hernia patients with obstructed inguinal hernia were evaluated during the study period. Majority of the patients were in 5th and 6th decade. Right sided hernias were more common.. Over the period of study only male patients presented with obstructed inguinal hernia.11.32% cases has direct hernia,88.67 % has indirect hernia. Incarceration was the commonest complication seen in92.45 % of case followed by strangulation (7.54%). Strangulation was high in the age group of 63-74 years. Majority of the patients (40%) presented with localized groin pain, vomiting, constipation and abdominal distension. Without exception all patients presented with swelling in the inguino scrotal region, which was tender, and there was no impulse on coughing and 47,16% of patients had cardiorespiratory illness. All of the cases (53 numbers) were operated as emergency procedure. Viable bowel was seen 88.67% of cases. Bowel resection and end-to-end anastomosis was done in all cases of non-viable bowel. The commonest postoperative complication encountered in the study was wound infection (9.43%) and scrotal seroma (9.43%).
In the present study , 75.47% had undergone Lichtenstein repair, 24.53% patients undergone Modified Bassinis repair.26.41% of patients who had undergone Modified Bassinis repair complained of post operative complications. In the present study , 11.42 % of patients who had undergone Lichtenstein repair developed seroma/haematoma and wound infection. Mortality occurred in 3.7 % of cases. There was no evidence of recurrence in any of the operated cases.
INTERPRETATION AND CONCLUSION:
Majority of the patients underwent Lichtenstein repair ( 75.47 %). Most common site of constriction was observed to be at the deep ring (81.13%). The most common content was small bowel followed by omentum (52.8% and35.8 % respectively). Most of the patients did not have any post-operative complications (62.2%). Wound infection and seroma was the most common complication 9.43(%) and mortality was observed in two patients (3.7%) and the causes of death were sepsis and acute respiratory distress syndrome.
