Presentation & Clinical Outcome of Inguinal Hernia in Elderly Adults in 5th Decade or Later: A Prospective Descriptive Study!

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Presentation & Clinical Outcome of Inguinal Hernia in Elderly Adults in 5th Decade or Later: A Prospective Descriptive Study!

Journal Title: New Indian Journal of Surgery - Year 2018, Vol 9, Issue 6

Abstract

Aim: To evaluate the presentation and clinical outcome of inguinal hernias in patients in their fifth decade or later. Objective: To analyze inguinal hernia in the subset of elderly adults with respect to the type of inguinal hernia, type of surgery, postoperative complications and recurrence. Material & Methods: The present study is a two year prospective descriptive study conducted from July 2015 to Jun 2017. 112 elderly adults in the age group of > 50 years of either sex, diagnosed with ‘Inguinal Hernia’ were included in the study. The patients were initially evaluated in the general surgery outpatient department of a tertiary care hospital & then admitted for surgery. Patients who were <50 years or those who were unwilling for surgery were excluded from the study. Elective surgical treatment was offered in the form of Lichteinstein’s tension free mesh hernioplasty or Plug & Patch mesh hernioplasty or laparoscopic TEP (Total Extra-Peritoneal) repair; whereas the patients presenting with direct hernias or both direct & indirect hernia underwent herniorrhaphy also along with mesh hernioplasty. Herniorrhaphy was performed on all complicated inguinal hernias. Polypropylene mesh measuring 15 x 7.5 cm was employed in tension-free mesh hernioplasty and approximation of conjoint tendon & the inguinal ligament was done with 2-0 polypropylene sutures in herniorrhaphy in order to strengthen the weak posterior wall. The follow-up visits were scheduled at three weeks, six weeks, three months and six months postoperatively. Results: Maximum number of patients selected in the study belonged to the age group of 61-70 years with a representation of 42 individuals & a share of 37.5% of the included subjects. The oldest patient in the study population was 84 years old. Males constituted 98.2% of subject population with 1.8% female subjects. The most common presenting complaints of the study population were groin swelling (100%) & associated pain over the swelling (54.46%). 48 (42.8%) patients out of the study population had direct inguinal hernia, 53 (47.3%) had indirect inguinal hernia & 11 (9.82%) patients harbored both direct & indirect inguinal hernias. 101 (90.18%) patients had unilateral inguinal hernia whereas 11 (9.82%) patients had bilateral hernia. 64 (57.14%) patients with unilateral hernias were on the right side & the rest 37 (33.03%) were on the left side. 8 (7.14%) patients in various age groups had complicated inguinal hernia; whereas 6 (5.35%) patients had evidence of recurrent inguinal hernia. 91 (81.25%) patients suffered from associated co-morbid conditions. 85.71% patients with the diagnosis of uncomplicated inguinal hernia could be operated comfortably under spinal anesthesia. Elective Lichteinstein’s tension free mesh hernioplasty was performed on 25 (22.32%) patients, 1 (0.89%) patient with only indirect inguinal hernia underwent Laparoscopic TEP, Plug & patch mesh hernioplasty was performed on 4 (3.57%) patients on elective basis. 74 (66.07%) patients with direct inguinal hernia & both direct + indirect inguinal hernia underwent Herniorrhaphy + Lichteinstein’s tension free mesh hernioplasty. 7 (6.25%) patients with irreducible inguinal hernia underwent Herniorrhaphy + Lichteinstein’s tension free mesh hernioplasty after reduction of the hernia sac & herniotomy. whereas 1 (0.89%) patient with strangulated inguinal hernia underwent resection of the strangulated bowel segment followed by bowel anastomosis & herniorrhaphy. All recurrent inguinal hernias underwent Herniorrhaphy & tension free mesh hernioplasty. The mean hospital stay was 5.57±0.96 days. In the post operative phase, a total of 23 (20.53%) patients were detected with surgical site infection (SSI), 1 (0.89%) patient with strangulated inguinal hernia & with co-existing COPD had ARDS (Acute Respiratory Distress Syndrome) & SSI. 3 (2.67%) patients in the age group of 61-80 years developed scrotal edema. 3 (2.67%) recurrences were observed and there was no peri/postoperative mortality. Conclusion: Inguinal hernia is a relatively common surgical ailment in the elderly adults. The challenge of managing this entity becomes complex in the background of multiple associated co-morbid medical conditions. However, an elderly human shall not be denied surgical treatment of his/her inguinal hernia despite presence of a plethora of associated illnesses. The tension free mesh hernioplasty is a feasible, comfortably safe & cost-effective surgical technique for elderly adult population once a comprehensive pre-operative assessment & optimization of co-morbid conditions is done.

Authors and Affiliations

Susanta Tripathy

Keywords

Inguinal Hernia; Elderly Adults; Herniorrhaphy; Mesh Hernioplasty.

EP ID EP548305
DOI 10.21088/nijs.0976.4747.9618.15
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