Groin Hernia Surgery in Northern Ghana - Humanitarian Mission of Polish Surgeons in Tamale
Languages of publication
Availability of surgical care in Africa is severely limited. This is due to the lack of surgeons and a small number of public hospitals. Only 25 out of 100,000 patients with inguinal hernia undergo a surgical treatment. As many as 65% of inguinal hernia repairs are performed urgently because of incarceration. Among patients with incarceration who do not reach the hospital there is recorded as many as 87 deaths per 100 cases. In order to improve the availability of treatment of inguinal hernia in Africa, humanitarian medical missions involving surgeons from Europe are organized. During regular visits to selected centers in Africa, they also carry out intensified treatment of patients and training of the local staff.The aim of the study was to present the experience of Polish surgeons from the humanitarian medical mission in Tamale in northern Ghana undertaken in fall of 2014.Material and methods. Surgical repair was performed in 87 patients (74 men – 85% and 13 women – 15%) between the ages of 26 to 70 years (mean 52.8 years; SD 10.3), who underwent a total of 98 inguinal hernia repairs under local anesthesia.Results. Lichtenstein procedure was performed in 93 and Desarda technique in 5 patients. Patients reported the long-term presence of hernia symptoms - from one to 7 years (mean 3.4 years, SD 1.4). In most patients, hernia occurred more than 3 years earlier (61 patients; 70%). There were no intraoperative complications. All patients were discharged the next day after surgery. There was one wound infection in postoperative period which required mesh explantation.Conclusions. Inguinal hernia commonly found in Ghana is a major issue for the inefficient health care system. Humanitarian medical missions can help to improve the treatment results, as long as they are carried out periodically and allow for training of local personnel. Scarce equipment of medical facilities in Ghana is not a significant difficulty in performing the Lichtenstein repair under the local anesthesia.
1 - 3 - 2015
27 - 11 - 2014
- Department of General Surgery, Hospital in Siedlce1 Kierownik: lek. M. Romańczuk, email@example.com
- Department of General Surgery, Beskid Center of Oncology - Municipal Hospital in Bielsko Biała Kierownik: dr n. med. J. Wróbel
- Department of Pediatric Surgery, Hospital No. 1 in Zabrze, Silesian Medical University in Zabrze Kierownik: dr hab. W. Korlacki
- 1. Dare L, Buch E: The future of health care in Africa. Br Med J 2005; 331: 1-2.
- 2. Lucas AO: Human resources for health in Africa. Br Med J 2005; 331: 1037-38.
- 3. Coombes R: Developed world is robbing African countries of health staff. Br Med J 2005; 330:923.
- 4. Sanders DL, Porter CS, Mitchell KCD et al.: A prospective cohort study comparing the African and European hernia. Hernia 2008; 12: 527-29.[Crossref][WoS][PubMed]
- 5. Ohene-Yeboah M: Strangulated external hernias in Kumansi. West Afr Med J 2003; 22: 310-13.
- 6. Sanders DL, Kingsnorth AN: Operation hernia: humanitarian hernia repairs in Ghana. Hernia 2007; 11: 389-91.[PubMed][Crossref]
- 7. Kingsnorth AN, Oppong C, Akoh J et al.: Operation Hernia to Ghana. Hernia 2006; 10: 376-79.[Crossref]
- 8. Nordberg EM: Incidence and estimated need of caesarean section, inguinal hernia repair and operation for strangulated hernia in rural Africa. Br Med J 1984; 289: 92-93.
- 9. Simons MP, Aufenacker T, Bay-Nielsen M et al.: European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009; 13(4): 343-403.[WoS][Crossref]
- 10. Dietz UA, Winkler MS, Hartel RW et al.: Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia 2014; 18: 19-30.[WoS][PubMed][Crossref]
- 11. http://www.kropp.org.pl
- 12. Shafqat S, Zaidi AKM: Unwanted foreign doctors: what is not being said about the brain drain. J R Soc Med 2005; 98: 492-93.[Crossref]
- 13. Ozgediz D, Galukande M, Mabweijano J et al.: The neglect of the global surgical workforce: experience and evidence from Uganda. World J Surg 2008; 32(6): 1208-15.[Crossref]
- 14. World Health Organization. High level forum on the health MDGs. Addressing Africa's health workforce crisis: an avenue for action. 2004. www.hlfhealthmdgs.org/Documents/AfricasWorkforce-Final.pdf.
- 15. Adetokunbo O: Human resources for health in Africa. Better training and firm national policies might manage the brain drain. BMJ 2005; 331: 1037-38.
- 16. Maki J, Qualls M, White B et al.: Health impact assessment and short-term medical missions: a methods study to evaluate quality of care. BMC Health Serv Res 2008; 8(1): 121.[Crossref][WoS]
- 17. Wang YT, Mehes MM, Naseem HR et al.: Assessing the impact of short-term surgical education on practice: a retrospective study of the introduction of mesh for inguinal hernia repair in sub-Saharan Africa. Hernia 2014; 18: 549-56.[WoS][Crossref]
- 18. Romañczuk M, Mitura K: Valenti method in inguinal hernia repair. New technique or innovative technique? The analysis of early treatment results. Videosurgery 2007; 2(4): 145-49.
- 19. Czyak W, Rybak Z: Modern techniques of fixing of meshes in surgical repair of inguinal and abdominal hernias. Pol Przegl Chir 2014; 86(6): 297-304.
- 20. Mitura K, Romanczuk M: Comparison between two methods of inguinal hernia surgery - Lichtenstein and Desarda. Pol Merkur Lekarski 2008; 24(143): 392-95.
- 21. Kulacoglu H, Ozyaylali I, Yazicioglu D: Factors determining the doses of local anesthetic agents in unilateral inguinal hernia repair. Hernia 2009; 13:511-16.[Crossref][PubMed][WoS]
- 22. Patriquin ML, Steyn M, Loth SR: Metric assessment of race from the pelvis in South Africans. Forensic Sci Int 2002; 127(1-2): 104-13.
- 23. Rabe R, Yacapin CP, Buckley BS et al.: Repeated in vivo inguinal measurements to estimate a single optimal mesh size for inguinal herniorrhaphy. BMC Surg 2012; 12: 19.[PubMed][WoS][Crossref]
- 24. Seker D, Oztuna D, Kulacoglu H et al.: Mesh size in Lichtenstein repair: a systematic review and meta-analysis to determine the importance of mesh size. Hernia 2013; 17: 167-75.[WoS][PubMed][Crossref]
Publication order reference