Management of Giant Inguinal Hernia

OBJECTIVES: To determine the frequency and evaluate the clinical presentation and management policies of giant inguinal hernia. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: This study was conducted in the department of surgery at Liaquat University of Medical & health Sciences Jamshoro / Hyderabad and Rajputana Hospital Hyderabad from October 2000 to September 2002 (two years) MATERIAL AND METHODS: Male patients of all ages with giant inguinal hernia diagnosed clinically were included in the study. A uniform system of history taking, physical examination, investigations and treatment was adopted for all patients and information was recorded on predesigned proforma. RESULTS: All 30 patients were male with age ranging from 50 to 70 years. Average age being 54.33+5.62. Most of the patients 60% were farmers by occupation and having right sided giant inguinal hernia. Ninty percent of patients presented as an uncomplicated case with complaints of giant inguinoscrotal swelling causing difficulty in walking, sitting and difficulty in voiding. Only 3 cases (10%) were admitted with features of intestinal obstruction. Out of 30 cases, 14 (46.66%) underwent basini repair while 8 (26.66%) underwent repair with mesh and orchidectomy. Right hemicolectomy including resection of half portion of ileum with orchidectomy and mesh repair was done in 8(26.66%) patients. Two patients of 70 years died due to cardiorespiratory failure while one patient died because of renal failure. Clinically maximum number of patients (46.66%) belonged to MHL grade-I while only one patient belonged to MHL grade-IV. Postoperative complications, hematoma in 5 patients(41.6% cases) and wound infection in 4 patients (33.33%) were the most common complications followed by chest infection developed in 3 (10%). Twenty cases (66.66%) had hospital stay of 7 to 9 days while others were discharged late due to postoperative complications. CONCLUSION: The frequency of giant inguinal hernia is more among patients of old age, labour class and from rural areas. It is common in our population because of ignorance of hernia, living in remote areas and unawareness of complications of the disease.