Inguinal Hernia Disease in Africa: A Common but Neglected Surgical Condition

BACKGROUND: Hernia surgery is one of the most frequent procedures done by surgeons – paediatric and general surgeons – in the African continent. OBJECTIVE: To review the surgical literature, on the epidemiology, clinical features, treatment and outcome of inguinal hernia surgery in Africa. DATA SOURCE: The search terms used were groin hernias in Africa, hernia surgery in Africa, inguinal hernias in Africa, hernias in adults and hernias in children in Africa using Medline, Cochrane Central Register of Controlled Trials and EMBASE. SELECTION CRITERIA: All journal articles on inguinal hernias performed in Africa and published in the world journals from 1990–2010 were retrieved. DATA EXTRACTION an‎d ANALYSIS: All articles containing information on inguinal hernias in children and adults were carefully studied for epidemiology, clinical presentation, method of hernia repair, complications (including morbidity and mortality rates) and the future of hernia surgery in Africa. RESULTS: There was an absolute dearth of knowledge of the burden of inguinal hernias in the various communities in Africa, especially, in sub-Saharan Africa. There were non-existent population-based studies in the sub-Saharan context that could inform us about the epidemiology of inguinal hernias and hence estimate the necessity for surgery in Africa. The studies were all clinical in nature and did not reflect the true burden of the disease among Africans. In many of these hospital-based studies, the method of inguinal hernia repair used most was the Bassini repair. Not much was found in the literature about the use of the Lichtenstein tension-free mesh repair of inguinal hernias, the reason being that the mesh was too expensive for the patients to afford. Scarcely, was laparoscopic hernia repair mentioned. CONCLUSION: Based on the clinical studies reviewed, there is a large disease burden of inguinal hernias in Africa. There is, understandably, also a limited surgical capacity to reduce this burden. The authors advocate the formation of an African Hernia Society to partner with corporate and international organisations to make hernias a public health problem and to attempt to determine, using population-based studies, the actual burden of the disease in Africa and then to take modern hernia surgery to most parts of the continent to help reduce the hernia burden, especially its complications.