胃腸および消化器系

抽象的な

Management of Giant Inguinoscrotal Hernia in Resource Limiting Setting

Roger Lebeau, Kouakou Ibrahim Anzoua, Mamadou Traoré, Ismael Leh BI Kalou, Ahou Bernadette N’Dri, Aka Gérard Kakou, Bamourou Diané

Purposes: To describe our experience in the management of giant inguino-scrotal hernia outlining the epidemiological, clinical profil, treatment and outcome after treatment. Methods: A Descriptive and retrospective study was carried out of giant inguino-scrotal hernia seen between 2007 and 2014 at Bouaké teaching hospital in the central part of our country (Côte d’Ivoire) and during free rural medical missions for hernia treatment organized by a non governemental organization. A structured questionnaire was designed including for each patient, socio-demographic data, clinical profil, treatment and outcome after treatment. Results: During the period under study 30 patients with giant inguino-scrotal hernia were taking in charge. The ages of our patients ranged from 15 to 60 years with a mean age of 48.5 years. The duration of symptoms ranged 5 to 25 years with a mean of 10.2 years. Reasons for late presentation were mainly financial constraints (n=11). Hernia was irreducible in four patients. A pre-operative progressive pneumoperitoneum was conducted in those four patients. During operation reduction of the hernia content into the abdominal cavity was impossible in one patient. In this patient a debulking left hemicolectomy with colo-rectal anastomosis was necessary. Hernia repair was conducted in all patients, with Lichtenstein procedure (n=10), Shouldice procedure (n=7) Bassini’s procedure (n=7), Mc Vay’s procedure (n=4) and Stoppa’s procedure (n=2). Abdominal compartment syndrome (ACS) occurred per operatively in three patients. Two of them underwent emergency midline laparotomy followed by an exclusive skin closure and the third patient died on the operating table. In post-operative period scrotal hematoma was found in 12 patients (41.4%), suppuration of the inguinal wound in 3 patients and scrotal seroma in 2 patients. The average length of hospital stay was 4.75 days (3 days to 9 days) and after a mean follow up period of 29.19 months (range 7 months to 53 months), no recurrence was observed.