Clinical and Therapeutic Aspects of Inguinal Hernia in Children in the General Surgery Department of Reference Health Center in Commune I of Bamako Mali

Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of cases and hematoma: 1.7%). The immediate consequences were simple in 96.6% of cases. No cases of recurrence occurred during the 6 months after the intervention. The average cost of care was estimated at 69,743 FCFA.

Comparative Analysis of the Efficacy of Transabdominal Pre-Peritoneal Vs Open Tension-Free Hernia Repair in Treating Inguinal Hernia

Objective:To investigate and analyze the clinical outcomes of inguinal hernia patients treated with transabdominal pre-peritoneal repair(TAPP)versus open tension-free hernia repair.Methods:The study was carried out from January 2021 to August 2023,and a total of 50 inguinal hernia patients were selected for this study.The patients were randomly divided into a study group(n=25)and a control group(n=25)by the numerical table method.The patients in the control group were treated with open tension-free hernia repair,whereas the patients in the study group were treated with TAPP.The surgical and postoperative recovery indexes,complication rates,and recurrence rates of the two groups were compared.Results:There was no significant difference in the operative time and intraoperative blood loss between the two groups(P>0.05),and the postoperative feeding time,time out of bed,and hospitalization time of the study group were shorter than those of the control group(P<0.05);the incidence rate of postoperative complications in the study group was lower than that in the control group(P<0.05);and there was no significant difference in the recurrence rate of the two groups after operation(P>0.05).Conclusion:Compared to open tension-free hernia repair,TAPP offers a shorter postoperative recovery duration and hospitalization time,and reduces the incidence of complications.Therefore,this surgical method should be popularized in the treatment of inguinal hernia.

Omental fibroma combined with right indirect inguinal hernia masquerades as a scrotal tumor: A case report

BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum,inflammation,hydrocele of the tunica vaginalis,and indirect inguinal hernia;scrotal enlargement caused by external tumors of the scrotum is rare.The patient had both a greater omentum tumor and an inguinal hernia,and the tumor protruded into the scrotum through the hernia sac,which is even rarer.Moreover,omental tumors are mostly metastatic,and primary omental fibroma is rare.CASE SUMMARY Here,we report a rare case of a 25-year-old young man with scrotal enlargement and pain for 3 months.Preoperative examination and multidisciplinary discu-ssions considered intra-abdominal tumor displacement and inguinal hernia,and intraoperative exploration confirmed that the greater omentum tumor protruded into the scrotum.Therefore,tumor resection and tension-free inguinal hernia repair were performed.The final diagnosis was benign fibroma of the greater omentum accompanied by an indirect inguinal hernia.CONCLUSION This unusual presentation of a common inguinal hernia disease illustrates the necessity of performing detailed history taking,physical examination,and imaging before surgery.

Inguinal Hernia in Adults: Diagnostic and Therapeutic Aspects at Cs Ref CI Bamako Mali

The inguinal hernia is a very frequent surgical pathology in the world and it represents 95% of the hernias of the groin. This work aimed to determine the frequency of inguinal hernias, describe the clinical and therapeutic aspects of inguinal hernias, describe the morbidity and mortality related to inguinal hernias and evaluate the cost of treatment. Our study was conducted from January 2010 to December 2010 in the general surgery department of the Reference Health Center of Commune I in the district of Bamako. We collected 130 cases of inguinal hernias with a sex ratio of 15.25 in favor of the male sex. The mean age was 48.02 years (standard deviation: 17.53 years). Strangulated inguinal hernias accounted for 4.9% of abdominal surgical emergencies and 14.6% of all operated inguinal hernias. More than half of the patients (82%) were operated under local anesthesia. Clinical signs were marked by painless or irreducibly painful inguinal swelling. The diagnosis was clinical in all patients. Some patients benefited from a minimum blood assessment (rhesus grouping, glycaemia, hemoglobin level and hematocrit). The Shouldice technique was performed in 68% of patients. One case of organ resection was performed, i.e. 0.8% of cases. Morbidity was 4.6% due to wall abscess;0.8% scrotal hematoma type. We have not recorded any recurrence or death.

Simultaneous Management of Inguinal Hernia and Benign Prostatic Hypertrophy in a Single Operation at the Chu D’abeche/Chad

Introduction: Benign prostatic hypertrophy and inguinal hernia are related and frequent pathologies in people over 50 years old. Their incidence is 15% to 25% according to the literature. The occurrence of hernia during benign prostatic hyperplasia is favored by disorders of the lower urinary tract. Simultaneous single-stage treatment of these two pathologies makes it possible to obtain satisfactory results that can reduce the cost of hospital stay and the multiple risk of anesthesia. The aim of our study was to: 1) Report the epidemiological, anatomo-clinical and para-clinical aspects of hernias during benign prostatic hypertrophy;2) Evaluate the feasibility and the results of the combined treatment of inguinal hernia and prostatic adenectomy in a single operation. Patients and Method: This was a retrospective descriptive study over a period of 7 years from March 2014 to February 2021, including patients operated on simultaneously at the University Hospital of Abeche for inguinal hernia and benign prostatic hypertrophy. The variables studied were: age, antecedents, favouring factors, clinical symptomatology, para-clinical elements, treatments and results: Results: 356 patients underwent surgery for benign prostatic hyperplasia, 36 of whom had an associated inguinal hernia. The mean age was 65.5 years, ranging from 50 to 93 years. The main reason for consultation was chronic urinary retention. The average consultation time was 10.2 months. The inguinal hernia was located on the right in 51% of cases and on the left in 18.4%. The mean prostatic volume measured by suprapubic ultrasound was 60.5 ± 25 cc. 14% and 10.2% of patients respectively were found to have struggle bladder and bilateral ureterohydronephrosis. Transvesical suprapubic adenectomy of the prostate was performed in all patients. The Bassini technique was the most commonly used (91%) for hernia repair. The average hospital stay was 7.5 days. Conclusion: Simultaneous treatment of benign prostatic hypertrophy and inguinal hernia reduces the number of hospital admissions in elderly patients, as well as the length of hospital stay.

Utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection

AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.

Repair of a giant inguinoscrotal hernia with herniation of the ileum and sigmoid colon:A case report

BACKGROUND Giant inguinoscrotal hernias are huge inguinal hernias that extend below the midpoint of the inner thigh in the standing posture.Giant inguinoscrotal hernias are rare in developed countries because of their better medical resources and early treatment.However,they can develop in patients who refuse surgery or ignore their condition.Intervention is inevitable because strangulation and organ perforation can occur,leading to peritonitis and sepsis.Common surgical approaches include open abdominal and inguinal approaches or a combination of both.CASE SUMMARY We present the case of a 73-year-old man who visited our emergency department with a huge mass in his left scrotum and septic complications.Abdominal computed tomography revealed a large left inguinoscrotal hernia that contained small bowel loops and the colon.Emergency surgical intervention was performed immediately because intestinal strangulation was highly suspected.The operative repair was performed using a combination of mini-exploratory laparotomy and the inguinal approach.The incarcerated organs,which included the ileum and sigmoid colon,had relatively good intestinal perfusion without perforation or ischemic changes.They were successfully reduced into the abdomen,and bowel resection was not necessary.A tension-free prosthetic mesh was used for the hernia repair.Two weeks after the initial surgery,and with adequate antimicrobial therapy,the patient recovered and was discharged from our hospital.No evidence of hernia relapse was noted during the outpatient follow-up examination 3 mo after surgery.CONCLUSION Emergency surgery involving combined mini-exploratory laparotomy and the inguinal approach should be performed for serious incarcerated giant inguinoscrotal hernias.

Mesh plug erosion into the small intestine after inguinal hernia repair: A case report

BACKGROUND Mesh plug(MP)erosion into the intra-abdominal organs is a rare but serious long-term complication after inguinal hernia repair(IHR),and may lead to aggravation of symptoms if not treated promptly.It is difficult to diagnose MP erosion as there are no obvious specific clinical manifestations,and surgery is often needed for confirmation.In recent years,with the increased understanding of postoperative complications,MP eroding into the intra-abdominal organs has been a cause for concern among surgeons.CASE SUMMARY A 50-year-old man was referred to the Department of General Surgery with the complaint of abdominal pain in the right lower quadrant for 2 d.He had a surgical history of right open IHR and partial thyroidectomy performed 20 years and 15 years ago,respectively.Computed tomography revealed a circinate highdensity image with short segmental thickening of the ileum stuck to the abdominal wall,and no evidence of recurrent inguinal hernia.Laparoscopic abdominal exploration confirmed adhesion of the middle segmental portion of the ileal loop to the right inguinal abdominal wall;the rest of the small intestine was normal.Further exploration revealed migration of the polypropylene MP into the intraperitoneal cavity and formation of granulation tissue around the plug,which eroded the ileum.Partial resection of the ileum,including the MP and end-to-side anastomosis with an anastomat,was performed.CONCLUSION Surgeons should aim to improve their ability to predict patients at high risk for MP erosion after IHR.

Perioperative Local Cooling Reduce Significantly Early Pain after Open Inguinal Hernia Repair:A Prospective Randomized Study

Pain and local complications are the major determinants of outcome after inguinal hernia repair. To evaluate the respective impact of peri-operative cooling of surgical site and usual care after open inguinal hernia repair, we performed a prospective randomized study. Methods: One hundred and eight consecutive patients with primary unilateral inguinal hernia were included the study. Repair was performed by local direct access during ambulatory surgery. The first study group underwent standard pre- and postoperative local care (control group). In the second group (cold compress group), a single-use disposable sterile cold compress was applied on the surgical site for at least 30 minutes before and 2 hours after surgery. Primary endpoints were immediate postoperative pain using a visual analogue scale, and local complications. Secondary endpoints included: analgesic drug consumption, length of hospital stay, delay to return to normal activity and patient satisfaction. Results: There was no difference concerning operative time (36.3 ± 14.0 vs 39.6 ± 7.2 minutes) and early (one-week) complications, although there was a non significant reduced incidence of hematoma and ecchymosis (0/54 versus 4/54) for the cold compress group. Analgesic drug consumption was significantly (p = 0.01) reduced. During the day of surgery and the first postoperative day, the visual analogue scale was significantly lower after cooling. There was a non-significant reduction in length of hospital stay (150 ± 37 versus 210 ± 47 min), and time to return to normal activity was shorter in the cold compress group. Conclusion: For open inguinal hernia repair, immediate pre- and post operative surgical site cooling, targeting a controlled temperature between 12?C and 15?C significantly reduced postoperative pain, analgesic drug consumption and resulted in improved immediate outcomes. This technique is safe, simple, easy to use, inexpensive and well tolerated by the patient.

Evaluation of Ultrasound-guided Genitofemoral Nerve Block Combined with Ilioinguinal/iliohypogastric Nerve Block during Inguinal Hernia Repair in the Elderly

To evaluate the anesthetic effect of ultrasound-guided(USG)ilioinguinal/iliohypogastric nerve(Ⅱ/IHN)block combined with genital branch of genitofemoral nerve(GFN)block in the elderly undergoing inguinal hernia repair,54 old patients(aged 60-96years,ASAⅠ-Ⅲ)with indirect hernia were enrolled and scheduled for unilateral tensiofree herniorrhaphy.Patients were grouped randomly to receive either USGⅡ/IHN plus GFN block(Group G)or USGⅡ/IHN block alone(GroupⅠ).The intraoperative visual analogue scale(VAS)scores were recorded at skin incision,at spermatic cord/round ligament traction and at sac ligation.The resting and dynamic VAS scores were recorded postoperatively.The requirements of extra sedatives and analgesics for intra-and postoperative analgesia were assessed.Occurrence of complications of the block,postoperative nausea and vomiting and femoral nerve palsy was also reported.Both groups showed similar sensory block.When stretching spermatic cord/round ligament,the patients in group G had significantly lower VAS scores than in group.And group G used much fewer adjuvant sedatives and analgesics to achieve adequate anaesthesia.In addition,group G was presented with better intraoperative anaesthesia and lower postoperative dynamic VAS scores at all time points tested.No significant difference was found in the postoperative requirement of rescue medication.Both groups showed no complications related to the block and group G reported no femoral nerve palsy.The addition of GFN block toⅡ/IHN block improves the quality of perioperative anesthesia and analgesia in the elderly and reduces the consumption of extra sedatives and analgesics during the surgery.

Analysis of the Causes of Chronic Pain after Inguinal Hernia Repair without Tension and Its Prevention and Treatment

Purpose: Analyzing the causes of pain after tension-free repair in the inguinal hernia, and propose corresponding treatment strategies. Results: The patients in this group were followed up for 3 - 12 months. A total of 5 patients still had pain relief within 3 months after surgery. Further treatment was needed, and the incidence rate was 5%. Conclusion: Skilled surgical procedures are performed in patients with local anesthesia, and some of the absorbable repair materials can be used. The improved patch fixation and extra peritoneal repair can reduce the pain after inguinal hernia repair without tension.

Giant Hydroureteronephrosis Associated with Ipsilateral Inguinal Hernia and Contralateral Hydronephrosis:a Case Study

GIANT hydronephrosis is a rare urological entity. It was first defined as the presence of more than 1000 mL of fluid in the collecting sys-tem.1 That disease is seen more often in males

Cost effective use of mosquito net mesh in inguinal hernia repair

Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery,divided into the polypropylene mesh(PPM)group and the mosquito net mesh(MNM)group each containing fifty patients.All cases were completed successfully and results revealed no difference in two groups.The results of the present study,in consistent with the published literature,reveal that the cheap indigenous mosquito mesh,which has similar properties of an imported mesh,can be safely used for tension-free inguinal hernia repair in adults.Further trials with a larger number of patients and longer follow-ups are justified and recommended.

Omental mass combined with indirect inguinal hernia leads to a scrotal mass: A case report

BACKGROUND Primary omental tumors are uncommon,and omental fibromas account for 2%of these tumors.Due to the low incidence of omental fibromas and the limited relevant literature,it is challenging for clinicians to make an accurate diagnosis of this condition,especially before surgery.CASE SUMMARY A 30-year-old man was admitted to the hospital because of a left epididymal mass with vague discomfort for more than 1 mo.A physical examination was performed,and the findings showed that the epididymal mass may have entered the abdominal cavity.Pelvic computed tomography was performed in our hospital and revealed a left inguinal hernia with a mass in the hernial contents,and no masses were found in the left epididymis.A traditional inguinal hernia incision was made.Intraoperative hernia contents were found to be of the greater omentum,and a 2.5 cm-diameter mass was found at the distal end of the greater omentum.The scrotum and epididymis did not exhibit other masses.Then,the mass of the greater omentum was excised.Intraoperative frozen pathological examination suggested a spindle cell tumor.The postoperative pathological examination suggested that the mass was an omental angiofibroma.Postoperatively,the patient recovered well and was discharged.Outpatient re-examinations were performed at 1 mo and half a year after the operation and showed no obvious abnormalities.CONCLUSION Due to the low morbidity rate associated with and latent nature of omental tumors,these tumors are difficult to diagnose preoperatively;thorough medical history taking,detailed physical examinations,and necessary imaging auxiliary examinations can help clinicians diagnose and treat these cases.

Indirect inguinal hernia containing portosystemic shunt vessel: A case report

BACKGROUND Inguinal hernia repair is one of the most common general surgical operations worldwide.We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel.CASE SUMMARY We report a 72-year-old man who had a 4 cm×4 cm swelling in the right inguinal region,which disappeared with light manual pressure.Abdominal-pelvic computed tomography(CT)revealed a right inguinal hernia containing an expanded portosystemic shunt vessel,which had been noted for 7 years due to liver cirrhosis.We performed Lichtenstein’s herniorrhaphy and identified the hernia sac as being indirect and the shunt vessel existing in the extraperitoneal cavity through the internal inguinal ring.Then,we found two short branches between the expanded shunt vessel and testicular vein in the middle part of the inguinal canal and cut these branches to allow the shunt vessel to return to the extraperitoneal cavity of the abdomen.The hernia sac was returned as well.We encountered no intraoperative complications.After discharge,groin seroma requiring puncture at the outpatient clinic was observed.CONCLUSION If an inguinal hernia patient has portal hypertension,ultrasound should be used to determine the contents of the hernia.When atypical vessels are visualized,they may be shunt vessels and additional CT is recommended to ensure the selection of an adequate approach for safe hernia repair.

Polypropylene versus Polyester Mesh for Laparoscopic Inguinal Hernia Repair: Short-Term Results of a Comparative Study

Background: Polypropylene meshes are commonly used in laparoscopic inguinal hernia repair, although they may cause complications. In this prospective study, a polyester mesh was compared to a polypropylene mesh. Methods: Transabdominal preperitoneal (TAPP) laparoscopic repair was performed in 160 consecutive male patients suffering from unilateral inguinal hernia. The first 80 cases received a polypropylene mesh (Parietene, Covidien, France), and a polyester mesh (Parietex, Covidien, France) was implanted in the second half of patients. Both groups were comparable with respect to clinical and demographic variables. Patients rated their pain using the visual analogue scale (VAS), and ultrasonography was performed on postoperative days 1 and 3 to measure seroma formation. Results: The duration of surgery and the length of stay were similar in both groups. Postoperative pain, measured on day 1 and 3, was significantly less in patients who had received a polyester mesh as compared to the polypropylene group. The size of local seroma was also significantly reduced in the polyester group. Complication rates were 10% in the polypropylene and 9% in the polyester group and included one early recurrence in each group. Conclusions: Polyester meshes may be useful in TAPP, as this mesh material produces less foreign body reaction with less seroma formation and lower pain levels than conventional polypropylene.

Laparoscopic bilateral inguinal hernia repair: Should it be the preferred technique?

Inguinal hernias are amongst the most common conditions requiring general surgical intervention.For decades,the preferred approach was the open repair.As laparoscopy became more popular and available and more surgeons became familiarized with this modality,laparoscopic inguinal hernia repair became an alternative.The aim of this study is to assess the effectiveness of laparoscopic inguinal repair,with a focus on bilateral inguinal hernias.Initial reports have shown promising clinical outcomes compared to those of conventional repair of bilateral hernias.However,there are only a few studies concerning laparoscopic repair of bilateral hernias.It is yet to be proven that laparoscopy is the“gold standard”in the treatment of bilateral inguinal hernias.So far,the choice of an inguinal hernia repair technique has been up to each surgeon,depending on their expertise and available resources after taking into consideration each patient’s needs.

Ultra-Pro Hernia System for Repair of Primary Complex Inguinal Hernia: Should It Be the Technique of Choice?

Purpose: The introduction of light weight three-dimension meshes into the field of inguinal hernia repair showed excellent outcomes. Ultrapro Hernia System (UHS) is one of these three-dimension meshes that allow reinforcing the pre-peritoneal space with minimal fixation. It improves the patient quality of life with rapid resumption of the daily activities. The aim of this study is to evaluate the short-term outcomes of open mesh repair of primary complex inguinal hernia using UHS mesh. Methods: Between November 2013 and November 2015, seventy five male patients with complex primary inguinal hernia were submitted to open inguinal hernia mesh repair using the UHS. Results: The mean age was 46.1 years. Thirty three patients had inguinoscrotal hernias, 14 with Nyhus type IIIA, 22 with Nyhus type IIIB, & 6 patients had strangulated hernias. The mean operative time was 48 minutes. No operative complications were recorded. Post-operatively, the mean VAS scale on 1 day, 1 week, & 1 month was 3.22, 1.2, & 0.3 respectively. The mean duration of oral analgesics use was 2.1 days. None of the patients reported any chronic pain at 12 months post-operatively. Two cases of superficial wound infection were recorded that were treated by oral antibiotics. No recurrence was reported during a mean follow-up period of 26 months. Conclusion: Inguinal hernia repair using UHS is an effective technique that combines the advantages of the anterior and the pre-peritoneal approaches. It improves the patient’s quality of life with minimal recurrence rates. A larger number of patients with longer follow up periods are needed to increase the validity of our results.

Unusual Contents of Inguinal Hernia Sac. An Approach to Management

Background-Unusual contents of hernia sac are uncommon, but are likely to be encountered by a surgeon in his career due to the frequency of hernia repair. The aim of this study, is to present our experience of unusual contents in inguinal hernia sac, discuss its management and review the relevant literature with regards to others experience. Patients and methods-Retrospective study of 662 patients who underwent inguinal hernia repair over an 8 year period from 2000 to 2008 was carried out. Results-Seven patients presented with unusual contents in inguinal hernia sac;an incidence of 1.05%. Three of them had vermiform appendix, with acute appendicitis (Amyand’s Hernia) noted in one of them. All patients underwent appendicectomy with repair of hernia, with mesh being employed only in patients with normal appendix. In 2 cases urinary bladder had herniated and there was one case each of ovarian cyst and fallopian tube with ovary as its content. In all these patients hernia repair was carried out after carefully reducing the contents. Conclusion-Unusual contents of hernia may pose a surgical dilemma during hernia repair even to an experienced surgeon. Although rare, a hernia may contain vermiform appendix and exceptionally it may be acutely inflamed. Tubal and ovarian herniation in an inguinal hernia may be found in adult and perimenopausal women, though the incidence is reported to be more common in children. Urinary bladder herniation occurs with similar incidence as tubo ovarian hernia;however it requires special attention because of the risk of iatrogenic bladder injury during inguinal dissection. Though appendix as a content is dealt with by appendicectomy followed by hernioplasty, every effort should be made to preserve other organs found in the hernia sac to achieve an uneventful postoperative period.

The Use of Mosquito-Net Cloths as Prosthesis in Inguinal Hernia Repair: An Experience in Southern Sudan

Inguinal hernia is one of the commonest medical problems in Africa and the treatment via open repair is considered as one of the most affordable and secure procedures. In the industrialized countries, the gold standard treatment is represented by placing a prosthesis which is usually a mesh, made of alloplastic material, such as polypropylene. In developing countries, a piece of nylon mosquito-net without insecticide is a cheaper and safe alternative as prosthesis. This study shows the security of implant of nylon mosquito-net in 70 patients, operated on with Lichtenstein’s tension-free technique, and performed in rural hospitals of Southern Sudan. The easy use of analyzed low-cost material and the demonstrated safety of these sterilized prostheses are two important factors that make them excellent solutions in poor and rural areas such as Southern Sudan. Objective: the aim of this article is to demonstrate that prostheses, made of well analyzed low-cost material, can be cost-effective and a valid solution for surgical inguinal hernia repair in both poor and rural developing areas.