Inguinal Mesh Hernia Repair (MHR) In Sierra Leone (SL): Complication Rates Are Comparable To High Income Settings

GASOC International Conference 2025
ABSTRACT FIRST PRESENTED: 24.10.2025

doi: 10.52648/GASOC.1006_313

Inguinal Mesh Hernia Repair (MHR) In Sierra Leone (SL): Complication Rates Are Comparable To High Income Settings

Anthony A Kamara, Foday D Mansaray, Mark Szymankiewicz, Lesley M Hunt
Partners in Health, Koidu Government Hospital and SWIFTSS, Koidu, Sierra Leone; Partners in Health, Koidu Government Hospital, Koidu, Sierra Leone; Salisbury NHS Foundation Trust. University of Winchester Centre for Global Health, SWIFTSS, Salisbury, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust and SWIFTSS, Sheffield, United Kingdom

Introduction: SL ranks 178th on Human Development Index. Following facility initiation with Surgical teams Working In aFrica Together for Safer Surgery (SWIFTSS) local teams prepare and use mesh on site.

Aim: Assess outcomes after mesh hernia repair (MHR) in a SL government hospital

Method: MHR is the default operation for adult hernia at Koidu Government Hospital (KGH). All cases prospectively recorded on e-registry. All MHRs June 2023 – June 2025 reviewed.

Results: 145 repairs: 121 (83%) inguinal, 16 (11%) umbilical/ventral, 8 (6%) incisional; 107 (74%) primary, 33 (23%) recurrent, 5 (3%) re-recurrent; 101 small/medium, 39 large/very large, 5 massive; 132 uncomplicated,13 incarcerated or obstructed; Anaesthesia: GA 17, spinal 99, LA 29; diathermy available 127 (88%); ♂ 130 (90%); age 17 -78 yrs; Antibiotic prophylaxis 100%; single surgeon (AAK) performed 116 procedures

Complications:

92 primary inguinal: Surgical Site Infection (SSI) 0, seroma 1, urinary retention 1
29 (20%) recurrent and re-recurrent: SSI (wound infection) 3 (10%), mesh infection 0, haematoma 2, seroma 1
24 (17%) ventral / umbilical / incisional: haematoma 2; return to theatre (evacuation of haematoma) 1; seroma 1; ileus 1; delayed wound healing 1

Conclusion: MHR complications at KGH are comparable with high-income settings. The SWIFTSS model places mesh preparation, decision making and surgery all in local hands. Resources providing expatriate hernia camps could be better spent empowering local teams. Local champions are indispensable in establishing and documenting new services.

Keywords: hernia, mesh, outcomes

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