Inguinal Mesh Hernia Repair (MHR) In Sierra Leone (SL): Early Results Suggest Headroom For Antibiotic Stewardship

GASOC International Conference 2025
ABSTRACT FIRST PRESENTED: 24.10.2025

doi: 10.52648/GASOC.1006_314

Inguinal Mesh Hernia Repair (MHR) In Sierra Leone (SL): Early Results Suggest Headroom For Antibiotic Stewardship

Anthony A Kamara, Abdul Sesay, Mark Szymankiewicz, Lesley M Hunt
Partners in Health Koidu Government Hospital and SWIFTSS, Koidu, Sierra Leone; City Garden Clinic, Makeni, 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 routinely prepare and use mesh.

Aim:Review antibiotic prophylaxis for MHR in SL

Method: Koidu Government Hospital (KGH), Hatfield Archer Memorial Hospital (HAM) and City Garden Clinic (CG) use SWIFTSS mesh. Prospectively recording outcomes on e-registry. Inguinal MHRs June 2023 – June 2025: KGH 121, HAM 18, CG 50.

Results: Complete early follow up (FU) all hernia types KGH: first 61 patients 100%, subsequent patients 29%; Complications still registered. Complication rate static: 3 of 61 (5%) and 4 of 84 (5%) respectively. CG FU: first 30 patients 93%, subsequent 10% (upload issue) HAM: inadequate data. All KGH + 30 CG MHRs suitable for analysis. 151 inguinal MHRs: 120 primary, 27 recurrent and 4 re-recurrent.

All patients received IV antibiotic pre-surgery. Diverse additional prophylaxis: no additional doses 26 (17%); 24 hrs 9 (6%); 48 hrs 78 (52%); 72 hrs 38 (25%). CG reduced antibiotic use over time. KGH no clear pattern. No SSIs were recorded after 120 primary MHRs. Wound infections recorded after 3 recurrent/ re-recurrent MHRs (10%). No mesh infections occurred.

Conclusion: SSI rates appear in line with published data from high-income countries. Preliminary data suggests, with quality surgery, additional antibiotic doses maybe unnecessary after MHR for uncomplicated primary inguinal hernia. Further study required for optimum prophylaxis in SL.
Ethical approval not required. All patients provided written / fingerprint consent for MHR and data collection. Photographic consent as required

Keywords: hernia, mesh, antibiotic, prophylaxis

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