Ethnicity-related differences in inguinal canal dimensions between African and Caucasian populations and their potential impact on the mesh size for open and laparoscopic groin hernia repair in low-resource countries in Africa - PubMed (original) (raw)

Kryspin Mitura et al. Wideochir Inne Tech Maloinwazyjne. 2018 Mar.

Abstract

Introduction: Access to surgery in Africa is significantly limited. Treatment outcomes in Africa differ significantly compared to those achieved in Europe or the US. Therefore, to popularise tension-free repair, it is essential to determine the economically justified mesh size for the African population.

Aim: To conduct anthropometric evaluation of the inguinal canal in African and European patients to determine its potential consequences for the mesh size for open and laparoscopic hernia repair.

Material and methods: The measurements were made in 44 adult males in Africa (group I) and were compared to measurements in 45 consecutive Caucasian males (group II). The mean age of patients was respectively 48.3 and 51.2 years.

Results: There was no statistically significant difference in the internal ring diameter between groups (2.2 vs. 2.1 cm; p = 0.58). The distance between the pubic tubercle and the inferomedial border of the internal inguinal ring was significantly shorter in group I (3.8 vs. 5.1 cm; p < 0.001). A similar difference was found in the length of transverse arch aponeurosis (2.9 vs. 4.0 cm; p < 0.001). The distance between the pubic tubercle and anterior superior iliac spine in group I was approximately 2 cm shorter on each side (10.0 vs. 11.8 cm; p < 0.001).

Conclusions: The anatomical differences in inguinal dimensions between Central African and European populations support the potential need to adjust the standard size of synthetic mesh used for hernia repair to the needs of local populations. The significantly smaller dimensions of the inguinal canal in African males may allow the use of smaller meshes.

Keywords: Africa; hernia repair; inguinal canal; low-resource country; mesh size.

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Figures

Figure 1

Figure 1

Diagram showing the internal dimensions of the inguinal canal. A – internal ring diameter, B – length of inguinal ligament between public tubercle and medial margin of internal ring, C – length of transverse arch aponeurosis from the public tubercle up to a point at the level of the inferior border of the internal inguinal ring, D – distance between midpoint of inguinal ligament and transverse arch aponeurosis, 1 – pubic tubercle, 2 – spermatic cord

Figure 2

Figure 2

Diagram showing the external dimensions of the pelvis. E – length of inguinal ligament between pubic tubercle and anterior superior iliac spine, F – distance between anterior superior iliac spines (interspinous line), G – distance between midpoint of interspinous line and public symphysis, 1 – pubic tubercle, 3 – anterior superior iliac spine

Figure 3

Figure 3

Diagram showing the relationship between the length of the inguinal ligament and the length of the interspinous line

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References

    1. Dare L, Buch E. The future of health care in Africa. Br Med J. 2005;331:1–2. - PMC - PubMed
    1. Lucas AO. Human resources for health in Africa. Br Med J. 2005;331:1037–8. - PMC - PubMed
    1. Sanders DL, Kingsnorth AN. Operation hernia: humanitarian hernia repairs in Ghana. Hernia. 2007;11:389–91. - PubMed
    1. Kingsnorth AN, Oppong C, Akoh J, et al. Operation hernia to Ghana. Hernia. 2006;10:376–9. - PubMed
    1. Nordberg EM. Incidence and estimated need of caesarean section, inguinal hernia repair and operation for strangulated hernia in rural Africa. Br Med J. 1984;289:92–3. - PMC - PubMed

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