Volume 8, Issue 10, October – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Outcome of Surgical Site Infection Following Inguinal

Hernia Closure
1:
Dr. Mukarram Mustajab
MBBS, FCPS General Surgery (Consultant General Surgeon Mardan Medical Complex and Teaching Hospital Mardan).
2:
Dr. Saddam Hussain
MBBS, FCPS General Surgery (Medical Officer Type C Hospital Karak ) .
3:
Dr. Muhammad Ali
MBBS, FCPS General Surgery (Consultant General Surgeon Bacha Khan Medical Complex Sawbi ) .
4:
Dr. Sumayya Sahar
MBBS, FCPS General Surgery ( Medical Officer Surgical B Ward Mardan Medical Complex And Teaching Hospital Mardan)
5:
Dr. Waleed Shaukat
MBBS, FCPS General Surgery ( Medical Officer DHQ Hospital Nowshera)
6:
Dr. Muhammad Ibrahim Shuja
MBBS, FCPS General Surgery ( Assistant Professor General Surgery Gajju Khan Medical College Swabi)
7:
Dr Ammad Ali
MBBS , D-DERMA , Astheitic Medicine (KMU) Asthetic Physician

Corresponding author:
Name: Dr. Muhammad Ali
Designation: Consultant Surgeon

Abstract:- education levels was as follows: 17(14.9 %) with no

Objective: This study's goal is to look into how inguinal education, 46 (40.4%) with SSC-level education and
hernia surgery patients respond to surgical site infections 51(44.7%) with HSSC or higher education. Hospital stays
(SSIs). The purpose of the study is to examine the lasting 1-3 days in 55 (48.2%) of cases and 3-6 days in 59
association between the prevalence of SSIs and (51.8%) of cases, respectively. There were two categories
demographic factors such as age, body mass index (BMI), for operation length: 1-3 months 59(51.8%) and 3-6
habitation type (urban/rural), presence of diabetes mellitus months 55 (48.2%). 22 (19.3%) of cases had surgical site
and hypertension, degree of education, length of hospital infections, while 92 (80.7%) of cases had no infections at
stay, and length of surgery. all.
Methods: Patients who underwent inguinal hernia closure Conclusion: The results of surgical site infections after
surgeries were included in this retrospective analysis, inguinal hernia closure are clarified by this investigation.
which was carried out in a medical facility. A patient's The frequency of SSIs highlights the significance of strict
demographics, BMI, type of habitation, diabetes and infection control procedures. Further investigation is
hypertension status, education level, length of hospital required to determine the association between
stay, length of operation, and presence or absence of demographic factors and the prevalence of SSI. These
surgical site infections were all collected from their findings have implications for post-operative care plans
medical records from feb to aug 2023. To evaluate the and surgical protocols that aim to reduce the risk of SSIs
patient population's characteristics and the prevalence of and improve patient outcomes. To fully comprehend the
SSIs, data analytic techniques included frequency multifactorial nature of SSIs in inguinal hernia closure
distribution and percentage calculation. In order to surgeries, additional study is required.
identify correlations between factors and the occurrence of
SSI, statistical tests were run. Keywords:- Inguinal Hernia, Surgical Site Infection, Diabetes,
Results: The study involved all of the patients. The age Hypertension, Age.
distribution displayed 35.1% in the 20–30 age, 21.1% in
the 40–50 age, and 43.9 % in the 40–50 age. BMI I. INTRODUCTION
categories were revealed with BMIs of 20–23, 23–25, and
25–28. Participants who lived in cities made up 22(29.7%) It is essential to make efforts to find and lower risks for
of the group, whereas participants who lived in rural areas persistent discomfort. Patient-related risk factors for persistent
made up 35.1 %. Diabetes mellitus was more common than pain following inguinal hernia repair include things like young
hypertension 23 (20.2%) vs. 17(14.9%). The distribution of age, female sex, preoperative suffering, substantial pain

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Volume 8, Issue 10, October – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
elsewhere, particular genotypes, and surgery. Open hernia underwent inguinal hernia closure surgeries at Mardan
repair, together with the postulated risk factors of nerve medical complex and teaching hospital mardan from February
handling, mesh material selection, and fixation method1. 2023 to august 2023. Medical records were used to collect
Globally, about 20 million hernia repairs are made each year. patient information, including demographic data, BMI,
The reported lifetime risk for groin hernia surgery is 3% for residence type, presence of diabetes mellitus, presence of
women and 27% for men. Chronic Postoperative Inguinal Pain hypertension, education level, length of hospital stay, length of
(CPIP), which can be prevented with modern surgical operation, and the frequency of SSIs. For the different age
methods, is the most unfavorable result of inguinal hernia ranges (20–30, 30–40, and 40–50), frequencies and
surgery. When pain lasts more than three months, it is percentages were determined. The BMI groups (20-23, 23-25,
considered chronic2. Patients who had experienced severe pain and 25-28) were computed using frequencies and percentages.
during the immediate aftermath of hernia surgery were more For both urban and rural habitation, frequencies and
likely to experience pain in the operated groin or testicles at percentages were estimated. For the presence and absence of
the follow-up 8 years later. Eight years following hernia diabetes mellitus, frequencies and percentages were estimated.
surgery, patients who had reported urinary tract issues were For the presence and absence of hypertension, frequencies and
also more likely to experience pain in the ipsilateral testicles3. percentages were estimated. For those with no education,
Numerous genital issues, including undescended testes, cystic SSC-level education, and HSSC or higher education,
fibrosis, bladder extrophy, increased intra-abdominal pressure, frequencies and percentages were computed. For hospital stay
increased peritoneal fluid, and connective tissue abnormalities, lengths (1-3 days, 3-6 days), frequencies and percentages were
may be exacerbated by an inguinal hernia4. Regardless of the computed. The frequency and percentages for the operation's
approach utilized, the British Association of Day Surgery duration (1-3 months, 3-6 months) were calculated. For the
recommends performing 80% of inguinal hernia repairs as day presence and absence of surgical site infections, frequencies
cases. Primary inguinal hernia repairs (unilateral) were and percentages were computed.
performed as day cases in 77.8% of cases in 2014–15, with
rates varying amongst institutions from 67% to 88%5. 75% of To ascertain the relationships between demographic
abdominal wall hernias are caused by inguinal hernias. The factors and the frequency of SSIs, statistical analyses were
most typical intra-abdominal tissues that cross the fasial defect run. To determine the importance of these correlations,
and are susceptible to imprisonment and strangling are the logistic regression analysis and chi-square testing were used.
omentum and small bowel6. The benefits of minimally Before beginning the investigation, institutional ethics
invasive technologies, such as lowered wound problems, a committee consent was requested. Data security and patient
lower recurrence rate, and a quicker recovery time, are privacy were maintained during the investigation. This study's
particularly valued by patients as well as doctors7. The methodology was designed to thoroughly examine how SSIs
relationship between age, surgical approaches (LIHR and affected patients who had inguinal hernia closure surgeries.
OIHR), and surgical results has not been investigated in This study provides important insights for optimizing infection
prospective research. According to a retrospective study, control practices and enhancing patient outcomes by
LIHR also demonstrated similar benefits when used to treat examining the correlations between demographic
inguinal hernia repair in older individuals8. The choice of characteristics and SSIs. The multifactorial character of SSIs
whether to do non-emergency inguinal hernia surgery openly will be better understood through more research, which will
or laparoscopic ally depends on a number of factors, including also influence preventive measures in this situation.
the patient's unique medical history and anatomical structure,
the surgeon's preferences, and the resources available at the III. RESULTS
patient's attending hospital9. Open surgery may be required for
individuals with coagulopathy, severe preperitoneal adhesions, Total 114 patients data was analyzed out of which Males
and local extraperitoneal hematoma10. were 69(60.5%) and female 45(39.5%).

II. METHODOLOGY Table 1: age distribution

AGE FREQUENCY PERCENTAGES
To investigate the outcomes of surgical site infections DISTRIBUTION
(SSIs) following inguinal hernia closure surgeries, a 20-30 40 35.1%
retrospective observational study was carried out. To learn 30-40 50 43.9%
more about the connection between demographic factors and 40-50 24 21.1%
the prevalence of SSIs, patient data from medical records was
analyzed. The study included 114 individuals in all who

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Volume 8, Issue 10, October – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Table: 2 Different categories with frequency and percentage details
Categories Frequencies percentages
BMI AGE 20-30 31 27.2%
23-25 38 33.3%
25-28 45 39.5%
RESISENCE URBAN 74 64.9%
RURAL 40 35.1%
DAIBETES MELLITUS PRESENT 23 20.2%
ABSENT 91 79.8%
EDUCATION UNEDUCATED 17 14.9%
SSC 46 40.4%
HSSC OR ABOVE 51 44.7%
HYPERTENSION PRESENT 17 14.9%
ABSENT 97 85.1%
HOSPITAL STAY 1-3 DAYS 55 48.2%
3-6 DAYS 59 51.8%
DURATION OF Surgery 1-3 MONTHS 59 51.8%
3-6 MONTHS 55 48.2%
SUR SITE INFECTION PRESENT 22 19.3%
ABSENT 92 80.7%

TABLE 3: P-value and their details all included in the data analysis. The analysis of the p-values
Categories Surgical site infection p- that follows sheds light on potential relationships and their
Present Absent value implications for SSIs. In a research by Singh S et al., 51.85%
Age 20-30 5(12.5%) 35(87.5%) 0.259 of patients fell into the 45–64 age range, 31.48% of cases fell
group 30-40 10(20%) 40(80%) into the 15–44 age range, and 16.67% of cases fell into the
40-50 22(19.3%) 92(80.7%) 65–plus age range11 . Males made up 60.5% (69 patients) of
gender Male 17(24.6%) 52(75.4%) 0.074 the 114 patients in total that were analyzed, while females
female 5(11.1%) 40(88.9%) made up 39.5% (45 patients). 51.85% of cases in the 45–64
bmi 20-33 4(12.9%) 27(87.1%) 0.261 age range, 31.48% of cases in the 15–44 age range, and
23-25 6(15.8%) 32(84.2%) 16.67% of cases older than 65 years were included in a study
by Singh S et al12. With 35.1% of respondents in the 20–30
25-28 12(26.7%) 33(73.3%)
age range, 43.9% in the 30–40 age range, and 21.1% in the
residence urban 22(29.7%) 52(70.3%) 0.001
40–50 age range, the age spread was remarkable. With this
rural 0(0%) 40(100%)
distribution, representation across several age cohorts is
education uneducated 4(23.5%) 13(76.5%) 0.671 guaranteed, allowing for a thorough examination. According
Ssc 10(21.7%) 36(78.3) to a study by Hariprasad and Srinivas, occurrences of severe
Hssc or 8(15.7%) 43(84.3%) inguinal hernias predominately affect patients between the
above ages of 51 and 60 (22.5%)13. The information examined the
duration 1-3 months 5(8.5%) 54(91.5%) 0.002 connection between home type and BMI as well. The BMI
3-6 months 17(30.9%) 38(69.1%) category with the highest frequency was 25-28 (39.5%),
Hospital 1-3 days 11(20%) 44(80%) 0.855 followed by 23-25 (33.3%) and 20-23 (27.2%). Urban housing
stay 3-6 days 11(18.6%) 48(81.4%) made up 64.9% of all housing, while rural housing made up
Diabetes mellitus 5(21.7%) 18(28.3%) 0.74 35.1%. Increasing public knowledge will likely result in early
detection and a decrease in disease morbidity14. The
17(18.7%) 74(81.3%)
distribution of observed BMI and residences indicates a varied
hypertension 6(35.3%) 11(64.7%) 0.07
patient group. Twenty.2% of patients had diabetes mellitus,
16(16.5%) 81(83.5%) while 14.9% had hypertension. All varieties of open inguinal
hernia procedures have benefits and drawbacks. Tissue tension
IV. DISCUSSION is attributed to existing non-prosthetic healing (Should ice),
which has a recurrence rate that varies from 0.7 to 17%
Inguinal hernia closure procedure-related surgical site depending on experience15. These results highlight the
infections (SSIs) are investigated in the current study in significance of taking pre-existing medical problems that can
connection to a variety of demographic parameters. Age, affect SSIs into account. study reported 85 patients out of 100
gender, BMI, place of residence, education, length of surgery, who had inguinal hernia surgery under local anesthesia were
length of hospital stay, diabetes mellitus, and hypertension are

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Volume 8, Issue 10, October – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
released the same day. The need to treat comorbid diseases [6]. Heylen J,Campioni-Norman D, Lowcock
(hemophilia, chronic renal failure), prolonged surgery, D, Varatharajan L,Kostalas M, Irukulla M, et
postponing surgery until later in the day, surgical al. Inguinoscrotal hernias containing stomach: risk of
complications (scrotal hematoma, perioperative vagal emergency presentation.Ann R Coll Surg Engl
stimulation), postoperative nausea and pain, and these factors 2021;103:713–7.
all prevented same-day discharge16. In terms of surgery time, [7]. Aiolfi A, Cavalli M, Micheletto G, Lombardo F, Bonitta
51.8% of patients had operations that lasted 1-3 months, while G, Morlacchi A, Bruni PG, Campanelli G, Bona D.
48.2% had surgeries that lasted 3-6 months. Regarding Primary inguinal hernia: systematic review and Bayesian
postoperative complications, Khairy et al. reported 4 seroma network meta-analysis comparing open, laparoscopic
cases, 4 wound infection cases, and 4 hematoma cases among transabdominal preperitoneal, totally extraperitoneal, and
100 patients17. 51.8% of patients stayed 1-3 days in the robotic preperitoneal repair. Hernia. 2019 Jun 1;23:473-
hospital, while 48.2% stayed 3-6 days. P-value analysis in 84.
respect to SSIs offers insightful information. Notably, [8]. Pang NQ, Ng CS, Wong CJ. Laparoscopic versus open
statistically significant correlations between the frequency of groin hernia repair in older adults: a systematic review
SSIs and dwelling type (p = 0.001), surgical time (p = 0.002), and meta‐analysis. ANZ Journal of Surgery. 2022
and gender (p = 0.074) were found. According to Bansod et Oct;92(10):2457-63.
al., surgical site infection occurred in two patients (1.66%), [9]. Ma Q, Jing W, Liu X, Liu J, Liu M, Chen J. The global,
while three patients (2.5%) experienced seroma18. A longer regional, and national burden and its trends of inguinal,
surgical procedure was linked to a higher occurrence of SSIs, femoral, and abdominal hernia from 1990 to 2019:
as was living in an urban area. Compared to women, men findings from the 2019 Global Burden of Disease Study–
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TE, Loftus TJ, Al-Mansour MR. Safety of laparoscopic
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demographics into account when estimating the risk of SSIs. 2017;4:282-90.
Healthcare professionals can use this information to establish [12]. Pulin Kumar CH, Paul Pratik. A Clinical Study of
targeted infection prevention efforts and enhance patient Complicated Inguinal Hernia with Special Reference to
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