Challenges of giant ventral hernia repair in children in an African tertiary care center with limited resources

The objective of this study is to report the challenges and outcome of giant ventral abdominal hernia repair in infants/children in a tertiary care center in Africa.

A retrospective analysis of infants/children who had a repair of giant ventral abdominal hernia between January 1998 and December 2007 at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, was carried out.

A total of 41 children aged between 9 months and 12 years (mean 2.6 ± 1.8 years) comprising 25 males and 16 females with a male:female ratio of 1.6:1 had a repair of giant ventral abdominal hernias which were due to healed omphalocele in 37 (90.3%), incisional hernia in three (7.3%), and following initial skin closure of gastroschisis in one (2.4%). They had an average hernia defect of size 7.1 × 8.3 cm, which contained both solid and hollow viscera in all of the patients, along with 11 (29.7%) syndromic omphalocele. The major challenge was inadequate intraabdominal volume needed to accommodate the herniated viscera in nine children, which was compounded by the nonavailability of silastic materials, a pediatric ventilator, facilities required for intraabdominal pressure monitoring during closure, as well as undiagnosed associated cardiac anomaly. Overall, 39 (95.1%) children survived, while two (4.9%) mortalities were recorded due to postoperative aspiration in one child and cardiopulmonary failure in the other. Of those who survived, 29 (74.4%) had a smooth postoperative course, while ten (25.6%) had morbidity, with a mean hospitalization duration of 10 ± 2.5 days. There was no recurrence recorded on follow-up for 5 years at the surgical outpatient clinic.

Despite the challenges, better results were achieved with repairs in infants/children compared to repairs performed in neonates.