, Volume 22, Issue 3, pp 491–498 | Cite as

Sustainability in humanitarian surgery during medical short-term trips (MSTs): feasibility of inguinal hernia repair in rural Nigeria over 6 years and 13 missions

  • F. Oehme
  • L. Fourie
  • F. J-P. Beeres
  • S. Ogbaji
  • P. Nussbaumer
Original Article



Surgical teaching missions are known to contribute significantly in reducing the local burden of disease. However, the value of short-term medical service trips (MSTs) remains under debate. Humanitarian surgery is highly dependent on funding, and consequently, data evaluation is needed to secure funding for future projects. The aim of this trial is to evaluate the results of 6-year MSTs to rural Nigeria with a specific emphasis on hernia repairs.


Retrospective series of consecutive operations performed between 2011 and 2016 in rural Nigeria during 13 MSTs. Operations were categorized into type and number of procedures and origin of the surgeon. In terms of inguinal hernia repairs additional data was evaluated such as frequency of local anaesthesia (LA) and the type of hernia. The total amount of disability-adjusted life years (DALYs) averted during each mission are presented and discussed with regard to sustainability of these missions.


From 2011 to 2016, a total of 1674 patients were operated. Of these, 1302 patients were operated for 1481 hernias of which 36.7% accounting as inguinoscrotal hernias. The percentage of operations performed by Nigerian staff increased from 31 to 55%. Overall, eighteen percent of the operations was solely performed by Nigerians. Totally, we averted 8092.83 DALY’s accounting for 5.46 DALY’s per hernia.


The presented missions contribute significantly to an improvement in local healthcare and decrease the burden of disease. We were able to show the sustainable character of these surgical missions. As a next step, we will analyse the cost-effectiveness of MSTs.


Humanitarian surgery Groin hernia Nigeria DALY 




Compliance with ethical standards

Conflict of interest

None of the authors or any member of their immediate family has funding or commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

Ethical approval was not required as no personal datas included.

Human and animal participants

No animals were involved in this study.

Informed consent

No informed consent was required for this study.


  1. 1.
    Ohene-Yeboah M, Abantanga FA (2011) Inguinal hernia disease in Africa: a common but neglected surgical condition. West Afr J Med 30(2):77–83PubMedGoogle Scholar
  2. 2.
    Sanders DL, Kingsnorth AN (2007) Operation hernia: humanitarian hernia repairs in Ghana. Hernia J Hernias Abdom wall Surg 11(5):389–391. CrossRefGoogle Scholar
  3. 3.
    Stephenson BM, Kingsnorth AN (2011) Safety and sterilization of mosquito net mesh for humanitarian inguinal hernioplasty. World J Surg 35(9):1957–1960. CrossRefPubMedGoogle Scholar
  4. 4.
    Grimes CE, Law RS, Borgstein ES, Mkandawire NC, Lavy CB (2012) Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa. World J Surg 36(1):8–23. CrossRefPubMedGoogle Scholar
  5. 5.
    Farmer PE, Kim JY (2008) Surgery and global health: a view from beyond the OR. World J Surg 32(4):533–536. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wright IG, Walker IA, Yacoub MH (2007) Specialist surgery in the developing world: luxury or necessity? Anaesthesia 62(Suppl 1):84–89. CrossRefPubMedGoogle Scholar
  7. 7.
    Bae JY, Groen RS, Kushner AL (2011) Surgery as a public health intervention: common misconceptions versus the truth. Bull World Health Organ 89(6):394. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. CrossRefGoogle Scholar
  9. 9.
    Kingsnorth AN (2004) A clinical classification for patients with inguinal hernia. Hernia J Hernias Abdom wall Surg 8(3):283–284. CrossRefGoogle Scholar
  10. 10.
    Gourgiotis S, Germanos S, Stratopoulos C, Moustafellos P, Panteli A, Hadjiyannakis E (2006) Lichtenstein tension-free repair of inguinal hernia. Chirurgia (Bucharest, Romania: 1990) 101(5):509–512Google Scholar
  11. 11.
    GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England). 2016;388(10053):1545–1602. CrossRefGoogle Scholar
  12. 12.
    Fox-Rushby JA, Hanson K (2001) Calculating and presenting disability adjusted life years (DALYs) in cost-effectiveness analysis. Health Policy Plan 16(3):326–331CrossRefPubMedGoogle Scholar
  13. 13.
    Shillcutt SD, Clarke MG, Kingsnorth AN (2010) Cost-effectiveness of groin hernia surgery in the Western Region of Ghana. Arch Surg (Chicago, Ill : 1960) 145(10):954–961. CrossRefGoogle Scholar
  14. 14.
    Lopez A, Salomon J, Ahmad O, Murray C, Mafat D (2001) Life tables for 191 countries: data, methods and results. EIP/GPE/EBD World Health OrganizationGoogle Scholar
  15. 15.
    Wilhelm TJ, Anemana S, Kyamanywa P, Rennie J, Post S, Freudenberg S (2006) Anaesthesia for elective inguinal hernia repair in rural Ghana—appeal for local anaesthesia in resource-poor countries. Trop Doct 36(3):147–149. CrossRefPubMedGoogle Scholar
  16. 16.
    De Rosa A, Meyer A, Seabra AP, Sorge A, Hack J, Soares LA et al (2016) An international surgical collaboration: humanitarian surgery in Brazil. Hernia J Hernias Abdom Wall Surg 20(4):553–557. CrossRefGoogle Scholar
  17. 17.
    Beard JH, Oresanya LB, Ohene-Yeboah M, Dicker RA, Harris HW (2013) Characterizing the global burden of surgical disease: a method to estimate inguinal hernia epidemiology in Ghana. World J Surg 37(3):498–503. CrossRefPubMedGoogle Scholar
  18. 18.
    Ozgediz D, Jamison D, Cherian M, McQueen K (2008) The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull World Health Organ 86(8):646–647CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Agbakwuru E, Arigbabu AO, Akinola OD (1995) Local anaesthesia in inguinal herniorrhaphy: our experience in Ile–Ife, Nigeria. Cent Afr J Med 41(12):405–409PubMedGoogle Scholar
  20. 20.
    Mbah N (2007) Morbidity and mortality associated with inguinal hernia in Northwestern Nigeria. West Afr J Med 26(4):288–292PubMedGoogle Scholar
  21. 21.
    Arowolo OA, Agbakwuru EA, Adisa AO, Lawal OO, Ibrahim MH, Afolabi AI (2011) Evaluation of tension-free mesh inguinal hernia repair in Nigeria: a preliminary report. West Afr J Med 30(2):110–113PubMedGoogle Scholar
  22. 22.
    Ohene-Yeboah M (2003) Strangulated external hernias in Kumasi. West Afr J Med 22(4):310–313PubMedGoogle Scholar
  23. 23.
    Shillcutt SD, Sanders DL, Teresa Butron-Vila M, Kingsnorth AN (2013) Cost-effectiveness of inguinal hernia surgery in northwestern Ecuador. World J Surg 37(1):32–41. CrossRefPubMedGoogle Scholar
  24. 24.
    EACOOTAAAAAEADR A (2015) Groin Hernias at the Wesley Guild Hospital Ilesa, Nigeria: characteristics and emerging patterns of repair. Niger J Surg Sci 25(1):9–14CrossRefGoogle Scholar
  25. 25.
    Olasehinde OO, Adisa AO, Agbakwuru EA, Etonyeaku AC, Kolawole OA, Mosanya AO (2015) A 5-year review of darning technique of inguinal hernia repair. Niger J Surg 21(1):52–55. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Nordin P, Hernell H, Unosson M, Gunnarsson U, Nilsson E (2004) Type of anaesthesia and patient acceptance in groin hernia repair: a multicentre randomised trial. Hernia J Hernias Abdom Wall Surg 8(3):220–225. CrossRefGoogle Scholar
  27. 27.
    Sanjay P, Woodward A (2007) Inguinal hernia repair: local or general anaesthesia? Ann R Coll Surg Engl 89(5):497–503. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Sanjay P, Woodward A (2009) Local anaesthetic inguinal hernia repair performed under supervision: early and long-term outcomes. Ann R Coll Surg Engl 91(8):677–680. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General SurgeryCantonal Hospital LucerneLucerneSwitzerland
  2. 2.Department of PharmacySt. Mary’s Hospital OkpogaOkpogaNigeria
  3. 3.Department of SurgeryHospital LachenLachenSwitzerland

Personalised recommendations