M. Gurakar1,2, E. Kwon2, B. Guzhnay1, A. L. Vicuna3,4, H. B. Perry2, S. P. Jayaraman1, M. B. Aboutanos1, E. B. Rodas1,3 1Virginia Commonwealth University,Program For Global Surgery, Department Of Surgery,Richmond, VA, USA 2Johns Hopkins Bloomberg School of Public Health,Baltimore, MD, USA 3CINTERANDES Foundation,Cuenca, Ecuador 4Universidad del Azuay,Cuenca, Ecuador
Introduction:
Hernias are one of the leading causes of morbidity in low and middle-income countries. Herein, we describe the results of a Mobile Surgical Unit (MSU) performing hernia repairs for remote and underserved populations in Ecuador.
Methods:
A retrospective review from 2013 to 2017 of all patients undergoing hernia repair by a non-profit foundation (CINTERANDES). Data was extracted from medical records and a database was constructed in Excel.
Results:
In a five-year period, MSU carried out 260 hernia repairs on 233 patients. Thirty-one took place in the home base city of Cuenca and 202 in other small towns and rural settings. Female 49% and male 51%; mean age 46.7 ± 15.3 years, mean BMI 26.1 ± 3.9 kg/m2. Hernia repair with mesh was the most common form of repair (59.2%). Repairs included 122 inguinal hernias (46.9%), 98 umbilical (37.7%), 26 epigastric (10.0%), and 14 incisional (5.4%). Patients underwent local (51.0%), spinal (33.0%), or general anesthesia (15.9%). Mean operative time was 62.6 ± 33.3 min. Intraoperative and post-operative complications encountered include wound infection (5), dehiscence (3), hematoma formation (2), and one infection requiring mesh explant at six months. Follow-ups were conducted at one week for 182 patients (78.1%) via videoconference (42.8%), telephone (36.3%), and in-person interview (20.9%).
Conclusion:
Hernia repair can be safely performed in a MSU with low complication rates comparable to hospital-based surgery. Using Mobile Surgery to supplement existing healthcare infrastructure can expand the availability of hernia repair to those in isolated communities.