Groin hernia is common, progressive, and debilitating
It starts small
Beginning with a tear in the abdominal wall, groin hernias are present in 11 - 15% of males and are 3x more common in males than females. As a person strains and works, the tear enlarges, and abdominal contents push outward through the opening — resulting pain and discomfort.
It worsens with time
Over time, a small tear grows bigger, until large portions of the small intestine and bowel protrude through the abdominal wall. The end result? Pain, discomfort, loss of functional anatomy — inability to carry out the routine activities of daily life.
It can be fixed
Groin hernias are easily repaired — however the key ingredient is mesh. The use of mesh has been shown to reduce the 5-year recurrence rate from 10 - 20% to 1 - 3% versus suture repair alone. At both the individual and population level, this is a massive benefit.
Groin hernia is a global health priority
In fact, it has a greater disability burden than malaria and HIV
Because groin hernia is progressive and disabling, it pulls entire populations out of the labor pool. Globally there are 223M hernias and 44,000 deaths from hernia every year [1]. In a middle income country like Ghana, with a population of nearly 30M and where manual labor is key to survival, groin hernia imparts a cost to the population of over 5M disability adjusted life years (DALYs) [2]. That’s the equivalent of pulling 1M people out of the workforce for five years; with malaria and HIV, sick patients are still able to work and support themselves.
[1] Essential Surgery, Chapter 9: Hernia & Hydrocele. Beard JH et al. http://bit.ly/2mZuq9Z
[2] Forrester JD et al. JAMA Surg. 2016. http://bit.ly/2mZmW76
Groin hernia repair is essential for global health
Hernia repair is so important it was added to the Work Health Organization’s list of essential surgical care [3]. In fact, it has such a high return on investment that it is as cost-effective as vaccines and other prioritized health interventions [4]. Most importantly, mesh-based repairs have the lowest rates of recurrence and the greatest overall effectiveness on lowering the burden of disease.
[3] Emergency & essential surgical care. World Health Organization. https://bit.ly/2Zg0QOJ
[4] Surgical Care at the District Hospital. World Health Organization. http://bit.ly/2onflPm
“Groin hernia repair does not have the glamour of a Whipple or a heart transplant, but in terms of preserving years of useful life, in sheer volume, it is one of the most important surgical procedures of all.”
—Jonathan Rhoads MD
Professor Emeritus of Surgery, University of Pennsylvania