Standardised Competency-Based Training of Medical Doctors and Associate Clinicians in Inguinal Repair with Mesh in Sierra Leone
Date
2023
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
World Journal of Surgury
Abstract
Introduction In low-income settings, there is a high unmet need for hernia surgery, and most procedures are
performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate
clinicians received a short-course competency-based training on inguinal hernia repair with mesh under local
anaesthesia. The aim of this study was to evaluate feasibility, safety and effectiveness of the training.
Methods All trainees received a one-day theoretical module on mesh hernia repair under local anaesthesia followed
by hands-on training. Performance was assessed using the American College of Surgeon’s Groin Hernia Operative
Performance Rating System. Patients were followed up two weeks and one year after surgery. Outcomes of the
patients operated on during the training trial were compared to the 229 trial patients operated on after the training.
Results During three surgical camps, seven medical doctors and six associate clinicians were trained. In total, 129
patients were operated on as part of the training. Of the 13 trainees, 11 reached proficiency. Patients in the training
group had more wound infections after two weeks (8.5% versus 3.1%; p = 0.041). There was no difference in
recurrence and mortality after one year, and none of the deaths were attributed to the surgery.
Discussion and conclusion Mesh repair is the international standard for inguinal hernia repair worldwide. Never theless, this is not widely accessible in low-income settings. This study has demonstrated that short-course intensive
hands-on training of MDs and ACs in mesh hernia repair is effective and safe.
Description
Research Article
Keywords
Mesh, Sierra Leone, Inguinal Repair