Rural Surgery in Niger: A Multicentric Study in 21 District Hospitals

Sani, Rachid; Sanoussi, S.; Didier, James Lassey; Salifou, Garba Mohamed; Abarchi, H

doi:10.1007/s12262-013-1015-0

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…In rural or low resource settings, training may be focused on the basic ability to perform any inguinal repair for patients with significant symptoms without causing mortality or serious morbidity (see also Chapter 28). 1 …”

Section: Training and The Learning Curvementioning

confidence: 99%

International guidelines for groin hernia management

Simons¹,

Śmietański²,

Bonjer³

et al. 2018

Hernia

1,557

712

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IntroductionWorldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery.MethodsAn expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group’s first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as “strong” (recommendations) or “weak” (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term “should” refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores.Results and summaryThe risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with “watchful waiting” since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment s...

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Section: Training and The Learning Curvementioning

confidence: 99%

International guidelines for groin hernia management

Simons¹,

Śmietański²,

Bonjer³

et al. 2018

Hernia

1,557

712

View full text Add to dashboard Cite

show abstract

“…Overall, of the 1101 post‐training inguinal hernia repairs, only 89 were repaired with mesh due to a shortage of mesh supply. Included studies mostly reported anecdotal qualitative capacity‐building effects (Table 3) such as: the feasibility of prospective research in limited‐resource settings [9], improved access to surgical care [12, 13], change in practice pattern of local physicians after training for mesh repair [10, 14], and a higher likelihood that trained clinical officers stay in the country and in rural areas [15].…”

Section: Resultsmentioning

confidence: 99%

“…Between 2013 and 2015, surgical training of COs increased the volume of procedures performed by 74%. Sani et al [13] reported on the Capacity of District Surgery initiative which included a 12‐month surgical training of general practitioners and senior nurses in Niger, Africa. Trainees were dispatched to 21 District Hospitals, and outcomes were followed between 2007 and 2010.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies from African countries reported 14,108 elective inguinal hernia repairs performed by 230 nonsurgeons with a mortality rate of 0.36% as shown in Table 2 [8][9][10][11][12][13][14]. Complications were reported in 4 of the 7 studies with a morbidity rate of 14.2% [8,9,11,14].…”

Section: Surgical Outcomesmentioning

confidence: 99%

“…Quantitative capacity-building effects include increase in surgical workforce, case volume, and elective procedures, decreased referrals to higher level of care institutions, and increased mesh utilization for inguinal hernia repair as shown in 3) such as: the feasibility of prospective research in limited-resource settings [9], improved access to surgical care [12,13], change in practice pattern of local physicians after training for mesh repair [10,14], and a higher likelihood that trained clinical officers stay in the country and in rural areas [15].…”

Section: Capacity-building Effectsmentioning

confidence: 99%

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The State of Surgical Task Sharing for Inguinal Hernia Repair in Limited‐Resource Countries

et al. 2020

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Background In limited-resource countries, the morbidity and mortality related to inguinal hernias is unacceptably high. This review addresses the issue by identifying capacity-building education of non-surgeons performing inguinal hernia repairs in developing countries and analyzing the outcomes. Methods PubMed was searched and included are studies that reported on task sharing and surgical outcomes for inguinal hernia surgery. Educational methods with quantitative and qualitative effects of the capacity-building methods have been recorded. Excluded were papers without records of outcome data. Results Seven studies from African countries reported 14,108 elective inguinal hernia repairs performed by 230 nonsurgeons with a mortality rate of 0.36%. Complications were reported in 4 of the 7 studies with a morbidity rate of 14.2%. Two studies reported on follow-up: one with no recurrences in 408 patients at 7.4 months and the other one with 0.9% recurrences in 119 patients at 12 months. Direct comparison of outcomes from trained non-surgeons to surgeons or surgically trained medical doctors is limited but suggests no difference in outcomes. Quantitative capacity-building effects include increase in surgical workforce, case volume, elective procedures, mesh utilization, and decreased referrals to higher level of care institutions. Qualitative capacity-building effects include feasibility of prospective research in limited-resource settings, improved access to surgical care, and change in practice pattern of local physicians after training for mesh repair. Conclusion Systematic training of non-surgeons in inguinal hernia repair is potentially a high-impact capacitybuilding strategy. High-risk patients should be referred to a fully trained surgeon whenever possible. Randomized study designs and long-term outcomes beyond 1 year are needed.

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Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review

et al. 2023

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Introduction The Lancet Commission on Global Surgery (LCoGS) set the benchmark of 5000 procedures per 100,000 population annually to meet surgical needs adequately. This systematic review provides an overview of the last ten years of surgical volumes in Low and Middle- Income-Countries (LMICs). Methodology We searched PubMed, Web of Science, Scopus, Cochrane, and EMBASE databases for studies from LMICs addressing surgical volume. The number of surgeries performed per 100,000 population was estimated. We used cesarean sections, hernia, and laparotomies as index cases for the surgical capacities of the country. Their proportions to total surgical volumes were estimated. The association of country-specific surgical volumes and the proportion of index cases with its Gross Domestic Product (GDP) per capita was analyzed. Results A total of 26 articles were included in this review. In LMICs, on average, 877 surgeries were performed per 100,000 population. The proportion of cesarean sections was found to be high in all LMICs, with an average of 30.1% of the total surgeries, followed by hernia (16.4%) and laparotomy (5.1%). The overall surgical volumes increased as the GDP per capita increased. The proportions of cesarean section and hernia to total surgical volumes decreased with increased GDP per capita. Significant heterogeneity was found in the methodologies to assess surgical volumes, and inconsistent reporting hindered comparison between countries. Conclusion Most LMICs have surgical volumes below the LCoGS benchmark of 5000 procedures per 100,000 population, with an average of 877 surgeries. The surgical volume increased while the proportions of hernia and cesarean sections reduced with increased GDP per capita. In the future, it's essential to apply uniform and reproducible data collection methods for obtaining multinational data that can be more accurately compared.

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Rural Surgery in Niger: A Multicentric Study in 21 District Hospitals

Cited by 7 publications

References 9 publications

International guidelines for groin hernia management

International guidelines for groin hernia management

The State of Surgical Task Sharing for Inguinal Hernia Repair in Limited‐Resource Countries

Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review

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