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

Abstract

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.

Task Shifting and Task Sharing to Strengthen the Surgical Workforce in Sub‐Saharan Africa: A Systematic Review of the Existing Literature

“…Aside from having basic diagnostic knowledge and prescriptive ability, NSCs were primarily trained in simple general and emergency surgeries, with some having additional subspecialty training in fields such as orthopedics [22, 23]. Some of the most common surgeries performed by NSCs included hernia repairs, wound care, laparotomies, appendectomies, amputations, and fracture manipulation [22, 24–28]. In Uganda, trained non‐specialist medical officers performed operations in all fields except neurosurgery and congenital cardiothoracic malformations, [29] and in Mozambique and Malawi, they performed more than 90% of major procedures at the district level [10, 30, 31].…”

“…Fifteen articles demonstrated the non-inferiority of NSCs compared to surgeons when looking at morbidity and mortality data [10,22,26,30,[33][34][35][36][37][38][39][40][41][42][43]. In some cases, clinical outcomes of NSCs were comparable to those of their expatriate surgeon peers [22].…”

“…Out of 659 abstracts that matched our initial search terms, 31 studies were included in the final analysis. Exclusion criteria included descriptive or anecdotal articles, articles about other methods for expanding surgical care, articles examining regions outside of sub-Saharan Africa, and articles that focused on OB/GYN, male circumcision, and ophthalmology procedures only included hernia repairs, wound care, laparotomies, appendectomies, amputations, and fracture manipulation [22,[24][25][26][27][28]. In Uganda, trained non-specialist medical officers performed operations in all fields except neurosurgery and congenital cardiothoracic malformations, [29] and in Mozambique and Malawi, they performed more than 90% of major procedures at the district level [10,30,31].…”

Clinical Data Analysis for Treatment of Adult Inguinal Hernia by TAPP or TEP

“…Based on our clinical experience, we suggest that TEP surgery should be carried out gradually after gaining some amount of experience on the basis of TAPP surgery. Through standard and corresponding surgical skills training, surgical safety can be significantly improved and related complications can be reduced ( 29 ).…”

Economic evaluation of expanding inguinal hernia repair among adult males in Ghana

“…Task-sharing is defined as the pragmatic transfer of tasks from highly qualified professionals, in this case qualified surgeons, to those with shorter training periods or fewer qualifications, with sharing responsibility for high-quality outcomes [12]. Surgical task sharing between specialist surgeons, non-specialist medical doctors (MDs) as well as associate clinicians has shown promising results in sub-Saharan Africa [13][14][15].…”