Bloomberg Children's Center, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans St, Room 7337, Baltimore, MD, 21287-0005, USA.
Hernia. 2014 Aug;18(4):549-56. doi: 10.1007/s10029-014-1255-3. Epub 2014 Apr 29.
Inguinal hernia repair is the most common general surgery operation performed globally. However, the adoption of tension-free hernia repair with mesh has been limited in low-income settings, largely due to a lack of technical training and resources. The present study evaluates the impact of a 2-day training course instructing use of polypropylene mesh for inguinal hernia repair on the practice patterns of sub-Saharan African physicians.
A surgical training course on tension-free mesh repair of hernias was provided to 16 physicians working in rural Ghanaian and Liberian hospitals. Three physicians were requested to prospectively record all their inguinal hernia surgeries, performed with or without mesh, during the 14-month period following the training. Demographic variables, diagnoses, and complications were collected by an independent data collector for mesh and non-mesh procedures.
Surgery with mesh increased significantly following intervention, from near negligible levels prior to the training to 8.1 % of all inguinal hernia repairs afterwards. Mesh repair accounted for 90.8 % of recurrent hernia repairs and 2.9 % of primary hernia repairs after training. Overall complication rates between mesh and non-mesh procedures were not significantly different (p = 0.20).
Three physicians who participated in an intensive education course were routinely using mesh for inguinal hernia repair 14 months after the training. This represents a significant change in practice pattern. Complication rates between patients who underwent inguinal hernia repairs with and without mesh were comparable. The present study provides evidence that short-term surgical training initiatives can have a substantial impact on local healthcare practice in resource-limited settings.
腹股沟疝修补术是全球最常见的普通外科手术。然而，在资源有限的低收入环境中，由于缺乏技术培训和资源，无张力疝修补术加网片的应用受到限制。本研究评估了为期两天的培训课程，该课程指导使用聚丙烯网片进行腹股沟疝修补术对撒哈拉以南非洲医生实践模式的影响。
为在加纳和利比里亚农村医院工作的 16 名医生提供了关于疝无张力网片修补的外科培训课程。要求 3 名医生在培训后的 14 个月内前瞻性地记录所有使用或不使用网片的腹股沟疝手术。由独立的数据收集员收集网片和非网片手术的人口统计学变量、诊断和并发症。
手术加网片明显增加，从培训前几乎为零的水平增加到培训后的 8.1%。网片修复占复发性疝修复的 90.8%，原发性疝修复的 2.9%。网片和非网片手术的总体并发症发生率无显著差异（p = 0.20）。
3 名参加强化教育课程的医生在培训后 14 个月常规使用网片进行腹股沟疝修补术。这代表了实践模式的重大改变。接受腹股沟疝修补术的患者中，使用网片和不使用网片的并发症发生率相当。本研究提供了证据，表明短期外科培训计划可以对资源有限环境中的当地医疗保健实践产生重大影响。
