Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA.
World J Surg. 2020 Jun;44(6):1719-1726. doi: 10.1007/s00268-020-05390-9.
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.
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.
Seven studies from African countries reported 14,108 elective inguinal hernia repairs performed by 230 non-surgeons 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.
Systematic training of non-surgeons in inguinal hernia repair is potentially a high-impact capacity-building 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.
在资源有限的国家，腹股沟疝相关的发病率和死亡率高得令人无法接受。本综述通过确定在发展中国家对非外科医生进行腹股沟疝修补术的能力建设教育，并分析其结果来解决这一问题。
对 PubMed 进行了检索，纳入了报告任务分担和腹股沟疝手术结果的研究。记录了具有定量和定性效果的教育方法的能力建设方法。排除了没有记录结果数据的论文。
来自非洲国家的 7 项研究报告了 230 名非外科医生进行的 14108 例择期腹股沟疝修补术，死亡率为 0.36%。7 项研究中有 4 项报告了并发症，发病率为 14.2%。有 2 项研究报告了随访情况：一项研究在 7.4 个月时对 408 例患者无复发，另一项研究在 12 个月时对 119 例患者复发率为 0.9%。从经过培训的非外科医生与外科医生或接受过外科培训的医生的结果直接比较受到限制，但结果没有差异。定量能力建设效果包括增加手术人员、手术量、择期手术、网片使用率和减少向更高水平医疗机构转诊。定性能力建设效果包括在资源有限的环境中进行前瞻性研究的可行性、改善获得外科护理的机会，以及在接受网片修复培训后改变当地医生的实践模式。
对非外科医生进行腹股沟疝修复的系统培训可能是一种具有高影响力的能力建设策略。应尽可能将高风险患者转诊给受过全面培训的外科医生。需要随机研究设计和 1 年以上的长期结果。
