Good results for groin hernia work not done by doctors in Sierra Leone

In countries with a severe shortage of surgeons it is common for some operations to be performed by medical staff with lower formal qualifications. Researchers at Karolinska Institutet, Sweden, have led an international study on the safety and efficacy of a common surgical procedure. The study, published in
Open JAMA Network, showing that inguinal hernia work performed by allied clinicians at a hospital in Sierra Leone was just as safe and effective as those performed by doctors.

There is a shortage of surgeons in many sub-Saharan countries, and to ensure that as many patients as possible are treated, some operations are performed by medical professionals who are not specialists in work. -lannsa. The sharing of such activities is supported by a number of organizations, including the World Health Organization.

To date there are few clinical studies on the safety and efficacy of activity sharing. Researchers at Karolinska Institutet and, among other places, Kamakwie Wesleyan Hospital, Sierra Leone, have now compared inguinal hernia work performed by affiliated clinicians with those performed by medical doctors or -special. In Sierra Leone, medical doctors do not have special training in surgery but regularly perform surgical procedures as part of their regular work.

It is estimated that 220 million people worldwide live with inguinal hernia, which causes severe suffering and, 40,000 deaths each year. Twenty million inguinal hernia operations are performed each year, making it the most common method of general surgery in the world, including low-income countries like Sierra Leone. In Sierra Leone there is less than one surgeon per 100,000 population, and sharing activities between MDs and allied clinicians is one way of providing general surgery to many people.

The study included 229 men who underwent surgery for an inguinal hernia between 2017 and 2018 at a district hospital in rural Sierra Leone. Patients were randomly assigned to an associated physician or clinician for their surgery and were followed up after two weeks and one year.

The findings suggest that sharing activities with associated clinicians provide safe and effective surgery for non-life inguinal hernias in countries where there is a shortage of surgeons.

“The study showed that related clinicians were not inferior to registered physicians when it comes to recurrence, complications, groin pain or patient satisfaction,” said the paper’s last author Jenny Löfgren, assistant professor at Department of Molecular Medicine and Surgery, Karolinska Institute. “There were even fewer recurrence cases in the patients run by affiliated clinicians compared to the group on which MDs were operating. This was a unique and unexpected finding. and functional sharing seems to be an attractive option that will help millions of people suffering from inguinal hernia. “

The next step for the researchers is to develop training programs for doctors and allied clinicians to expand surgical services. Upcoming studies will be conducted in Sierra Leone and Uganda.

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The study was funded by the Swedish Research Council. Authors Håkon Bolkan, Alex van Duinen and Thomas Ashley are unpaid members of the CapaCare board. Conflicts of interest are not reported.

Disclosure: “Results after selective inguinal hernia repair performed by clinicians affiliated with medical doctors – randomized trial, non-blind inferiority.” Thomas Ashley, Hannah Ashley, Andreas Wladis, Håkon A. Bolkan, Alex J. van Duinen, Jessica H. Beard, Hertta Kalsi, Juuli Palmu, Pär Nordin, Kristina Holm, Michael Ohene-Yeboah, Jenny Löfgren. JAMA Open Network, online January 11, 2020.