Non-Surgeons in Ghana Are Competently Repairing Hernias

By David Douglas

July 08, 2019

NEW YORK (Reuters Health) - Medical doctors can be trained to perform mesh inguinal hernia repair as competently as surgeons, a study from Ghana shows.

In fact, Dr. Jessica H. Beard told Reuters Health by email "We are excited to share the results of our study on outcomes." Following training, "both medical doctors with no formal surgical training and specialist surgeons can safely and effectively perform inguinal hernia repair with mesh in a low-resource setting. This study is the first of its kind and has important implications for surgical workforce development in both high and low-income countries."

In a June 26 online paper in JAMA Surgery, Dr. Beard of Temple University, Philadelphia, and colleagues observe that there is a great need for hernia and other surgery in sub-Saharan Africa and surgical capacity doesn't meet the demand. Currently, medical doctors rather than trained surgeons perform much of this work but there is no evidence that they do so adequately.

To prospectively examine the influence of instruction in Ghana, three experienced consultant surgeons provided training for three medical doctors and two general surgeons in tension-free mesh hernia repair according to the Lichtenstein technique. They underwent a two-week course of lectures and were given hands-on training as well as competency testing.

The trainees then went on to operate on 242 men with primary reducible inguinal hernia. In all, 119 were treated by the medical doctors and the remaining 123 by the surgeons. They were followed up at two weeks and at one year. No patients required reoperation or developed a mesh infection.

There was no significant difference in the rate of postoperative complications (29.1% versus 24.2%) between groups. Patient satisfaction, severe chronic pain and self-assessed health were also similar for the two groups. Overall, 98.7% of patients were satisfied with the outcome of the operation.

"Our results indicate that task-sharing of surgical tasks with non-surgeons is a tool that can be safely used to expand the surgical workforce and bring high-quality essential surgical care to those most in need around the world, " Dr. Beard concluded. "Going forward, we plan to use task-sharing to develop surgical capacity for hernia repair in Ghana and throughout sub-Saharan Africa."

Commenting by email, Dr. Sherry M. Wren, co-author of an accompanying editorial, told Reuters Health, "Training to competency is the key, more so than specific initials after your name."

Dr. Wren of Stanford University School of Medicine, California, added, "Task shifting of a cadre of basic procedures could be done safely and with good outcomes if people are trained to competency standards," and "this could result in more cost efficient health care and work force utilization."


JAMA Surgery 2019.