Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana
Objective:. To assess long-term outcomes following inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. Background:. Task sharing of surgical care with nonsurgeons can increase access to essential surgery. Long-term safety and outcomes of task sharing are not well-des...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2024-09-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000460 |
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| author | Jessica H. Beard, MD Michael Ohene-Yeboah, MBChB Emmanuel S. Kasu, MBChB Nelson Affram, MBChB Stephen Tabiri, MD Joachim K. A. Amoako, MBChB Francis A. Abantanga, MD Jenny Löfgren, MD |
| author_facet | Jessica H. Beard, MD Michael Ohene-Yeboah, MBChB Emmanuel S. Kasu, MBChB Nelson Affram, MBChB Stephen Tabiri, MD Joachim K. A. Amoako, MBChB Francis A. Abantanga, MD Jenny Löfgren, MD |
| author_sort | Jessica H. Beard, MD |
| collection | DOAJ |
| description | Objective:. To assess long-term outcomes following inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana.
Background:. Task sharing of surgical care with nonsurgeons can increase access to essential surgery. Long-term safety and outcomes of task sharing are not well-described for hernia repair.
Methods:. This prospective cohort study was conducted in Ho, Ghana. After completing a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repairs with mesh on men with primary, reducible hernias. The primary outcome of this study was hernia recurrence at 5 years. The noninferiority limit was 5 percentage points. Secondary endpoints included pain and self-assessed health status at 5 years.
Results:. A total of 242 operations in 241 participants were included, including 119 hernia repairs performed by the medical doctors and 123 performed by the surgeons. One hundred and sixty-nine participants (70.1%) were seen in follow-up at 5 years, 29 participants (12.0%) had died and 43 (17.8%) were lost to follow-up. The overall 5-year recurrence rate was 4.7% (n = 8). The absolute difference in recurrence rate between the medical doctor group (2 [2.3%]) and the surgeon group (6 [7.3%]) was −5.0 (1-tailed 95% confidence interval, −10.5; P = 0.06), demonstrating noninferiority of the medical doctors. Participants experienced improvements in groin pain and self-assessed health status that persisted at 5 years.
Conclusions:. Long-term outcomes of elective mesh inguinal hernia repair in men performed by medical doctors and surgeons in Ghana were excellent. Task sharing is a critical tool to address the substantial morbidity of unmet hernia surgery needs in Ghana. |
| format | Article |
| id | doaj-art-f4b6e1051e714df2ac8aaf0d04b77269 |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-f4b6e1051e714df2ac8aaf0d04b772692025-01-24T09:18:48ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-09-0153e46010.1097/AS9.0000000000000460202409000-00018Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in GhanaJessica H. Beard, MD0Michael Ohene-Yeboah, MBChB1Emmanuel S. Kasu, MBChB2Nelson Affram, MBChB3Stephen Tabiri, MD4Joachim K. A. Amoako, MBChB5Francis A. Abantanga, MD6Jenny Löfgren, MD7* From the Department of Surgery, Division of Trauma Surgery and Surgical Critical Care, Lewis Katz School of Medicine, Temple University, Philadelphia, PA† Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana‡ Department of Public Health, Volta Regional Hospital, Ho, Ghana§ Department of Surgery, Ho Teaching Hospital, Ho, Ghana‖ Department of Surgery, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana† Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana‖ Department of Surgery, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana¶ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.Objective:. To assess long-term outcomes following inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. Background:. Task sharing of surgical care with nonsurgeons can increase access to essential surgery. Long-term safety and outcomes of task sharing are not well-described for hernia repair. Methods:. This prospective cohort study was conducted in Ho, Ghana. After completing a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repairs with mesh on men with primary, reducible hernias. The primary outcome of this study was hernia recurrence at 5 years. The noninferiority limit was 5 percentage points. Secondary endpoints included pain and self-assessed health status at 5 years. Results:. A total of 242 operations in 241 participants were included, including 119 hernia repairs performed by the medical doctors and 123 performed by the surgeons. One hundred and sixty-nine participants (70.1%) were seen in follow-up at 5 years, 29 participants (12.0%) had died and 43 (17.8%) were lost to follow-up. The overall 5-year recurrence rate was 4.7% (n = 8). The absolute difference in recurrence rate between the medical doctor group (2 [2.3%]) and the surgeon group (6 [7.3%]) was −5.0 (1-tailed 95% confidence interval, −10.5; P = 0.06), demonstrating noninferiority of the medical doctors. Participants experienced improvements in groin pain and self-assessed health status that persisted at 5 years. Conclusions:. Long-term outcomes of elective mesh inguinal hernia repair in men performed by medical doctors and surgeons in Ghana were excellent. Task sharing is a critical tool to address the substantial morbidity of unmet hernia surgery needs in Ghana.http://journals.lww.com/10.1097/AS9.0000000000000460 |
| spellingShingle | Jessica H. Beard, MD Michael Ohene-Yeboah, MBChB Emmanuel S. Kasu, MBChB Nelson Affram, MBChB Stephen Tabiri, MD Joachim K. A. Amoako, MBChB Francis A. Abantanga, MD Jenny Löfgren, MD Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana Annals of Surgery Open |
| title | Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana |
| title_full | Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana |
| title_fullStr | Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana |
| title_full_unstemmed | Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana |
| title_short | Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana |
| title_sort | long term outcomes following inguinal hernia repair with mesh performed by medical doctors and surgeons in ghana |
| url | http://journals.lww.com/10.1097/AS9.0000000000000460 |
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