Outcomes after elective inguinal hernia repair with mesh performed by associate clinicians versus medical doctors in Sierra Leone: 5-year follow-up of a randomized clinical trial.

Abstract

<h4>Background</h4>Inguinal hernia repair is one of the most performed surgical procedures, but, nevertheless, there is a high unmet need, with over 200 million people worldwide living with an inguinal hernia. The aims of this study were to evaluate 5-year outcomes after anterior mesh inguinal hernia repair, to assess the safety of a training intervention, and to compare the outcomes of patients operated on by a medical doctor (MD) versus an associate clinician (AC).<h4>Methods</h4>Adult men with a primary inguinal hernia were included either as training patients or in the randomized trial, with surgical treatment performed by an MD or an AC. Patients were followed up mostly at hospital or at home; questionnaire information was collected and physical examinations were performed. Outcomes of training and trial patients were compared and outcomes of patients who underwent surgeries performed by MDs or ACs during the trial were compared.<h4>Results</h4>In total, 129 patients were included in the training group and 229 patients were included in the randomized trial group. At 5-year follow-up, 288 patients (80.4%) were alive, 40 patients (11.2%) had died, and 30 patients (8.4%) were lost to follow-up. The overall recurrence rate was 5.0% and the all-cause mortality rate was 11.2%. Mortality and recurrence were not significantly different between the training and trial patients or between the patients who underwent surgeries performed by MDs or ACs during the trial.<h4>Conclusion</h4>Long-term outcomes after primary elective inguinal mesh hernia repair indicate that hands-on short-course training can be implemented effectively and that task sharing is safe and effective.