Discussion
deaths, death, groin hernia, hernia
SITE INFECTION, RECURRENCE, SURGICAL SITE INFECTION
This study demonstrates that an intensive hands-on, competency-based short-course training in mesh hernia repair for MDs and ACs with experience in tissue hernia repair is feasible and safe. Two MD trainees did not reach proficiency, and the remaining trainees reached proficiency after an average of between 5 and 6 procedures as the lead surgeon.Open anterior mesh inguinal hernia repair is the gold standard technique for adult men globally. Currently, this is not standard practice in Sierra Leone due to cost and limited availability of mesh along with lack of widespread training in this technique. The situation is comparable to other sub-Saharan countries [Patient outcomes were favourable, with an overall recurrence rate of 3.9% after one year in the training group. This is much lower than the 13.1% recurrence rate that was identified from a nation-wide population study from Sierra Leone. However, most of those surgeries were done without mesh and with a longer follow-up time [The surgical site infection rate in the training group was more than double compared to the trial group. In previous research, an association between increased operating time and surgical site infections has been described [We found the one-year mortality in the training group was more than double that of the trial group (4.7% versus 2.2%). For all patients that died, the cause of death was recorded based on interviews. All deaths occurred more than 6 months after surgery, and none of the deaths could be attributed to the hernia surgery. Taking all this into account, we conclude that a short competency-based training is a safe and effective way to train MDs and ACs how to perform a mesh inguinal hernia repair under local anaesthesia in adult men in this low resource setting.In order to reach a recurrence rate for groin hernia mesh repair of about 1% as described in high-income settings, more efforts are needed [