Page 115 - International guidelines for groin hernia management

Hernia

• Surgeons needing focused training and skill income countries (HIC) in the Global Surgery Project 263
development http://www.lancetglobalsurgery.org. Internet-based tech-
nologies are efficient ways of sharing surgical experience
– Hernia societies can create a hernia surgery certifi-
and may be a way to expand surgical education and
cate program whereby LRS surgeons receive a 264, 265
strengthen local expertise in LRS. One article
certificate of completion/competence after finishing
describes that two surgeons from Paraguay and Brazil were
a supervised course of study and demonstrate
trained by two international experts to perform a Lichten-
competent performance of a series of IH repair
stein IH repair using Google Glasses via an interactive
skills. 265
online video stream. Multimedia are now used to dis-
• Healthcare provider continuous education and skills seminate medical content through archived and live video
training allowing physicians to stay current in a variety of
settings. 266
– Open to surgeons and all others involved in IH
Most LRS physicians are connected to the World Wide
patient care activities.
Web. Advanced interactive technology allows experts to be
– May involve periodic visits from referral hospital
virtually present, and assist through tele-mentoring, while
personnel, telemedicine, review of educational 265, 266
other surgeons perform operations.
materials.
Internet-based data collection will facilitate the rapid
– On-site support and training in hernia surgery by
development of hernia registries in LRSs as well as world
surgeon specialists from referral hospitals to outly-
hernia registries. The EHS now offers the global surgical
ing facilities.
community an online platform for registration and outcome
• Operators/surgeons in outlying hospitals measurements of abdominal wall hernia repairs (http://
www.eurahs.eu/HOME.php). 168
– Can be visited on a rotating or as-needed basis by
The challenge in the short-term is the optimization of
hernia specialists in a series of ‘‘surgical camps’’.
medical technology and clinical practice in order to deliver
Few studies have evaluated the impact of short inter- the best medical care and the highest patient satisfaction at
national training trips on the practice of local physicians the lowest cost. 267 Research is needed on the impact of
following training trip participation. One study conducted internet use and other technologies to achieve safe effective
in Ghana and Liberia reported on a 2-day surgical training surgery globally.
course on tension-free mesh repair performed in a
resource-limited setting. It also looked at the course’s Research, General Practitioners and Patients
impact on local surgical practice. It concluded that a brief perspectives
training course can significantly improve local practice.
Operation Hernia is a UK-registered charity initiative
involving the EHS and the Plymouth–Takoradi (Ghana) Chapter 29
Hospital which trains, and teaches hernia surgery, in
Africa. It sends volunteer teams to work alongside African
surgeons, training them in local anesthetic administration Questions for research
and guiding/mentoring during hernia operations. Teams B. van den Heuvel, M. P. Simons
operate on a large volume of cases in a short time, often in The members of Hernia Surge have attempted to evaluate
two theatres simultaneously. 8, 201, 262 all available literature on inguinal hernia surgery. Con-
When deciding which surgical services to offer facility cerning many topics high quality designed studies have led
capabilities and infrastructure must be considered. A well- to clear statements and conclusions. However, on many
equipped facility is necessary to support a strong education other topics high quality studies are lacking, resulting in
program in LRSs. 261 Per the WHO Safe Surgery Initiate, great opportunities for future research. In this chapter we
operating theatres must be of adequate size, have appro- have attempted to sum up systematically research questions
priate lighting and have dependable electricity and water at that we have encountered during the development of these
a minimum. 245 guidelines. We hope that this chapter inspires hernia
KQ28.h How can the internet and other technologies be researchers to conduct new studies to answer these inter-
used to teach physicians in LRSs? esting questions.
Continuing education/training and data collection
should be the focus of using new technologies to improve
hernia surgery in LRSs. Internet use has already been
highlighted by the cooperation between LMICs and high

123