Background: In Brazil, access to healthcare varies widely by community. Options for repair of surgically correctable conditions, such as inguinal hernias, are limited. A training program was instituted to expand access to Lichtenstein hernioplasty. Methods: Between September, 2014 and September, 2015, 3 orders of training series took place in São Paulo, Brazil. Participating surgeons received training and assessments from expert trainers using the Operative Performance Rating Scale (OPRS). Those who completed training successfully were invited to become trainers. OPRS scores were compared between training series. Outcomes were documented up to 6 months post-training. Results: The 3 orders of training series resulted in 45 surgeons trained and 213 hernias repaired. Eleven trainees subsequently became trainers. Mean post-training OPRS scores were 4.4 (scale of 5) and did not vary significantly between training series. The overall complication rate was 4.7%, with no hernia recurrences or reoperations at 6 months. Conclusions: Competency-based training generates a regional network of surgeons proficient in Lichtenstein hernioplasty. Each training session progressively expands patient access to high quality operations in underserved communities in Brazil. Summary: In Brazil, there is widely disparate access to healthcare services, including surgical care, across various regions of the country. Inguinal hernia is a significant problem in underserved communities and most patients receive surgical repairs using a variety of open techniques with persistent utilization of tissue based repairs despite the public availability of mesh. In this study, a training program was successfully instituted to expand access to Lichtenstein hernioplasty. Each training session progressively improves patient access to high quality operations in underserved communities in Brazil.
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