Locally developed low-cost simulator for manual reduction of pediatric inguinal hernia in Rwanda

Manual reduction of incarcerated inguinal hernias is a fundamental skill to decrease morbidity from bowel strangulation. It is essential in low-income countries, where surgical care may not be available at the initial receiving facility. We created a low-cost, reproducible simulator using materials available in Rwanda. The simulator teaches learners to identify and reduce incarcerated bowel, stabilizing the bowel with two hands to guide it into the inguinal canal. We implemented it in the context of a structured training course on initial management of pediatric surgical conditions for Rwandan general practitioners at rural hospitals.

The design was adapted from a previously described simulator, costing $95USD, replacing components with low-cost materials totaling $0.92USD. We utilized 12-inch balloons as scrotum, water bottle necks as inguinal canal, long balloons as bowel, vinyl as skin, styrofoam as the patient, and lubricating jelly. Pre- and post-training data were analyzed using Rstudio v1.1.4.

Fifty-nine Rwandan general practitioners at rural hospitals tested the simulator. On a 5-point Likert scale, self-rated comfort with manual reduction of inguinal hernias improved from 2.95 ± 1.15 to 3.85 ± 1.2 (p < 0.001). Learners perceived that the simulation was useful, resembled real life, and should be used to train colleagues.

This simulator is effective for training Rwandan general practitioners in operative pediatric hernia repair. It can be readily assembled, allowing practical training at multiple trainee or provider levels. Simulation can be additive to instruction in developing global surgery coursework.