SP 6.05 Consultant-Led Delivery of Common General Surgical Procedures Under Local Anaesthesia in a Low-Resource Setting: A Programme Evaluation from Sierra Leone
Hasseeb Yaqub, Syed Muzzafer Ahmad, Awais AhmadAbstract
Aims
Limited access to essential surgical services and theatre infrastructure frequently delays treatment in lower-income countries. Inguinal hernia is a common cause of morbidity here, particularly among working-age men reliant on physical labour. This programme evaluation assessed the feasibility and safety of consultant-led delivery of common general surgical procedures under local anaesthesia (LA), while supporting supervised surgical training.
Methods
A service evaluation was conducted across three UK-led outreach visits between January 2025 and January 2026. Adult patients with symptomatic groin, umbilical, or epigastric hernias and lipomas underwent open surgery under LA using a standardised technique of lidocaine and bupivacaine with adrenaline. Procedures were led by UK consultant surgeons, with registrar and junior doctor involvement. Outcomes included operative volume, anaesthetic success, peri-operative complications, procedural feasibility, and supervised training exposure.
Results
Approximately 90 patients underwent surgery across the programme, including 28 procedures performed over a four-day period on the most recent visit, of which around 70% were inguinal hernia repairs. All procedures were completed successfully under LA without conversion to general anaesthesia. No immediate peri-operative complications or early post-operative issues were recorded. Theatre activity was maintained despite intermittent electricity outages and limited resources. Operative exposure was provided for junior clinicians.
Conclusions
Consultant-led delivery of common general surgical procedures under LA is feasible and safe in lower-income countries and could be considered for routine day-case practice. This model supports high-volume essential surgery while providing structured training opportunities in low resource settings. Formalised follow-up and comparative evaluation will support wider adoption and sustainability.