Title

Quality outcomes for pediatric colorectal surgery treated during short-term international medical service trips at a dedicated site in Honduras

Document Type

Journal Article

Publication Date

1-1-2020

Journal

Journal of Pediatric Surgery

DOI

10.1016/j.jpedsurg.2020.06.040

Keywords

Anorectal malformation; Cloaca; Follow-up; Hirschsprung disease; Pediatric colorectal surgery; Short-term international medical service trips

Abstract

© 2020 The Authors Introduction: Short-term international medical service trips (MSTs) provide specialized care in resource-constrained countries. There are limited data on immediate and long-term reported outcomes following specialty MST. We hypothesized that dedicated collaborative MST team and host institution produce outcomes and results comparable to those of high-income settings. Our primary aim was to analyze the long-term surgical and functional outcomes of our specialty-specific MSTs following five years of annual MST in Honduras. Methods: We performed a single-institution retrospective analysis of 56 children who underwent colorectal and pelvic reconstructive operations between 2014 and 2018. Demographics, diagnosis, comorbidities, type of repair, long-term complications, and functional bowel and bladder results were recorded. Results: We included a total of 56 children, 47 with ARM and 9 with HD, with a median age of 43.5 months (17–355) at the time of surgery. 25% (22) of the patients were lost to follow-up. Fecal continence was achieved by 23 (60%) patients < 5 years who reported toilet training (n = 39) and by 5 (45%) patients > 5 years (n = 11). Complications included constipation in 18 (42.9%) children with ARM and in 1 (12.5%) with HD. Eleven (19.6%) patients required revisional surgery for skin level anal stricture. Seventy-five percent of the patients with pediatric colorectal disorders attending the MST were compliant with continued long-term follow-up. Conclusion: We were able to demonstrate that with organized, dedicated site and surgeon, results achieved can be comparable to those in the high-income countries (HICs). We conclude that this type of specialized care is feasible and beneficial for affected pediatric colorectal patients in resource-limited settings, when a strong partnership with a system of preoperative assessments and peri- and postoperative care can be established. Level of evidence: Level IV (retrospective cohort study).

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