Quality outcomes for pediatric colorectal surgery treated during short-term international medical service trips at a dedicated site in Honduras
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In brief
In brief
Retrospective analysis of 56 pediatric patients with anorectal malformations and Hirschsprung disease treated during annual medical service trips to Honduras demonstrates that dedicated collaborative teams can achieve functional outcomes comparable to high-income countries, with 60% continence in younger patients and 75% long-term follow-up compliance.
Written by the GCMD Library team from the article.
Abstract
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).