Medical University of Vienna, Department of Surgery, Clinical Department of Pediatric Surgery, Vienna, Austria.
Comprehensive Colorectal Center, Department of Surgery, Children's Mercy-Kansas City, Kansas City, MO 64108, USA.
J Pediatr Surg. 2021 Apr;56(4):805-810. doi: 10.1016/j.jpedsurg.2020.06.040. Epub 2020 Jul 1.
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.
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.
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.
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 IV (retrospective cohort study).
短期国际医疗服务旅行（MST）为资源有限的国家提供专业护理。关于专科 MST 后的即时和长期报告结果的数据有限。我们假设专门的协作 MST 团队和宿主机构会产生与高收入环境相当的结果。我们的主要目的是分析我们在洪都拉斯进行五年年度 MST 后，特定专科 MST 的长期手术和功能结果。
我们对 2014 年至 2018 年间接受过结直肠和骨盆重建手术的 56 名儿童进行了单机构回顾性分析。记录了人口统计学、诊断、合并症、修复类型、长期并发症以及肠和膀胱功能结果。
我们共纳入了 56 名儿童，其中 47 名患有肛门直肠畸形（ARM），9 名患有高位肛门闭锁（HD），手术时的中位年龄为 43.5 个月（17-355）。25%（22）名患者失访。23 名（60%）<5 岁的患者通过报告接受如厕训练（n=39）实现了粪便控制，5 名（45%）>5 岁的患者实现了粪便控制（n=11）。ARM 患儿中有 18 名（42.9%）和 HD 患儿中有 1 名（12.5%）发生便秘。11 名（19.6%）患者需要进行 Revision 手术以解决皮肤水平肛门狭窄。75%的参加 MST 的小儿结直肠疾病患者能够接受长期随访。
我们能够证明，通过有组织的、专门的地点和外科医生，所取得的结果可以与高收入国家（HICs）相媲美。我们得出结论，在能够建立术前评估、围手术期和术后护理系统的情况下，这种专业护理在资源有限的环境中对于患有小儿结直肠疾病的儿童是可行且有益的。
IV 级（回顾性队列研究）。
