Msosa Vanessa, Sincavage John, Henson Baker
Department of Surgery, Kamuzu Central Hospital.
Malawi Surgical Initiative, UNC Project-Malawi.
Malawi Med J. 2025 Jan 13;36(4):244-248. doi: 10.4314/mmj.v36i4.2. eCollection 2025 Jan.
An end colostomy is a potentially life-saving surgical intervention, but postoperative ostomy management is challenging in resource-limited settings. Socioeconomic, health system, and surgical capacity barriers may delay colostomy reversal. A surgery camp model for addressing the burden of unreversed colostomies has not previously been undertaken in Malawi. The study aims to present our institution's experience with the surgery camp model, assess patient outcomes, and identify improvement strategies for future efforts.
The surgery department at Kamuzu Central Hospital (KCH) carried out a two-day surgical camp in partnership with Access Health Africa (AHA) to reduce the local burden of reversible colostomies and train KCH surgery registrars in stapled end-to-end anastomosis (EEA). New, standardized preoperative and postoperative order sets for colostomy reversal were developed and implemented. Patient records were retrospectively reviewed, and descriptive analysis was performed. 13 patients underwent colostomy reversal via exploratory laparotomy. Twelve patients were male, median age was 41 (IQR 27 - 51), and average delay to reversal was 4.3 ± 6.6 months after clinical readiness.
Sigmoid volvulus was the most common indication for Hartmann's procedure (62%) among patients undergoing reversal. One major complication was reported, a return to theatre for suspected anastomotic leak with no adverse findings. Patients were discharged 5.3± 2.8 days after surgery. Operating theatre staff successfully prepared for increased surgical volume, and standard pre- and postoperative order sets remain in use. Distribution of administrative responsibility and communication between visiting and host teams were noted as targets for improvement.
Given the clinical, educational, and organizational success of the two-day surgery camp, a second, expanded effort is anticipated. Goals include inclusion of ileostomy patients, advanced notification in district facilities and clinics, and additional administrative support with case allocation, supply acquisition, and personnel coordination.
末端结肠造口术是一种可能挽救生命的外科手术干预，但在资源有限的环境中，术后造口管理具有挑战性。社会经济、卫生系统和手术能力障碍可能会延迟结肠造口还纳术。马拉维此前尚未采用手术营模式来解决未还纳结肠造口的负担问题。本研究旨在介绍我们机构在手术营模式方面的经验，评估患者预后，并确定未来工作的改进策略。
卡穆祖中央医院（KCH）外科与非洲医疗救助组织（AHA）合作开展了为期两天的手术营，以减轻当地可还纳结肠造口的负担，并培训KCH外科住院医师进行吻合器端端吻合术（EEA）。制定并实施了新的、标准化的结肠造口还纳术前和术后医嘱集。对患者记录进行回顾性审查，并进行描述性分析。1名患者通过剖腹探查术进行了结肠造口还纳术。12名患者为男性，中位年龄为41岁（四分位间距27 - 51岁），临床准备就绪后平均还纳延迟时间为4.3±6.6个月。
在接受还纳术的患者中，乙状结肠扭转是Hartmann手术最常见的指征（62%）。报告了1例主要并发症，因疑似吻合口漏返回手术室，但未发现不良情况。患者术后5.3±2.8天出院。手术室工作人员成功应对了手术量的增加，标准化的术前和术后医嘱集仍在使用。行政责任分配以及来访团队与主办团队之间的沟通被视为改进目标。
鉴于为期两天的手术营在临床、教育和组织方面取得的成功，预计将开展第二次规模更大的活动。目标包括纳入回肠造口患者、提前通知地区设施和诊所，以及在病例分配、物资采购和人员协调方面提供更多行政支持。
