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Rodríguez de Alarcón García J, Úbeda Pascual A, Fanjul Gómez M, Morató Robert P, Espinosa Góngora R, Martínez García E, Román Guerrero C, Abaga Abaga SJ, Soto Beauregard C. Analyzing complications and implementing solutions in a pediatric inguinal hernia cooperation program in Equatorial Guinea: a prospective cohort study. ANNALS OF PEDIATRIC SURGERY 2023; 19:5. [PMID: 36644327 PMCID: PMC9830599 DOI: 10.1186/s43159-022-00237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background Few studies have evaluated the efficacy of short-term medical missions. This study was aimed to evaluate complication rates and determine the effects of protocol changes in a pediatric inguinal hernia campaign in Equatorial Guinea and analyze post-operative follow-up capacity. Methods In this prospective observational cohort study, we evaluated two patient cohorts (group A, 2017-2018; group B, 2019) treated during campaigns in Equatorial Guinea for congenital inguinal pathology (hernia, hydrocele, and cryptorchidism). Patients aged < 18 years treated in referral campaigns were included. Complications occurring up to 6 months post-operatively were evaluated. Two stages were defined: Stage 1, wherein, complication rate in group A was compared to that in a control group from a tertiary hospital in Spain (with a case-control ratio of 1:2, paired according to age, sex and diagnosis); stage 2, wherein, complication rates between groups A and B were compared. Group B received a single dose of prophylactic amoxicillin-clavulanic acid. Follow-up capacity was assessed through follow-up appointments. Results In stage 1, complication and surgical site infection (SSI) rates were 21.3% and 7.4% in group A (n = 94), and 5.8% (p < 0.001) and 0.5% (p = 0.012) in the control group, respectively. Group A had 20.2% loss-to-follow-up. In group B (n = 62), 6-month postoperative follow-up could not be assessed owing to restrictions due to the COVID-19 pandemic, so only early complications were considered in stage 2, were complication and surgical site infection rates were 18.1% and 7.4% in group A and 11.3% (p = 0.350) and 1.6% (p = 0.150) in group B. Conclusion Our results showed higher than expected complication rates. Pre-operative prophylactic antibiotic could not show to reduce SSI. Further studies are needed to reduce complication rates in these campaigns. Patient loss-to-follow-up ratio warrants considering new strategies.
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Affiliation(s)
- Jaime Rodríguez de Alarcón García
- grid.411068.a0000 0001 0671 5785Department of Pediatric Surgery, Hospital Clínico San Carlos, Madrid, Spain ,grid.449795.20000 0001 2193 453XMedical Faculty, Universidad Francisco de Vitoria, Madrid, Spain
| | - Amalia Úbeda Pascual
- grid.449795.20000 0001 2193 453XMedical Faculty, Universidad Francisco de Vitoria, Madrid, Spain
| | - María Fanjul Gómez
- grid.410526.40000 0001 0277 7938Department of Pediatric Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Morató Robert
- grid.411107.20000 0004 1767 5442Department of Pediatric Surgery, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Rocío Espinosa Góngora
- grid.411107.20000 0004 1767 5442Department of Pediatric Surgery, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ernesto Martínez García
- grid.411107.20000 0004 1767 5442Department of Anesthesiology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Carlos Román Guerrero
- grid.411251.20000 0004 1767 647XDepartment of Anesthesiology, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Carmen Soto Beauregard
- grid.411068.a0000 0001 0671 5785Department of Pediatric Surgery, Hospital Clínico San Carlos, Madrid, Spain
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Martinez JG, González M, Hernández Q, Rodríguez MA, Torregrosa N, Gil E, Cascales PA, Delgado MA, Sancho J, Lopez‐Lopez V, Rodriguez JM. Goiter surgery recommendations in sub‐Saharan Africa in humanitarian cooperation. Laryngoscope Investig Otolaryngol 2022; 7:417-424. [PMID: 35434333 PMCID: PMC9008146 DOI: 10.1002/lio2.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- José Gil Martinez
- Department of General Surgery University Clinical Hospital Virgen de la Arrixaca Murcia Spain
| | - Miguel González
- Department of General Surgery University Hospital Reina Sofia Murcia Spain
| | - Quiteria Hernández
- Department of General Surgery University Clinical Hospital Virgen de la Arrixaca Murcia Spain
| | - María Angeles Rodríguez
- Department of Maxillofacial Surgery University Clinical Hospital Virgen de la Arrixaca Murcia Spain
| | - Nuria Torregrosa
- Endocrine Surgery Unit, Department of General Surgery General University Hospital Santa Lucía Cartagena Spain
| | - Elena Gil
- Department of General Surgery University Clinical Hospital Virgen de la Arrixaca Murcia Spain
| | - Pedro Antonio Cascales
- Department of General Surgery University Clinical Hospital Virgen de la Arrixaca Murcia Spain
| | - Miguel Angel Delgado
- Endocrine Surgery Unit, Department of General Surgery Getafe University Hospital Getafe Spain
| | - Joan Sancho
- Endocrine Surgery Unit, Department of General Surgery Consorci Parc de Salut Mar de Barcelona Barcelona Spain
| | - Victor Lopez‐Lopez
- Department of General Surgery University Clinical Hospital Virgen de la Arrixaca Murcia Spain
| | - Jose Manuel Rodriguez
- Endocrine Surgery Unit, Department of General Surgery University Clinical Hospital Virgen de la Arrixaca Murcia Spain
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Lopez-Lopez V, Morales A, García-Vazquez E, González M, Hernandez Q, Baroja-Mazo A, Palazon D, Tortosa JA, Rodriguez MA, Torregrosa NM, Kanyi W, Ndungu JK, Martinez JG, Rodriguez JM. Humanitarian Surgical Missions in Times of COVID-19: Recommendations to Safely Return to a Sub-Saharan Africa Low-Resource Setting. World J Surg 2021; 45:1297-1305. [PMID: 33611661 PMCID: PMC7896831 DOI: 10.1007/s00268-021-06001-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 12/03/2022]
Abstract
Background Since the declaration of the pandemic, humanitarian medicine has been discontinued. Until now, there have been no general recommendations on how humanitarian surgical missions should be organized. Methods Based on our experience in the field of humanitarian surgical missions to Sub-Saharan Africa, a panel of recommendations in times of COVID-19 was developed. The fields under study were as follows: (1) Planning of a multidisciplinary project; (2) Organization of the infrastructure; (3) Screening, management and treatment of SARS-COV-2; (4) Diagnostic tests for SARS-COV-2; (5) Surgical priorization and (6) Context of patients during health-care assistance. We applied a risk bias measurement to obtain a consensus among humanitarian health-care providers with experience in this field. Results A total of 94.36% of agreement were reached for the approval of the recommendations. Emergency surgery must be a priority, and elective surgery adapted. For emergency surgery, we established a priority level 1a (< 24 h) and 1b (< 72 h). For an elective procedure, according our American College of Surgeon adaptation score, process with more than 60 points should be reconsidered. Due to the low life expectancy in many African countries, we consider 45–50 years as age of risk. In case of SARS-COV-2 active infection or high clinical suspicion, the screening, management and treatment should be following the international guidelines adapted to duration of the stay, available infrastructure, size of the cooperation team and medical resources. Conclusions Humanitarian surgical mission in times of COVID-19 is a challenge that must extrapolate the established recommendations to the local cooperation environment. Supplementary Information The online version contains supplementary material available at (10.1007/s00268-021-06001-x).
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Affiliation(s)
- Víctor Lopez-Lopez
- Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, El Palmar, Murcia, Spain.
| | - Ana Morales
- Department of Neurology, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Elisa García-Vazquez
- Department of Internal Medicine, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Miguel González
- Department of Surgery, Reina Sofía University Hospital, Murcia, Spain
| | - Quiteria Hernandez
- Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Alberto Baroja-Mazo
- Digestive and Endocrine Surgery and Transplantation of Abdominal Organs, Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Dolores Palazon
- Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Jose A Tortosa
- Department of Anesthesiology, Molina Hospital, Murcia, Spain
| | - Maria A Rodriguez
- Department of Maxilofacial Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Nuria M Torregrosa
- Department of Surgery, Santa Lucía University Hospital, Cartagena, Murcia, España
| | | | - J K Ndungu
- Department of Surgery Maragua Hospital, Maragua, Kenia
| | - José Gil Martinez
- Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - José M Rodriguez
- Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, El Palmar, Murcia, Spain
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Agbakwuru EA, Olasehinde O, Onyeze CI, Etonyeaku AC, Mosanya AO, Wuraola FO, Akinkuolie AA, Aderounmu AA, Adisa AO. Use of commercial mesh for hernia repair in a low resource setting: experience after 500 cases. Hernia 2019; 24:613-616. [PMID: 31129796 DOI: 10.1007/s10029-019-01987-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/17/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND The use of mesh has revolutionized the management of hernias in many parts of the world. There is, however, limited experience on its use in sub-Saharan Africa. This study describes a single hospital experience after 500 cases of mesh hernia repairs in a sub-Saharan African country. METHODS We reviewed the records of the first 500 cases of abdominal wall hernia operations performed using commercial mesh since year 2007. Socio-demographic characteristics, hernia type, method of repair and outcome data were analyzed and presented as descriptive statistics. RESULTS The first 500 cases of mesh hernia repairs were performed between 2007 and 2017 during which a total of 1,175 hernia operations were carried out, mesh repair accounting for 42.5% of the total. There was a progressive rise in the uptake of mesh repairs over time, with mesh repairs overtaking tissue based repairs in the last few years of the review. Inguinal hernia was by far the commonest indication for mesh use (80.4%), followed by incisional hernia (9%). Polypropylene mesh was the most common type of mesh used in about 96.2% of cases. Overall, there were seven recurrences (1.4%) at a mean follow-up period of 15.3 months (1-108 months) CONCLUSION: In spite of resource limitations, the use of mesh for hernia repairs continues to rise and has overtaken tissue-based repairs in a sub-Saharan African setting. Results show good outcomes justifying continued use.
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Affiliation(s)
- E A Agbakwuru
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - O Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria.
| | - C I Onyeze
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - A C Etonyeaku
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - A O Mosanya
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - F O Wuraola
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - A A Akinkuolie
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - A A Aderounmu
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - A O Adisa
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
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Cooperación en cirugía en el siglo XXI. Cir Esp 2018; 96:466-472. [DOI: 10.1016/j.ciresp.2018.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 12/29/2022]
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Surgical Site Infections after Inguinal Hernia Repairs Performed in Low- and Middle-Human Development Index Countries: A Systematic Review. Surg Infect (Larchmt) 2018; 19:11-20. [DOI: 10.1089/sur.2017.154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Uribe-Leitz T, Jaramillo J, Maurer L, Fu R, Esquivel MM, Gawande AA, Haynes AB, Weiser TG. Variability in mortality following caesarean delivery, appendectomy, and groin hernia repair in low-income and middle-income countries: a systematic review and analysis of published data. LANCET GLOBAL HEALTH 2017; 4:e165-74. [PMID: 26916818 DOI: 10.1016/s2214-109x(15)00320-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/25/2015] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgical interventions occur at lower rates in resource-poor settings, and complication and death rates following surgery are probably substantial but have not been well quantified. A deeper understanding of outcomes is a crucial step to ensure that high quality accompanies increased global access to surgical care. We aimed to assess surgical mortality following three common surgical procedures--caesarean delivery, appendectomy, and groin (inguinal and femoral) hernia repair--to quantify the potential risks of expanding access without simultaneously addressing issues of quality and safety. METHODS We collected demographic, health, and economic data for 113 countries classified as low income or lower-middle income by the World Bank in 2005. We did a systematic review of Ovid, MEDLINE, PubMed, and Scopus from Jan 1, 2000, to Jan 15, 2015, to identify studies in these countries reporting all-cause mortality following the three commonly undertaken operations. Reports from governmental and other agencies were also identified and included. We modelled surgical mortality rates for countries without reported data using a two-step multiple imputation method. We first used a fully conditional specification (FCS) multiple imputation method to establish complete datasets for all missing variables that we considered potentially predictive of surgical mortality. We then used regression-based predictive mean matching imputation methods, specified within the multiple imputation FCS method, for selected predictors for each operation using the completed dataset to predict mortality rates along with confidence intervals for countries without reported mortality data. To account for variability in data availability, we aggregated results by subregion and estimated surgical mortality rates. FINDINGS From an initial 1302 articles and reports identified, 247 full-text articles met our inclusion criteria, and 124 provided data for surgical mortality for at least one of the three selected operations. We identified 42 countries with mortality data for at least one of the three procedures. Median reported mortality was 7·9 per 1000 operations for caesarean delivery (IQR 2·8-19·9), 2·2 per 1000 operations for appendectomy (0·0-17·2), and 4·9 per 1000 operations for groin hernia (0·0-11·7). Perioperative mortality estimates by subregion ranged from 2·8 (South Asia) to 50·2 (East Asia) per 1000 caesarean deliveries, 2·4 (South Asia) to 54·0 (Central sub-Saharan Africa) per 1000 appendectomies, and 0·3 (Andean Latin America) to 25·5 (Southern sub-Saharan Africa) per 1000 hernia repairs. INTERPRETATION All-cause postoperative mortality rates are exceedingly variable within resource-constrained environments. Efforts to expand surgical access and provision of services must include a strong commitment to improve the safety and quality of care. FUNDING None.
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Affiliation(s)
| | | | - Lydia Maurer
- Stanford University School of Medicine, Stanford, CA, USA
| | - Rui Fu
- Management Science and Engineering, Stanford University, Stanford, CA, USA
| | | | - Atul A Gawande
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Alex B Haynes
- Ariadne Labs: a Joint Center for Health System Innovation, Boston, MA, USA; Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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