GNCPS Major Surgical Procedures/year (877 out of total 3374 operated cases in 2014) | Main critical issues found. | Corrective measures | Results achieved or expected within a short term | |
---|---|---|---|---|
Exstrophy/Epispadias Complex repair | 20% among Major procedures | Too frequent late referral Poor continence after primary Bladder closure. Poor quality of life Follow up facilities unavailable. | Internal Continent Urinary Diversion (Mainz II) vs Primary Bladder Closure in late referred cases, failures after primary closure | Faster postoperative recovery after Mainz II Reduced complication rate Continence always achieved in short term Better quality of life Easier follow up |
Hypospadias repair | Recurrent failures of midshaft & proximal Hypospadias management | On the job Tutorials | Reduced number of failures | |
Divided Colostomy | 37% stoma confection by Residents unsatisfactory (prolapsed, inverted, retracted, poor sited) | On the job training of Residents on Colostomy confection Re-do of failures | Residents performing 50% of new colostomies under Visiting Surgeons assistance with better results | |
PSARP for ARM & CLOACA | pre-op distal loopgram Inadequate poor distal loop preoperative cleaning PSARP procedures without nerve stimulator >60% post-op incontinence frequent post-op wound infections Post-op anal stenosis secondary to unattended dilatation regimen | on the Job training on loopgram and distal loop pre-op cleaning Nervous stimulator supplied 20 sets of Hegar dilators donated post-op Bowel Management introduced Malone conduit (MACE) for post PSARP incontinence | Residents supervising all distal loopgrams and distal loop pre-op cleaning All PSARP were done under nerve stimulator assistance Mothers, trained to do post-PSARP dilatation, paying a rental deposit to take home the dilators set Post-PSARP follow up clinic established with a Staff Nurse trained to Bowel management | |
Surgery for H.D. | X-ray imaging unreliable High risk of inappropriate pull through for Constipation without H.D. Suction rectal biopsy and Frozen section biopsy unavailable. | Prevention of surgical overtreatment of constipation Suction rectal biopsy device donated Tutorials on Radiology for H.D. Transanal de La Torre Pull-Through | Residents trained to perform Suction rectal biopsies in all cases of suspected H.D. The pathologist learning curve on suction biopsy specimens has started Residents supervising Barium enema for all suspected H.D. Visiting Surgeons assisting local Consultant doing De la Torre Pull-Through |