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Table 2 Quality Assurance of Surgical Standards for selected complex pediatric procedures

From: Improving standard of pediatric surgical care in a low resource setting: the key role of academic partnership

Major Surgical Procedures/year
(877 out of total 3374 operated cases in 2014)
Main critical issues found.Corrective measuresResults achieved or expected within a short term
Exstrophy/Epispadias Complex repair20% among Major proceduresToo 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 closureFaster postoperative recovery after Mainz II
Reduced complication rate
Continence always achieved in short term
Better quality of life
Easier follow up
Hypospadias repairRecurrent failures of midshaft & proximal Hypospadias managementOn the job TutorialsReduced number of failures
Divided Colostomy37% 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 & CLOACApre-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