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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

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