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- Springer Journals
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- Copyright © The Author(s) 2023
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- 2090-5394
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- 10.1186/s43159-022-00237-5
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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 com- pared. 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. Keywords Short-term medical mission, Pediatric inguinal hernia, Pediatric surgery cooperation program, Complication rates, Surgical site infection *Correspondence: Jaime Rodríguez de Alarcón García jaime.ralarcon@gmail.com Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. Rodríguez de Alarcón García et al. Annals of Pediatric Surgery (2023) 19:5 Page 2 of 8 hydrocele, and cryptorchidism) were included. Exclusion Background criteria comprised children with generalized debilitating In short-term medical missions (STMMs), physicians, disease, infective focus, or fever. otherwise fully employed in their countries, spend short Demographic (age, sex) and anthropometric (weight, periods in lower- and middle-income countries (LMICs) height) parameters were recorded. According to age, providing unpaid service [1]. However, only a few stud- patients were divided into four groups: ≤ 12 mont ies investigating STMM efficacy have been published, hs, > 12 months to ≤ 5 years, > 5 years to ≤ 10 years, and they lack consistent terminology. Martiniuk et al. [2] and > 10 years to ≤ 18 years. To assess nutritional sta- reviewed studies concerning STMMs published between tus, weight size ratio percentile (pWS) was obtained in 1985 and 2009 in LMICs. Of 2512 studies, 230 were ana- patients younger than 5 years and divided into three cat- lyzed, with most being descriptive studies (74%) that egories: obesity if pWS is ≥ 90, normal for pWS between seldom addressed issues such as ethical conflicts or the 90 to ≥ 10, and malnourished for pWS of < 10. In patients evaluation of clinical outcomes. older than 5 years, body mass index percentile (pBMI) Without questioning the humanitarian value of these was calculated, and patients were categorized into three campaigns, it is important to determine the clinical effi - groups: Obesity (pBMI of ≥ 97), normal (pBMI of 97 cacy of STMMs and evaluate the quality of care provided. to ≥ 10), and malnourished (pBMI of < 10). This catego - Such analyses should also serve to identify any program- rization was made based on World Health Organization matic weaknesses and refine improvement strategies. 2006/2007 tables [7] and according to available guide- Our group has been conducting surgical cooperation lines [8]. The pre-operative examination included serol - campaigns in Equatorial Guinea for > 15 years in collab- ogy for malaria, human immunodeficiency virus (HIV), oration with the non-governmental organization, SOS hepatitis B virus (HBV), and hepatitis C virus (HCV), Children’s Villages. These expeditions focus on resolving and determination of hemoglobin levels (Hb). Addition- frequent pediatric pathologies that generate morbidity ally, any relevant previous medical history and adher- or disability, are relatively simpler to treat, and have few ence to the local vaccination schedule were noted. If an complications. We have mainly treated inguinal hernia inguinal hernia or hydrocele was significantly larger than and its associated conditions (hydrocele and cryptor- that observed in usual practice in Spain, as assessed by chidism). Inguinal hernia is a highly prevalent condition, two different surgeons, this was also recorded (Figs. 1 especially in Africa [3], and several studies have shown and 2). that inguinal hernia surgery programs are cost-effec - Complications were assessed intra-operatively, prior tive [4]. Saxton et al. [5] showed in a systematic review to discharge (24-h post-operatively), and at 7-day and of children surgical care in LMICs that inguinal hernia 6-month follow-ups. Parents were instructed to make repair has the lowest cost effectiveness ratio, consider - an unscheduled visit if there was any sign of compli- ing that inguinal hernia repair should be considered an cations, and unscheduled visits were also noted. If a essential children’s surgical procedure based on its great patient did not attend a follow-up appointment, contact economic value. Other studies shown also that can be was made through telephone. Complications were cat- delivered at the appropriate quality standards and have a egorized as intraoperative if happened during surgery, relevant effect on the quality of life [6]. The main goal of this study was to evaluate complica - tion rates in hernia and related conditions surgery in a pediatric age group and establish and analyze strategies to reduce them. The secondary goal was to assess the fol - low-up capacity of the patients enrolled in the coopera- tion program. Patients and methods We conducted an analytical observational prospective cohort study with two patient cohorts (group A [n = 94 patients; years 2017–2018] and group B [n = 62 patients; year 2019]) treated during cooperation campaigns under- taken at the SOS Children’s Village facilities in Bata, Equatorial Guinea. All patients aged < 18 years who had been treated dur- ing 2017, 2018, and 2019 in the referred campaigns for Fig. 1 Giant hernia uncomplicated congenital inguinal pathology (hernia, R odríguez de Alarcón García et al. Annals of Pediatric Surgery (2023) 19:5 Page 3 of 8 and infectious diseases were not available for control group, since it is not considered at this center proto- col for ambulatory procedures in otherwise healthy patients. Regarding surgical technique the same proce- dures were used for each diagnosis in groups A, B and Control group. In stage 2, we compared group A and B complication rates, in latter group the peri-operative protocol was modified to include the administration of a prophylactic dose of pre-operative antibiotic (intravenous amoxicillin- clavulanic acid, 30 mg/kg), which was not administered in group A and the control group, according to the avail- able evidence and guidelines [11]. Data analysis was performed using SPSS version 11.1 Fig. 2 Giant hernia for Windows software (SPSS Inc., Chicago, IL, USA). A two-sample chi-square test was used to compare the groups. Statistical significance was set at a P value of ≤ 0.05. early if occurred during the first week and late if hap - pened after the 7th day. Loss-to-follow-up (early or late) was also noted, and follow-up capacity was evalu- Results ated. Early post-operative complications were defined Group A comprised 94 patients (males, 84%). The larg - as surgical site infection (SSI), symptomatic hematoma, est age group (1–5 years) accounted for 41.49% of the symptomatic hydrocele, post-operative disabling pain, total patients, and 52.13% had unilateral hernia. Four- or significant post-operative nausea/vomiting, during teen patients had hernias or hydroceles considered larger the first week after surgery. Possible late complications than usual. The incidence of malnourishment and obesity were recurrence, hydrocele, hypertrophic/keloid scar- was 7.45% and 36.17%, respectively. Regarding infectious ring, or testicular atrophy. diseases, malaria was diagnosed and treated preopera- All patients with inguinal hernias underwent a stand- tively in 25.53% of patients in group A. Anemia, defined ard open approach, involving high ligation of the her- as hemoglobin levels < 11 g/dL in 6 to 59 month age nia sac and Ferguson repair of the inguinal canal, if group; < 11.5 g/dL in 5 to 11 years group; < 12 g/dL in 12- needed, using absorbable sutures [9]. For orchidopexy, to 14-year group; < 12 g/dL in non-pregnant women over the Shoemaker technique was performed [10]. General 15 years old and < 13 g/dL in males older than 15 years anesthesia with locoregional or caudal epidural block old [12], was found in 53.19% of patients in group A depending on age was performed in every patient. The (Table 1). About 60.6% had complete accomplishment of operating facilities were set up by the members of the vaccine calendar. expedition and all effort was made to comply with the Stage 1 compared the complication rates in group best standards of practice. A with those in a control group from a tertiary center A two-stage study was conducted. In stage 1, we ana- in Spain. Group A had an overall complication rate lyzed group A’s complication rate and was compared of 21.28%, compared with 5.85% of the control group with a cohort of historical controls from Hospital (p < 0.001). The SSI rates in group A and the control Clínico San Carlos in Madrid, Spain (control group). group were 7.45% and 0.53%, respectively (p = 0.012). Control group data were obtained through a review Seven patients in group A developed SSIs during the first of relevant medical records. A case–control ratio of 7 days post-operatively, only one of them had undergone 1:2 was considered and matched according to age bilateral surgery (Table 2). In the < 12-month age group, group: ≤ 12 months , > 12 months to ≤ 5 years , > 5 years two of seven patients presented with SSIs. Of those to ≤ 10 years , > 10 years to ≤ 18 years; sex; and pathol- assessed as having large hernias or hydroceles (n = 14), ogy. For bilateral involvement, a control with simi- five patients (36%) had complications (SSI, n = 2; hema- lar characteristics was chosen. Controls were selected toma, n = 2; deferential injury, n = 1). through non-randomized sampling and choosing the Regarding follow-up, eight patients (8.51%) in group first patient who had undergone surgery in the last A did not attend the 7-day post-operative follow-up 4 years who met the matching criteria, who had at least appointment; however, these patients were contacted via 6 months of follow-up, and who had not been previ- the telephone, and they reported no major complications. ously selected. Hemoglobin levels, nutritional status Rodríguez de Alarcón García et al. Annals of Pediatric Surgery (2023) 19:5 Page 4 of 8 Table 1 Comparison of demographics between groups A and B Characteristics Group A Group B P value Control group (n = 94) (n = 62) A vs B (n = 188) Males 79 (84.04%) 51 (82.26%) 0.770 158 (88.04%) Malnourished 7 (7.45%) 6 (9.68%) 0.79 N/A Overweight 34 (36.17%) 12 (19.35%) N/A Anemia 50 (53.19%) 41 (66.13%) 0.032 N/A Malaria 24 (25.53%) 14 (22.58%) 0.674 N/A HIV 1 (1.06%) 0 0% 0.523 N/A HBV 4 (4.26%) 2 (3.23%) 1.000 N/A HCV 2 (2.13%) 0 0% 0.518 N/A Age group < 12 months 7 (7.45%) 6 (9.68%) 0.275 14 (7.45%) 1–5 years 39 (41.49%) 27 (43.55%) 78 (41.49%) > 5 to 10 years 32 (34.04%) 13 (20.97%) 64 (34.04%) > 10 years 16 (17.02%) 16 (25.81%) 32 (17.02%) Diagnoses Inguinal hernia Unilateral 49 (52.13%) 38 (61.29%) 0.336 98 (52.13%) bilateral 7 (7.45%) 5 (8.06%) 0.887 14 (7.45%) Hydrocele Unilateral 17 (18.09%) 10 (16.13%) 0.752 34 (18.09%) Bilateral 3 (3.19%) 0 0% 0.277 6 (3.19%) Giant hernia or hydrocele 14 (14.89%) 4 (6.45%) 0.106 0 Cryptorchidism Unilateral 18 (19.15%) 0 (0%) 0.133 36 (19.15%) Bilateral 6 (6.38%) 3 (4.84%) 0.061 12 (6.38%) HIV Human immunodeficiency virus, HBV Hepatitis B virus, HCV Hepatitis C virus N/A No data available Twenty-one patients (22.34%) did not attend the 6-month follow-up appointment and could not be contacted. Table 2 Complication incidence distributed between study Group B comprised 62 patients (82.26% males) treated groups during the campaign of 2019. A preoperative antibiotic Complications Control group Group AGroup B prophylaxis with amoxicillin-clavulanic acid was admin- (n = 188) (n = 94) (n = 62) istered to every patient during anesthetic induction, as the selected strategy to reduce SSI rate. As observed Early in Group A, the largest age group (1–5 years) which Intraoperative included 43.55% of patients, had unilateral hernia as the Iatrogenic vasectomy 0 (0%) 2 (2.13%) 0 (0%) most common diagnosis, including 61.29% of patients. During first week Four patients had large hernias or hydroceles (Table 1). SSI 1 (0.53%) 7 (7.45%) 1 (1.61%) Approximately 9.68% of patients were considered mal- Hematoma 2 (1.06%) 5 (5.32%) 4 (6.45%) nourished and 19.35% were overweight. Malaria was also Wound dehiscence 1 (0.53%) 2 (2.13%) 0 (0%) the most common infectious disease in group B, with Other (pain, inflamma- 2 (1.06%) 1 (1.06%) 2 (3.23%) tion) 22.58% of patients diagnosed and treated preoperatively, Late 66.13% had anemia, and 30.65% accomplished the vac- Relapse 3 (1.6%) 2 (2.13%) N/D cine calendar, while the rest of them had an unknown or Hypertrophic scar 2 (1.065) 1 (1.06%) N/D uncomplete status. Total 11 (5.85%) 20 (21.28%) 7 (11.29%) In group B, all patients attended the first follow-up appointment. The second follow-up appointment was SSI Surgical site infection canceled, given the impossibility of undertaking the Antibiotic prophylaxis R odríguez de Alarcón García et al. Annals of Pediatric Surgery (2023) 19:5 Page 5 of 8 2020 campaign owing to restrictions due to the COVID- 19]; however, no robust evidence has been published to 19 pandemic. Table 1 presents the comparison between support this suggestion [3]. group A and B demographics, pathology, and diagnosis. Inguinal hernia repair is a frequent target of STMMs, Comparing both groups, only anemia shown a statisti- as it is a common condition affecting quality of life. It cally significant rate. is relatively simple to correct, involving a cost-effective At stage 2, complication rates between groups A and B procedure, even in low-resource scenarios [5], with were compared. As group B couldn’t be assessed for late few reported complications and can be undertaken to complications in the second follow-up appointment, only accomplish appropriate high-quality standards [19]. those during the first week were included. This study showed a higher complication rate than Early complication rates were 18.08% in group A and expected, especially in group A, with an SSI rate of 11.29% in group B (p = 0.350). SSI rates were 7.45% in 7.45%. Excluding SSI and late complications that could group A and 1.61% in group B. The addition of antibi - not be assessed in group B owing to restrictions due to otic prophylaxis in Group B did not achieved a statisti- the COVID-19 pandemic, similar early complication cal significance between SSI rates of groups (p = 0.150), rates were observed in both groups (group A, 10.63%; despite a reduction in the absolute frequency of com- group B, 9.67%), which were higher than found in our plications and SSI rates were observed in this group B. control group (2.65%), meaning that the major impact Four patients presented with symptomatic hematoma in those differences may be due precisely to SSI rate. In in group B, one of whom required surgical treatment group A, two of seven patients from the < 12 months (Fig. 3). age group (29%) developed SSI. This may be related to The overall incidence of complications in each group is the use of diapers and worse surgical wound hygienic summarized in Table 2. care in these patients. The same age group with a simi - lar number of patients presented no SSI in group B, Discussion where antibiotic prophylaxis was administered as the Inguinal hernia, hydrocele, and cryptorchidism are simi- finally implemented strategy in order to reduce the lar entities with patency of the processus vaginalis as a most frequently reported complication in group A. common feature [13]. Furthermore, 26% of cryptorchidic Five of 14 patients (36%) with “big” hernias or hydro- testicles are associated with inguinal hernia [14] and 25% celes had complications in group A, while none of the with hydrocele [15]. The surgical approaches are similar, four patients considered in group B had any complica- involving dissection and proximal ligation of the proces- tion. It remains unclear whether this could be related to sus vaginalis after separating it from the spermatic cord, antibiotic prophylaxis or due to the small sample size; or the round ligament in the case of a female patient with further studies with larger groups should specially con- a Nuck cyst [16]. sider younger children with larger hernias or hydroce- Together, these common surgical conditions in chil- les. Those “big” hernias could have higher complication dren are an important cause of morbidity and disability rates due necessity of wider dissection and bigger skin [5]. The overall incidence of inguinal hernia ranges from incisions. Given the absence of giant hernias in con- 0.8 to 5.0%, increasing to 30% in preterm infants [17]. trol group, the role of hernia size in complication rates Several studies have suggested that this incidence rate remains unclear. may be higher in sub-Saharan African populations [18, Vas deferens injury is uncommon in our practice and there were no cases observed in the control group. Two patients in group A who had iatrogenic vasectomy that was noticed and repaired during surgery, and it was the only intraoperative complication recorded. This may be attributed to the surgeons’ fatigue owing to long working hours for many days or particularly challenging cases. The sample size in this study is insufficient to deter - mine if any other demographic, biometric, or analyti- cal parameters have a direct effect on complication or SSI rates. Bucher et al. [20] suggested that developmen- tal, socioeconomic, and genetic parameters could be involved in higher SSI rates in some patients. Published complication rates for pediatric ingui- nal hernia differ substantially, probably due to vary - Fig. 3 Hematoma in a 16-year-old boy after hidrocelectomy, which required surgical drainage ing conditions in each study and different definitions Rodríguez de Alarcón García et al. Annals of Pediatric Surgery (2023) 19:5 Page 6 of 8 Table 3 Complication rates reported in different studies and rates found in this study b d Omar Nagraj Bamigbola et al. Erdogan Askapour Javaid Chu Control group Group AGroup B a c et al et al. et al et al Et al et al. Year 2004 2006 2012 2013 2013 2018 2019 2021 2017–2018 2019 Country Libya UK Nigeria Turkey Iran Pakistan China Spain Eq. Guinea Eq. Guinea Number of patients 827 125 41 3776 269 241 3006 188 94 62 Complication rate 6.6% 18.4% 24.4% 12% 5.2% 17.01% 1.4% 5.8% 21.3% 11.2% SSI 1.9% 2.3% 14.4% 0.6% 0.4% 0% 0.3% 0.5% 7.5% 1.6% Weight < 5 kg Complicated hernias Laparoscopic or open surgery with patch Antibiotic prophylaxis of complications (Table 3) [21–27]. General complica- studies have not provided high-quality evidence con- tion rates range from 1.4 to 17.0% in LMICs, but stud- cerning antibiotic prophylaxis use. Osuigwe et al. [31] ies related to complicated hernias in preterm or newborn published a randomized double-blinded study to evalu- patients have reported even higher complications and ate the need for prophylactic antibiotics in pediatric day- SSI rates [22, 23]. Also, group A showed a higher SSI rate case surgery in Nigeria; the study showed 4.3% and 5% than other studies form LMICs. SSI rates with and without antibiotics, respectively. In a Only few reports compare hernia repair results from randomized prospective study in India, the SSI rate was cooperation campaign in LMICs with data obtained from 3.73% and 2.22% in the case and control groups, respec- higher income countries. Gil et al. [19] compared differ - tively (P = 0.702) [32]; however, another study suggested ent effectiveness and quality indicators in campaigns in that, under certain conditions, antibiotic prophylaxis in Cameroon and Mali with a cohort from a tertiary center combination with occlusive dressings would likely pre- in Spain in adult populations. Despite the heterogeneity vent SSI [33]. In a systematic review, Murni et al. [34] of groups and lack of health infrastructure in the African found that the most effective measure to reduce nosoco - setting, they described similar complication rates and mial infection was the implementation of hand hygiene clinical outcomes. Some opportunities for improvement campaigns, which we will also implement in further were considered, like increasing the follow-up at dis- campaigns. Cooper et al. [35] concluded that inter- charge by local health agents. To the best of our knowl- ventions to prevent SSI should be adapted to the local edge, no previous results on STMM have been published context considering particular conditions, such as local regarding pediatric inguinal hernia; therefore, a com- antimicrobial resistance or education of patients regard- parison using previous studies could not be undertaken, ing antibiotic use. given the very particular conditions of our group. We In this study, the SSI rate was reduced from 7.5 to 1.6% considered the goal of complication rates in our mission with antibiotic prophylaxis use. While not statistically to be the same that those in our regular practice in the significant, maybe due to insufficient study sample, so we most similar patient cohort, as done in this study. intend to include larger patient groups in further studies Given the high complication and SSI rates found in to determine the effect of this intervention more clearly. this study, further efforts to reduce these, particularly, Other measures, such as hand hygiene campaigns, the the SSI rate, were proposed. At clean pediatric surgi- use of triclosan coated sutures [36], or changing the sur- cal procedures, the risk of SSI is extremely low, the gical dressing protocol, also must be evaluated. unnecessary use of antibiotics in children could cause Regarding follow-up, 20% of patients in group A did not deleterious adverse events and promote antimicrobial attend the 6-month appointment, and we were unable to resistance, so according to current evidence and guide- contact these patients via the telephone. While the com- lines, prophylactic antibiotics are not recommended for plication rate at 6 months was low (recurrent hydrocele, pediatric herniotomy or orchiopexy [28, 29], but after n = 2; hypertrophic scarring, n = 1), the relatively high the preliminar analysis of group A antibiotic prophylaxis loss-to-follow-up rate indicates that we should consider was considered to be included in the protocol. Zam- changing the follow-up protocol before including more kowski et al. [30] recommended that antibiotic prophy- complex pathologies in our program for which closer or laxis should be considered even in low-risk patients longer follow-up times would be required. Shorter time if SSI rates above 4% are found. Previously published between appointments may lead to better outcomes. R odríguez de Alarcón García et al. Annals of Pediatric Surgery (2023) 19:5 Page 7 of 8 Availability of data and materials This study is limited by the number of patients The authors confirm that the data supporting the findings of this study are included in each group. COVID-19 had a relevant available from the corresponding author upon request. impact also in cooperation abroad programs, and our campaigns are temporary stopped, so we could not Declarations assess long-term follow-up or include more patients in Ethics approval and consent to participate group B as was initially considered. Larger groups could Written informed consent was obtained from the patients/parents/guardians help to determine the role of antibiotic prophylaxis to for their participation in the study, and for the publication of patient data prevent SSI, as the contribution of demographic or ana- and photographic images. Patients’ data and identification were anonymized prior to analysis. The study was approved by the Ethics Committee at Hospital tomical factors on complication rates. Also, working Clínico San Carlos in Madrid, Spain, with registration number 20–632 E. in a foreign environment with limited resources along with language and social barriers makes it difficult to Consent for publication As referred above. collect and analyze other factors that may affect com - plication rates, such as personal hygiene, socioeco- Competing interests nomic status, or surgical wound care at home. Further The authors declare that they have no competing interests. studies should also consider even closer collaboration Author details with local agents to enable identification of patients Department of Pediatric Surgery, Hospital Clínico San Carlos, Madrid, Spain. 2 3 with higher complication rates risk and to focus efforts Medical Faculty, Universidad Francisco de Vitoria, Madrid, Spain. Depar tment of Pediatric Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain. on their prevention. Department of Pediatric Surgery, Hospital Infantil Universitario Niño Jesús, Madrid, Spain. Department of Anesthesiology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain. Department of Anesthesiology, Hospital Univer- Conclusion 7 sitario de la Princesa, Madrid, Spain. Medical Center, SOS Children’s Villages, While STMMs are undertaken in more challenging con- Bata, Equatorial Guinea. ditions, clinical data collection and analysis are feasible Received: 9 June 2022 Accepted: 21 December 2022 and desirable. The high complication rate found in this study has led us to review and adapt specific protocols. Antibiotic prophylaxis did not significantly affect SSI rates in our study; however, further studies with larger References groups are needed to confirm this result. The loss-to- 1. Caldron PH, Impens A, Pavlova M, Groot W. A systematic review of social, economic and diplomatic aspects of short-term medical missions. BMC follow-up rate in this campaign was high. Therefore, the Health Serv Res. 2015;15(15):380. implementation of patient loyalty programs is needed to 2. Martiniuk ALC, Manouchehrian M, Negin JA, Zwi AB. Brain Gains: a litera- assess long-term complications. ture review of medical missions to low and middle-income countries. BMC Health Serv Res. 2012;29(12):134. 3. Ohene-Yeboah M, Abantanga FA. Inguinal hernia disease in Africa: a com- mon but neglected surgical condition. West Afr J Med. 2011;30(2):77–83. Abbreviations 4. Eeson G, Birabwa-Male D, Pennington M, Blair GK. Costs and cost- SSI Surgical site infection effectiveness of pediatric inguinal hernia repair in Uganda. World J Surg. STMMs Short-term medical missions 2015;39(2):343–9. LMICs Lower- and middle-income countries 5. Saxton AT, Poenaru D, Ozgediz D, Ameh EA, Farmer D, Smith ER, et al. pWS Weight size ratio percentile Economic analysis of children’s surgical care in low- and middle- pBMI Body mass index percentile income countries: a systematic review and analysis. PLoS ONE. HIV Human immunodeficiency virus 2016;11(10):e0165480. HBV Hepatitis B virus 6. Gil J, Rodriguez JM, Gil E, Hernández Agúera Q, González FM, García JA, HCV Hepatitis C virus et al. The usefulness of international cooperation in the repair of inguinal Hb Hemoglobin hernias in Sub-Saharan Africa. World J Surg. 2015;39(11):2622–9. 7. WHO Western Pacific. World Health Organization. Philippines: World Acknowledgements Health Organization Western Pacific Region; c2021. Nutrition. 2022. Avail- To Gumersindo Ndong and all the people from SOS children´s village in Bata, able from: https:// www. who. int/ weste rnpac ific/ health- topics/ nutri tion. Equatorial Guinea, for his help with this study’s program, but most of all, for cited 2022 May 27 their friendship. 8. Cantón O, Ferreiro S, Bautista S. Guía de Nutrición Pediátrica Hospitalaria [Guide to Pediatric Hospital Nutrition]. 5 . spain: Ergon; 2021. 02–06 p. Authors’ contributions 9. Glick PL, Boulanger SC. Chapter 76 - Inguinal hernias and hydroceles. JRAG and AU were the major contributors in writing the manuscript, and a In: Coran AG, editor. Pediatric Surgery (Seventh Edition). 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Journal
Annals of Pediatric Surgery – Springer Journals
Published: Jan 10, 2023
Keywords: Short-term medical mission; Pediatric inguinal hernia; Pediatric surgery cooperation program; Complication rates; Surgical site infection