Report on the 2017 Paediatric Colorectal Conference

Timothy Jumbi1, Swaleh Shahbal1,Francis Osawa1, Joel Lessan2

  1. School of Medicine, University of Nairobi

  2. Department of Surgery, Kenyatta National Hospital

Correspondence to: Timothy Mwai Jumbi, P.O. Box 19762 – 00202, Nairobi, Kenya.

E-mail: mwaitim@gmail.com

Keywords: Colorectal Conference, Kenya, Paediatric Surgeons, Anorectal Malformation

Ann Afr Surg. 2018;15(2):48-51 DOI:http://dx.doi.org/10.4314/aas.v15i2.3

Conflicts of Interest: None

Funding: None

 

© 2018 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Background

The Kenya Association of Paediatric Surgeons (KAPS) in collaboration with the Kenyatta National Hospital (KNH) and the University of Nairobi (UON) organized colorectal conference on 6th -11thNovember2017. The theme of the conference was "Demystifying Anorectal malformations (ARM). There is Hope!” The main objective for the conference was to create awareness on the existence of ARM and its management with an aim of providing hope of care to the affected children and their families.

 

Situation Analysis

The pediatric surgical department in Kenyatta National Hospital is the main referral center for patients with ARM. ARM cases represent approximately 40% of total admissions annually most of which are referrals from peripheral facilities.(1) The challenges facing management of these conditions in Africa include delayed diagnosis and presentation, inadequate access to health facilities, limited number of pediatric surgeons, lack of standard management protocols and poor post-surgical follow-up. (2, 3)The above challenges formed the basis of the conference theme with an aim to demystify the condition to both the parents and the health professionals managing ARM.

 

Discussion and Training Activities

The conference was designed to include a surgical workshop and a seminar. The surgical workshop took place for five days and was held in the main pediatric surgical theater of the Kenyatta National Hospital.

 

The seminar was a single day event which took place at The Nairobi Hospital Anderson Convection Center. In line with the conference objective, the event was aired on one of the national TV stations. The short documentary included interviews of mothers with children born with ARMs who shared their experiences in dealing with the condition. In addition to publicizing the conference, this documentary was also used by the surgeons as an avenue of educating the public on ARM, its diagnosis and management. (4)

 

The participants

There were a total of 72 participants who attended the conference. The cadre of the delegate attendees consisted of pediatric surgeons, general surgeons, pediatric anaesthesiologists, pediatricians, medical officers, nurses and residents in surgery and anesthesia.

​This delegation included representatives from the University of Nairobi, Kenyatta National Hospital, AIC Kijabe Mission Hospital, Kenyatta University, Coast General Hospital, Moi Teaching and Referral Hospital and the Aga Khan University Hospital.

​The trainers were recruited from the faculties of pediatric surgery in the represented institutions who form the membership body of the Kenya Association of Peadiatric Surgeons. They are pediatric surgeons with experience in colorectal surgery, urology, neonatal surgery and laparoscopic surgery (Table 1).

Click here to view table 1

 

 

The Workshop

 

The 5 day surgical workshop had three main sessions which included a morning lecture session, a practical surgical demonstration session with live video coverage with commentary and an interactive question and answer session after the surgical demonstration. The main topics covered in the workshop session included: Initial Management of ARM; Anaesthetic considerations in ARM patients; Surgical anatomy and principles of repair of ARM; Laparoscopic considerations in ARM and Post-operative outcomes after ARM surgery.

​There were a total of 12 patients who underwent surgery during the surgical sessions. The children were pre-selected by the event facilitators to include various variants of ARM, these included: ARM with no fistula; ARM with Recto-vestibular fistula, recto-perineal fistula, recto- urethral fistula, bucket handle deformities and cloacal malformations. The training sessions included live surgical demonstrations of different repair techniques including: primary anoplasty, anterior saggitalanorectoplasty(ASARP), posterior saggitalanorectoplasty (PSARP) and laparoscopic assisted anorectoplasty.

​Notably, Dr. Lessan gave an in-depth demonstration on the fashioning of a divided sigmoid colostomy as the first stage of surgery in most of ARM patients. Dr. Kambuni demonstrated the steps of a primary anoplasty and highlighted the indications and advantages of this form of single stage repair over the staged repair for ARM. Dr. Muma and Dr. Kuria demonstrated the principles of the laparoscopic assisted anorectoplasty and emphasized that patient selection is key in determining a favorable outcome for this form of repair. The anesthetic principles surrounding the ARM patient were covered by Dr. Nabulindo and the focus was mainly on pain management and regional anesthesia. A procedural demonstration on caudal block was carried out on the patients prior to surgery.