Surgery camp for Colostomy reversals at a referral hospital in Lilongwe, Malawi.

Abstract

Aim: An end colostomy is a potentially life-saving surgical intervention, but postoperative ostomy management is challenging in resource-limited settings. Socioeconomic, health system, and surgical capacity barriers may delay colostomy reversal. A surgery camp model for addressing the burden of unreversed colostomies has not previously been undertaken in Malawi. The study aims to present our institution's experience with the surgery camp model, assess patient outcomes, and identify improvement strategies for future efforts.

Methods: The surgery department at Kamuzu Central Hospital (KCH) carried out a two-day surgical camp in partnership with Access Health Africa (AHA) to reduce the local burden of reversible colostomies and train KCH surgery registrars in stapled end-to-end anastomosis (EEA). New, standardized preoperative and postoperative order sets for colostomy reversal were developed and implemented. Patient records were retrospectively reviewed, and descriptive analysis was performed. 13 patients underwent colostomy reversal via exploratory laparotomy. Twelve patients were male, median age was 41 (IQR 27 - 51), and average delay to reversal was 4.3 ± 6.6 months after clinical readiness.

Results: Sigmoid volvulus was the most common indication for Hartmann's procedure (62%) among patients undergoing reversal. One major complication was reported, a return to theatre for suspected anastomotic leak with no adverse findings. Patients were discharged 5.3± 2.8 days after surgery. Operating theatre staff successfully prepared for increased surgical volume, and standard pre- and postoperative order sets remain in use. Distribution of administrative responsibility and communication between visiting and host teams were noted as targets for improvement.

Conclusion: Given the clinical, educational, and organizational success of the two-day surgery camp, a second, expanded effort is anticipated. Goals include inclusion of ileostomy patients, advanced notification in district facilities and clinics, and additional administrative support with case allocation, supply acquisition, and personnel coordination.