eP603 - Surgical Relief in Developing Countries, Is There a Role for Colorectal Surgeons? Learning Opportunities for International Collaboration in Surgical Missions

Purpose/Background: Surgical missions offer safe surgical care and improved accessibility in developing countries. However local disease diagnosis and long-term sustainability are required for an effective intervention. We assessed the annual surgical missions performed inside an affiliated hospital in Ecuador to identify areas of collaboration that have been neglected in the past. Benign anorectal diseases have a significant prevalence in Ecuador and require low-risk procedures. We focused on the potential behind the management of benign anorectal diseases to better explain the promising role of colorectal surgeons in this field. The collaboration between these institutions lays a foundation for future colorectal initiatives within the yearly surgical mission in the affiliated hospital with educational purposes.Methods/Interventions: We analyzed the surgical missions executed by Northwell Health since 2019. These were accomplished in collaboration with USFQ, a medical school in Quito, and Padre Carollo, a local public hospital. These missions are intended to provide surgical care to low-income patients suffering from gastrointestinal diseases and palate deformities. We also assessed the local burden of benign anorectal pathologies by evaluating the overall registries within the same time frame at HECAM, a public hospital in Quito. Continuous variables were expressed with median and interquartile range.Results/Outcomes: A total of 155 surgical procedures have been performed since 2019 during the missions: 63 for craniofacial deformities (40.66%) 76 hernias (49.03%) 11 bariatric surgeries (7.10%) and 5 for anorectal disease (3.23%). These missions required 30 members including physicians, nurses, and administrators. Long-term surveillance of patients was regulated by the Ecuadorian institutions involved. Despite an abundance of anorectal disease in the community, the number of procedures performed for anorectal disorders is only a fraction of the total number of surgeries done (Figure 1). We decided to take HECAM as a reference to evaluate the local burden of these benign diseases. There were three predominant anorectal diagnoses: hemorrhoidal disease (3844 patients), anorectal fistula (988 patients), and fissures (1561 patients). The proportion of patients with these conditions has fluctuated throughout the years but still represents a substantial portion of the community burden (Figure 1).Conclusion/

Discussion: This demonstrates the possible burden of anorectal disease in Ecuador. Despite the increasing international interest to fill this gap in the field through the active engagement of surgical missions, there are still challenges that prevent the long-term sustainability of such programs. Potential solutions include promoting local collaboration between institutions to instruct medical students, and surgical residents in conjunction with local general surgeons to identify and treat these conditions. Additionally, the involvement of local healthcare stakeholders is essential for the development of educational activities that allow visiting experts to share knowledge in the management of similar conditions and new surgical techniques. Benign anorectal diseases are the perfect target to promote long-lasting relationships between local institutions and international surgical missions that intend to impact local healthcare. Discussion panels and operating room exposure will allow a proper cultural exchange and eventual strengthening of the domestic workforce while improving local surgical standards.1a. Local burden of anorectal diseases by year at Hospital de Especialidades Carlos Andrade Marin 1b. Surgical mission activity in Ecuador.