Pan African Pediatric Surgical Association (PAPSA)
Abidjan, Côte d'Ivoire in Partnership with The Hendren Project
African Solutions for African Problems
African Solutions for African Problems focused on innovative approaches to managing pediatric surgical conditions in African settings, particularly gastroschisis, with presentations on cost-effective techniques using condoms and strategies to improve neonatal care. Discussions also covered challenges and solutions in managing colorectal disorders, the use of telehealth and educational videos to enhance surgical care access, and the development of minimally invasive surgery in various African countries. The conversation ended with presentations on charitable models for comprehensive pediatric surgical care and emphasized the importance of capacity building and multidisciplinary approaches in addressing congenital anomalies across Africa.
Presentations
Introduction
Sherif Emil, M.D., C.M.; The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
Milind Chitnis, M.D.; Frere Hospital, Walter Sisulu University, East London, South Africa
Solutions for Gastroschisis
This session focused on innovative techniques for managing gastroschisis, a condition requiring emergent care in specialized facilities. Presentations underscored the importance of innovation and adaptation of available tools to improve patient outcomes in resource-limited settings.
Use of the Male Condom in the Surgical Management of Gastroschisis: 10 Cases
D. Yonga, M.D.; Centre Hospitalier Regional de Thies, Thies, Senegal
Discussed the use of male condoms as cost-effective alternatives to traditional methods like silo or Alexis retractors, which are expensive and not readily available in low-resource settings. The technique involves creating a protective bag around the exposed organ using a male condom, which is accessible, easy to handle, and adaptable to different defect sizes. The discussion highlighted the method's advantages and limitations, such as the need for close monitoring and unsuitability for complex cases.
Beyond Financial Farriers: Using Female Condoms for Emergent Gastroschisis Management in Low Resource Settings
Fareeda Galley, M.D.; Komfo Anokye Teaching Hospital Kumasi, Ghana
Discussed the use of female condoms as a low-cost alternative in Ghana, emphasizing their availability, ease of use, and effectiveness in covering exposed intestines.
Evolution of Gastroschisis Management in a Developing Country
M. G. Yassegoungbe, M.D.; Pediatric Surgery Department Lagune Mother and Child University Hospital Cotonou, Benin
Presentation on neonatal and neonatology care in Benin, highlighting challenges with congenital anomalies and the lack of prenatal diagnosis access. They described a protocol developed to improve outcomes, including antenatal diagnosis optimization, timely deliveries, and specialized neonatal management, which resulted in an 8% survival rate compared to 0% previously. The project aims to establish a national multidisciplinary prenatal diagnosis unit to enhance neonatal surgical care and reduce mortality rates.
The discussion focused on the use of condoms for gastroschisis management, with Podium sharing their experience using both male and female condoms in Ghana. They explained that while male condoms can be too narrow, female condoms are often more suitable in terms of size but require suturing to stay in place. Podium also addressed questions about perforations, noting that while they have had one case of male condom perforation in Benin, proper technique can prevent issues.
Solutions for Colorectal and Anorectal Conditions
This session focused on resolving systemic challenges with context-driven strategies for managing anorectal anomalies in Africa.
Establishing Dedicated Pediatric Colorectal Care in Africa: Systemic Challenges and Context-driven Strategies
Ismael Elhalaby, M.D.; Tanta University Hospital, Faculty of Medicine Tanta, Egypt
Presented on managing pediatric colorectal disorders in African settings. He highlighted challenges such as cultural barriers, financial difficulties, and inadequate healthcare infrastructure, and proposed solutions including establishing patient databases, improving patient health literacy through educational materials in local languages, and implementing systematic follow-up protocols. He emphasized the importance of dedicated colorectal nurses and schedulers, remote follow-up methods, and creative solutions to equipment shortages, concluding that successful management of these disorders requires long-term coordinated care that can be achieved without complex infrastructure.
Discussed was the establishment of colorectal clinics in Africa, with questions about nurse scheduling and availability. The discussion highlighted the importance of education and simple communication tools like WhatsApp in low-resource settings, emphasizing the value of learning from both world-class centers and local programs.
Solutions for Knowledge Gaps
The use of telehealth as a tool in global surgery confronts the challenges of and improves access to pediatric surgical care in South Africa.
Telehealth as a Tool in Global Surgery
N. Patel, M.D.; Chris Hani Baragwanath Academic Hospital University of the Witwatershrand Johannesburg, SA
►Link to Dr. Patel's You Tube Channel
Dr. Patel outlined the challenges in pediatric surgical care in South Africa, highlighting inefficiencies and unnecessary costs in the healthcare system. He discussed the creation of educational videos to improve knowledge of common pediatric surgical conditions among healthcare providers, which have been well-received and distributed widely. He also described telehealth initiatives implemented to improve access to surgical care, including post-operative follow-ups and virtual preoperative consultations. The presentation concluded with a call for continued efforts to improve healthcare efficiency and access in the face of significant poverty and inequality in South Africa.
The discussion reviewed several medical apps and social networking sites such as WhatsApp that were helpful in bridging the distance between patient and pediatric surgeons. Physicians use these tools to refer patients to hospitals and physicians. The types of medical information that can be shared was also discussed. Most of these tools provide multilanguage platforms. AI is becoming used more to help in translations and in building content.
Solutions for Minimally Invasive Surgery
This session meeting focused on minimally invasive surgery solutions--particularly in pediatric laparoscopy in Benin--and appendectomy procedures. Dr. Akokpe presented on developing pediatric laparoscopy in Benin, while Dr. Koffi discussed appendectomy by laparoscopy at a hospital for infants. The presenters highlighted challenges and solutions in Africa, including the use of carbon dioxide as a gas for laparoscopy.
Development of Pediatric Laparoscopy in Benin (Presentation in French; Presentation Sides in English)
M.H.O. Akokpe, M.D.; Pediatric Surgery Department Lagune Mother and Child University Hospital Cotonou, Benin
English Overview of Presentation: Laparoscopy is a global procedure in pediatric surgery. The procedure has many proven advantages: less invasive, reduced postoperative pain, lower infection risk, and shorter hospital stays. However, in Benin, laparoscopy is rarely practiced and often limited to private facilities. The challenges to implementing minimally invasive surgery in pediatric surgery in Benin were outlined.
METHODOLOGY
Retrospective study conducted between January 2021 and December 2024 among 42 patients 9 mo to 16 yo. Males: 22; female: 20 who underwent laparoscopic surgery. Data collected from Medical records and operative reports. Analysis focused on postoperative outcomes.
Interventions: 2 thoracoscopies. Conversion rate of 21.4%
Problems caused by equipment failure and intraoperative change in initial diagnosis
DIFFICULTIES ENCOUNTERED
• Lack of specialized training for paramedical staff
• Lack of pediatric-specific equipment
• Poor or suboptimal equipment maintenance
• High cost of equipment purchase and maintenance
• Relatively higher cost of laparoscopic procedure
DISCUSSION
• Despite challenges encountered, we have established procedures for safe and effective pediatric laparoscopy and thoracoscopy.
• Conversion rate <10% for the same indications as in developed countries (Mishra et al., 2019).
• Length of hospital stay is similar to that in other African countries practicing laparoscopy, and slightly higher than the standards in developed countries
SUGGESTIONS
• Strengthening the training of healthcare professionals
• Creation of specialization programs in pediatric laparoscopy
• Partnerships with foreign hospitals and NGOs for training
• Improved access to equipment (purchases and donation requests)
• Awareness and advocacy
Appendectomie sous coelioscopie au service de chirurgie pediatrique de l’Hopital Mere-Enfant de Bingerville (Appendectomy by Laparoscopy in the Pediatric Surgical Service of the l’Hopital Mere-Enfant de Bingerville) (Presentation in French; Presentation Sides in English)
K. M. Koffi, M.D.; L’Hopital Mere-Enfant de Bingerville Bingerville, Côte d'Ivoire
English Overview of Presentation: The aim of our study was to describe the outcomes of complicated appendicitis cases treated laparoscopically at the Mother-Child Hospital of Bingerville (HME)
Patients and Methods
We conducted a cross-sectional, descriptive study from February 2019 to February. We conducted a cross-sectional, descriptive study from February 2019 to February 2025, involving patients who underwent laparoscopic surgery for complicated appendicitis. For each patient, the variables studied included age, sex, therapeutic aspects, and outcomes.
Results
We reviewed 11 cases out of 44 laparoscopically operated appendicitis patients. The average age was 10 years (range:
3 to 15 years). The sex ratio was 10:1. The mean operative time was 109 minutes (range: 73 to 137 minutes). In all procedures, three trocars were inserted using the open laparoscopy technique. The appendix was not found in one case. Postoperative recovery was uneventful in 9 patients. Two patients developed complications requiring reoperation-one for bowel obstruction due to volvulus following ileus, and one for an enteric fistula. The average hospital stay was 8 days (range: 2 to 22 days).
Discussion
Laparoscopic appendectomy is the treatment of choice for appendicitis complicated by peritonitis, according to P Buisson and al. However, some authors, such as SD St Peter and al. discuss appendicular abscess, starting their management with antibiotic therapy and deferring laparoscopy by a few weeks. Post-operative complications and length of hospital stay are significantly lower than with laparotomy appendechamy.
The discussion highlighted challenges and solutions in Africa, including the use of carbon dioxide as a gas for laparoscopy.
Solutions for Affordable Care
Nile of Hope Hospital: A Charitable Model for Comprehensive Pediatric Surgical Care in Africa
M. A. Abokandil, M.D.; Nile of Hope Hospital Alexandria, Egypt
The speaker discussed the Mount Robb Hospital, a nonprofit institution dedicated to providing free surgical services for children with congenital anomalies in Egypt. He highlighted the high prevalence of these conditions, with approximately 36 deaths per day due to congenital anomalies. The hospital focuses on advanced surgical care and has seen significant growth, providing over 2,000 surgeries in 2024 with an 85% utilization rate. They emphasized the importance of a multidisciplinary approach and long-term follow-up care, as well as incorporating training and research partnerships with organizations like Peter Puku.
A discussion revolved around how to finance pediatric surgery in Africa. There is an immense need, but limited capacity does not allow for all patients to be treated. How do you choose which patients receive treatment. The hospital selects patients based on medical conditions rather than financial criteria, and while they accept donations, their primary focus is on medical need. But this is still an immense challenge.