EP613 - Integration of Anorectal Specialty Care into a Safety-Net Ambulatory Surgical Center in Honduras

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Purpose/Background: In low- to middle-income countries such as Honduras, where over half of the population lives in poverty and 90% of the population is uninsured, pathology that is readily addressed with surgical solutions in wealthier nations can become an insurmountable problem. Without access to specialty care such as anorectal surgery, patient suffering is prolonged and the severity of pathology increases. The aim of this project was to improve access to anorectal care in Honduras. There are several ways to approach global surgical interventions, including direct care, capacity building, and joint ventures involving research and clinical care. We present a model of direct anorectal care that has the potential to develop into capacity building.

Methods/Interventions: We partnered with OneWorld Surgery to carry out one-week mission trips to an ambulatory surgery center near Tegucigalpa, Honduras. OneWorld Surgery is a nonprofit organization that facilitates surgical missions to Holy Family Surgery Center (HFSC). All care is free of charge to patients. Brigades of surgical teams from the United States travel for one week at a time to see consults and perform operations. Operating rooms are equipped with instruments familiar to US surgeons and follow US protocols. HFSC employs over 50 full-time staff, including permanent primary care providers. Local staff saw a need for anorectal care, and the first brigade including anorectal providers arrived in Honduras in February 2022. It included a colorectal surgeon and nurse practitioner. Additional anorectal brigades followed in September 2022 with the same core team members and additional surgeons in February 2024 and May 2024. Detailed data was collected from the first two anorectal brigades in 2022.

Results/Outcomes: In 2022, 126 patients were evaluated in clinic (Table 1). Of those, 34 had clinic procedures and 33 had operative intervention. The most common diagnosis was hemorrhoids, and of the 64 patients with hemorrhoids, 31 underwent hemorrhoid banding in clinic and 12 had hemorrhoidectomies. Fourteen patients were diagnosed with fissures and eight underwent lateral internal sphincterotomy, the remainder receiving fiber supplementation alone. Thirteen patients were diagnosed with fistulas. Two had setons placed and seven underwent fistulotomy. Other procedures included biopsy, excision of skin tags, and pilonidal cystectomy. 2024 brigades were composed of similar volume and pathology. Barriers to surgery included lack of medical clearance and scheduling conflicts. Facilitators to care included a strong partnership with local primary care physicians for both referral and post-operative care. Many post-operative management issues were addressed via WhatsApp messaging between local Honduran physicians and the US team following conclusion of the brigade.

Conclusion/Discussion: We present a direct care model of global anorectal surgery intervention which provided care to over 50 people each brigade. The advantages of this approach include in-country protocols familiar for volunteers, basic operating room equipment, experienced staff, and consistent pre- and post-operative care by primary care local providers. Unfortunately, anorectal subspecialty care remains available only if providers travel to Honduras. Future priorities include increased education and training to develop local expertise in the operative and nonoperative management of anorectal disease.