Colorectal Surgery Practice, Training, and Research in Low-Resource Settings

Area of Science:

• Global Surgery
• Surgical Education
• Health Systems Research

Background:

• Colorectal surgery (CRS) practice, training, and research significantly differ between low- and middle-income countries (LMICs) and high-income countries due to resource disparities.
• In LMICs, CRS is predominantly performed by general surgeons, with limited access to specialized colorectal surgeons and advanced technologies like laparoscopy or robotic platforms.
• The absence of multidisciplinary teams necessitates broad surgical knowledge and adaptability among practitioners in LMICs.

Purpose of the Study:

• To delineate the challenges and disparities in colorectal surgery practice, training, and research in LMICs compared to high-income countries.
• To highlight the limitations in formal training opportunities and research infrastructure for colorectal surgery in LMICs.
• To underscore the potential contributions of LMIC surgeons to understanding prevalent conditions and the need for investment in surgical care.

Main Methods:

• The study is a review and analysis of the current state of colorectal surgery in LMICs.
• It synthesizes information on surgical techniques, training availability, research output, and resource allocation.
• Comparative analysis between LMICs and high-income countries is implied.

Main Results:

• Colorectal surgery in LMICs is characterized by a reliance on open techniques, a scarcity of fully trained colorectal surgeons, and limited access to advanced surgical platforms.
• Formal training pathways and research funding for colorectal surgery are significantly restricted in LMICs, leading to less established academic presence and data generation.
• Despite limitations, LMIC surgeons can provide valuable insights into conditions more prevalent in their settings, such as anal squamous cell carcinoma and obstetric fistulas.

Conclusions:

• Addressing the disparities in colorectal surgery requires substantial investment in infrastructure, training, and governance within LMICs.
• Enhancing access to safe and effective surgical care for colorectal conditions is paramount for improving patient outcomes globally.
• Strengthening CRS in LMICs is essential for achieving equitable surgical healthcare access.