We have been conducting medical collaboration programs for cleft lip and palate in the Republic of Madagascar for seven years, from 2011 to 2017. The purpose of this study was to investigate the incidence of stula after primary palatoplasty in the Republic of Madagascar, which is a developing country. A further objective was to determine if the group of patients in Madagascar had an increased incidence of palatal stula compared to a similar group of patients in Japan, and to examine the factors that might be involved in any increase. We conducted a survey of the cleft type, age at time of surgery, and stula incidence in 44 patients 28 males and 16 females in Madagascar. The age at the time of surgery was 11 months to 29 years average, 7 years and 8 months , and the cleft types were 0 class , 14 class , 18 class , and 12 class , by the Veau classication. We used a modi ed two-ap palatoplasty for palatal closure. In addition to the selection of surgical technique, the factors which are suggested to in uence the incidence of stula include the experience of the surgeon, and the extent of the cleft. The incidence of postoperative stula complication in these patients was zero. In medical collaboration settings in developing countries, there are factors which may delay wound healing, such as poor oral hygiene, poor nutrition, and instability of the ap blood ow. Understanding such factors in surgery is important to avoid palatal stula. We report that a palatal stula incidence rate of 0% can be achieved by avoiding those factors which contribute to stula formation.