Title:Challenges & Outcome of Thoracic Surgery in a Resource Constrained Developing African Country
VOLUME: 13 ISSUE: 3
Author(s):Tarig Eltoum Fadelelmoula*, Momen Mukhtar Abdalla and Husameldin Suliman Hussein
Affiliation:Department of Cardiothoracic Surgery & Medicine, AL Hakeem Hospital, Omdurman, Department of Cardiothoracic Surgery & Medicine, AL Hakeem Hospital, Omdurman, Department of Cardiothoracic Surgery & Medicine, AL Hakeem Hospital, Omdurman
Keywords:Challenges, outcomes, RATS, surgery, thoracic, VATS.
Abstract:Background: Thoracic surgeries have been safely applied to the surgical treatment of
different thoracic conditions in our center since its introduction in September 2013. Our center is a
small private center, with cardiothoracic unit as its main component, with only 20 beds, including 4
beds for the ICU. The ICU is well staffed and equipped. The hospital is supported with two operation
rooms (OR), Clinical laboratory, Spirometry, Ultrasonography, Echocardiography, bronchoscopes
and conventional X-Ray. The hospital doesn't have CT facility but it's done in a nearby diagnostic
center when needed. This article summarizes and reflects our experience with thoracic surgery,
highlighting the salient challenges and outcome.
Methods: Retrospective description of cases, over a 3-year period (September 2013 to September
2016). All challenges and difficulties experienced during the course of patient care as well as
complications and outcomes were recorded and analyzed.
Results: Out of the 101 surgical operations performed in our hospital, during the study period, 87
(86%) were open thoracic surgeries. Patients were between the ages of 11 years and 67 years with a
mean of 39 ± 9 years (95% confidence interval (CI)). Infective thoracic conditions were the most
common indication for thoracic surgery in 45 patients (51.7%). Decortication for complicated pleural
effusion was the most common thoracic surgery and was performed in 49 (59.5%) patients. Tumor
resection was performed in 20 (22.9%) patients (Carcinoid tumors; 11 patients, Aspergillomas; in 5
patients and bronchial cancer; in 4 patients: 3 lobectomies & and 1 wedge resection). In 11 (12.6%)
patient surgery was done to remove foreign bodies from different sites of the bronchial tree when
removal with rigid bronchoscope was not possible. Penetrating chest stab wounds were repaired in 7
(8%) patients without complications. Major challenges experienced were patient late presentation to
the hospital, non-availability of video assisted thoracic surgery (VATS) and positron emission
tomography (PET) scan for proper staging and treatment of bronchial carcinoma. Complications
included 5 deaths, 2 cases of post-operative bleeding and 2 cases of post-operative sepsis following
decortication for empyema thoracic, hence the morbidity and mortality rates in our series of patients
were 4.5% and 5.7%, respectively. Overall, 82 (94%) patients in our study experienced a positive
outcome.
Conclusion: This study highlighted the main obstacles which thoracic surgery service deals with in
our hospital, as an example of a new private center in a resource-constrained setting. However,
thoracic surgery is still safer in spite of the difficulties faced and complications are significantly low
as compared to similar centers in the region.
