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Challenges & Outcome of Thoracic Surgery in a Resource Constrained Developing African Country

[ Vol. 13 , Issue. 3 ]


Tarig Eltoum Fadelelmoula*, Momen Mukhtar Abdalla and Husameldin Suliman Hussein   Pages 175 - 177 ( 3 )


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.


Challenges, outcomes, RATS, surgery, thoracic, VATS.


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

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