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Thoracoscopy in Cameroon: Indications, Technics and Short Term Results

Surgical Science 2024年第4期15卷 278-288页

作者： Guy Aristide Bang Richard II Mbele Fabrice Stephane Arroye Betou Arlette Joelle Moukitek Banaken Amos Bella Ela Charles Mve Mvondo arthur essomba Department of Surgery and Specialities Faculty of Medicine and Biomedical Sciences Yaound&#233 I University Yaound&#233 Cameroon Department of Surgery and Specialities Yaound&#233 Teaching Hospital Yaound&#233 Cameroon General Surgery Service Mvog-Ada District Hospital Yaound&#233 Cameroon Department of Cardiothoracic and Vascular Surgery Laquintinie Hospital Douala Cameroon Department of Cardiothoracic and Vascular Surgery Yaound&#233 General Hospital Yaound&#233 Cameroon Cardiac Center Shisong St. Elizabeth Catholic General Hospital Shisong Kumbo Cameroon

Introduction: Thoracoscopy is a video-assisted surgical approach that mirrors the techniques used in thoracotomy. Our aim is to map the current state of thoracoscopy practice in Cameroon’s hospitals. Methods: This was a descriptive study that collected both retrospective and prospective data over 57 months across four hospitals in Cameroon. It included 13 patients and focused on variables such as socio-demographic factors, clinical profiles, surgical procedures, and postoperative follow-up. Results: Thirteen patients, predominantly male (84.6%, n = 11), with a mean age of 37.5 ± 16 years, were enrolled. Alcohol use (61.5%) and smoking (38.5%) were the most common past histories. The major complaints were dyspnea (84.6%) and chest pain (58.3%). The primary surgical procedure was clot-free thoracoscopy in 30.8% of cases, mainly for persistent hemothorax (41.8%). Most surgeries were elective (76.9%) and performed under general anesthesia with selective intubation (61.5%). The most common approach was single-port thoracoscopy (U-VATS) (76.9%), with no reported difficulties;however, one intraoperative incident occurred and was successfully treated. Drainage was performed systematically in all patients, and one case required conversion to open surgery. Postoperative complications were minor (Clavien-Dindo grade I) and mainly consisted of pain, with a mortality rate of 15.4%. No significant association was found between risk factors and the occurrence of complications or postoperative mortality. Conclusion: Thoracoscopy, a novel approach in our context, primarily focuses on minor thoracic surgeries.

关键词： Thoracoscopy Single-Port Hemothorax Cameroon

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Rib Osteosynthesis for Sub-Acute Management of a Flail Chest in a Tertiary Centre in a Low-Middle Income Country of Sub-Saharan Africa: Case Report at Douala Laquintinie Hospital

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Open Journal of Thoracic Surgery 2024年第1期14卷 1-16页

作者： Fabrice Stéphane Arroye Betou Nyankoue Mebouinz Ferdinand Guy Aristide Bang Kobe Folkabo Zephany Banga Nkomo Douglas Moussa Seck Diop Abdoul Lahad Mbeng Marcella Derboise Christelle Biyouma Noel essomba Souleyman Diatta Handy Eone Daniel arthur essomba Hassan Ndiaye Maurice Aurelien Sosso Department of Surgery and Specialties Faculty of Medicine and Biomedical Sciences (FMBS) University of Yaoundé (UYI) Yaoundé Cameroon Department of Surgery and Affiliated Disciplines Douala Laquintinie Hospital Douala Cameroon Department of Surgery and Specialties Yaoundé General Hospital Yaoundé Cameroon Department of Surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences (FMPS) University of Dschang Dschang Cameroon Service de Chirurgie Thoracique et Cardiovasculaire Centre Hospitalier Universitaire de Fann Faculté de Médecine de Pharmacie et d’Odontologie Université de Cheikh Anta Diop Dakar Sénégal UFR des Sciences de la Santé Ziguinchor Sénégal

Background: Costal fracture surgical is still a debate, therefore we shall select between early and delay surgical management. Case Report: We are reporting two cases of post road traffic clash delay ribs fractures osteosynthesis involving a 63-year-old man with multistage fractures on the left and pulmonary pinning of one of the costal arches, complicated by a homolateral haemothorax and a 41-year-old man with a bilateral flail chest. Conclusion: The simple postoperative course and the immediate postoperative improvement in the patient’s clinical respiratory condition enabled us to discuss the time frame for management, in this case the indication for early or later surgery.

关键词： Flail Chest Fixation Plate Rib Fracture Osteosynthesis

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Results of Surgical Management of Malignant Obstruction of the Common Bile Duct in Yaoundé

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Surgical Science 2024年第4期15卷 265-277页

作者： Eric Patrick Savom Gaël Tsanga Nomo Richard II Mbele Mahamat Yannick Ekani Boukar Cédric Paterson Atangana Fred Dikongue Dikongue Guy Aristide Bang arthur essomba Yaoundé General Hospital Yaound&#233 Cameroon Faculty of Medicine and Biomedical Sciences of the Universityof Yaoundé I Yaound&#233 Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences of the University of Dschang Dschang Cameroon Yaoundé Teaching Hospital Yaound&#233 Cameroon

Introduction: In Cameroon, surgery remains the only approach in malignant obstructions of the common bile duct (MOCBD) even in palliative situations. The aim of this work was to describe the modalities of surgical treatment of MOCBD, evaluate the results and detect the factors associated with postoperative morbidity and mortality. Patients and Methods: We conducted an analytical observational study, with retrospective data collection from the files of patients operated upon for MOCBD. This was done in four referral hospitals in the city of Yaoundé for a 42-month period spanning from January 1, 2020 to June 30, 2023. Demographic data, clinical presentation, surgical data, and 30-day postoperative outcomes were collected. Results: We collected 71 files. The sex ratio was 1.4 and the mean age was 56 ± 11 years. Fifty-three (53) patients (74.6%) were overweight or obese and 10 patients (14.1%) were hypertensive. A clinical cholestasis syndrome was present in 69 patients (97.2%). Fifty-five (55) patients (77.5%) had a cancer of the head of the pancreas, 8 patients (11.3%) had an extra-hepatic cholangiocarcinoma and 8 patients (11.3%) had an ampullary adenocarcinoma. Eight (8) resections (11.3%) with curative intent had been carried out and in 63 cases (88.7%), surgery was palliative. Postoperative morbidity was 55.7%, influenced by advanced WHO stage (p = 0.02). Postoperative mortality was 25.7%, associated with a high ASA score (p = 0.01). Conclusion: Pancreatic head cancer is the main etiology of malignant obstructions of the common bile duct in Cameroon. Surgical treatment is most often palliative. Postoperative morbidity and mortality are high, influenced by high WHO and ASA scores.

关键词： Malignant Obstruction Common Bile Duct Palliative Treatment Morbidity Mortality

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Laparoscopic Surgery of Incisional Hernia: Technique and Short-Term Results in Three Surgical Units in Cameroon

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Surgical Science 2024年第4期15卷 232-243页

作者： Guy Aristide Bang Eric Patrick Savom Achille Aimé Bekolo Otiti Fred Dikongue Dikongue Mahamat Yannick Ekani Boukar Richard II Mbele Cédric Paterson Atangana Daniel Biwole Biwole arthur essomba Yaoundé Teaching Hospital Yaound&#233 Cameroon Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I Yaound&#233 Cameroon Yaoundé General Hospital Yaound&#233 Cameroon Faculty of Medicine and Biomedical Sciences of the University of Dschang Dschang Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Yaoundé Central Hospital Yaound&#233 Cameroon

Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in our milieu, but no data has been found. The aim of this study was to review this surgery done in our country so far, to describe the operative technique and to evaluate the postoperative outcomes. Patients and Methods: We conducted an observational descriptive study with retrospective collection of data from the 1st of July 2018 to 30th of June 2022, in three hospitals in Cameroon. Data on socio-demographic and clinical characteristics, surgical technique and postoperative outcomes of patients who had a laparoscopic repair of their incisional hernia were collected. Results: We reviewed 20 files. There were 14 women with an average age of 54.6 years. The average BMI was 32.8 kg/m2. Thirteen patients had a moderate size hernia and the hernia was localized at the midline in 18 cases. Only composite biface meshes were used with dimensions chosen to obtain at least 5 cm overlap. Spiral tacks were the only fixation means used. We registered 3 complications. One case of generalized peritonitis secondary to missed digestive perforation, one case of seroma and one case of postoperative ileus. We registered no death. Conclusion: Laparoscopic repair of incisional hernias is feasible in a resource-limited setting like ours. Compliance with the operative technique and recommendations is important to obtain short-term results closed to that put forward by literature.

关键词： Incisional Hernia Laparoscopy Repair Composite Biface Mesh Postoperative Outcomes

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Surgical Management of Perforated Colon Tumours in Yaoundé: A Multicentre Retrospective Review of 30-Day Postoperative Outcome

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Surgical Science 2024年第5期15卷 330-341页

作者： Eric Patrick Savom Richard II Mbele Colman Tamboh Tankou Mahamat Yannick Ekani Boukar Cédric Paterson Atangana Fred Dikongue Dikongue Daniel Biwole Biwole Guy Aristide Bang arthur essomba Yaoundé General Hospital Yaound&#233 Cameroon Faculty of Medicine and Biomedical Sciences University of Yaound&#233 I Yaound&#233 Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Dschang Dschang Cameroon Yaoundé Central Hospital Yaound&#233 Cameroon Yaoundé University Teaching Hospital Yaound&#233 Cameroon

Introduction: Colon cancer is often diagnosed late in our context and there is a high prevalence of complicated forms, this including perforation. The optimal surgical treatment remains controversial. The aim of this study was to improve the short-term postoperative outcomes of patients operated upon for perforated colon cancer, by identifying factors associated with complications occurring within 30 days after surgery. Patients and methods: We carried out an analytical observational study, with a retrospective collection of data from the files of patients operated upon for an in situ tumoral colon perforation. This was done in four referral hospitals in the city of Yaoundé. The period was from the 1st of January, 2012 to the 31st of December, 2021. Cox regression identified the factors associated with postoperative morbidity and mortality. Results: We collected files of 46 patients. The mean age was 54.7 ± 19.9 years with a sex ratio of 1.4. The clinical presentation on admission was dominated by the presence of signs of peritoneal irritation (91.3%) and bowel obstruction (28.3%). The diagnosis was made preoperatively in 16 cases (34.8%). The surgical procedures consisted of colectomy with anastomosis in 28 cases (60.9%) and without anastomosis in 14 cases (30.4%). Postoperative morbidity was 60.9% dominated by surgical site infection (37%). Postoperative mortality was 39.1%. The existence of generalized peritonitis was associated with the occurrence of postoperative complications (p = 0.019). The main factors associated with postoperative mortality were resection with primary anastomosis (p = 0.027), enterocutaneous fistula (p = 0.005). Conclusion: Colic resection with primary anastomosis or ideal colectomy is associated with an increased risk of mortality and should therefore not be performed in this setting.

关键词： Perforated Colon Cancer Postoperative Morbidity and Mortality Colectomy Acute Generalized Peritonitis

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Etiologies, Clinical Presentation and Outcome of Adult Patients Presenting with Bowel Obstruction on a Virgin Abdomen

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Surgical Science 2023年第3期14卷 252-269页

作者： Georges Bwelle Motto Tim Fabrice Yannick Mahamat Ekani Boukar El-Alaoui Mounjid Khadija Emmanuella Joseph Cyrille Chopkeng Ngoumfe arthur essomba Department of Surgery and Specialties Faculty of Medicine and Biomedical Sciences The University of Yaounde 1 Yaounde Cameroon Departement of Visceral and Digestive Surgery Yaounde Central Hospital Yaounde Cameroon Departement of General Surgery Soa District Hospital Yaounde 2 Yaounde Cameroon

Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the central hospital of Yaoundé in order to better understand the main causes and to better anticipate and improve the diagnosis, management and the evolution of intestinal obstruction on a virgin abdomen. Method: The patients were prospectively included from June 2021 to May 2022, these patients were recruited from the digestive and emergency surgery units of the Yaoundé Central Hospital during the study period and who met the inclusion criteria, with suspicion of partial or total intestinal obstruction or those with an intraoperative confirmed diagnosis were enrolled. Results: We recruited 73 patients including 43 (60.3%) men and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from 16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior consultations in the lower level center at the Central Hospital of Yaoundé. The patients retained for this work presented in majority the symptoms according to the abdominal pains, the stop of the materials and gases;meteorism and vomiting. Abdominal wall hernias with incarcerated intestinal loops were the most common cause of intestinal obstruction in an unscarred abdomen in adults at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%. Exceptionally, a cluster of roundworms was found as the cause of intestinal obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by nausea and hematoma (36%), local infections (24%) and malaria (24%). Death occurred in 5 of our patients, or 6.8% of cases, and was mostly caused by hypovolemic shock (40%) and pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without scarring remain the prerogative of young

关键词： Acute Abdomen Intestinal Obstructions Etiologies

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Internal Lateral Sphincterotomy in Yaounde: Comparative Short-Term Results of Open versus Closed Techniques

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Surgical Science 2021年第11期12卷 374-380页

作者： Georges Bwelle Motto Yannick Mahamat Ekani Boukar Guy Aristide Bang Joseph Cyrille Chopkeng Ngoumfe Fabrice Tientcheu Tim arthur essomba Maurice Aurélien Sosso Department of Surgery and Specialties Faculty of Medicine and Biomedical Sciences The University of Yaoundé I Yaounde Cameroon Department of Visceral and Digestive Surgery Yaoundé Central Hospital Yaounde Cameroon Department of Surgery University of Buea Buea Cameroon

Background: Chronic anal fissure is a benign disorder which is associated with considerable discomfort. Aim of the Work: The aim of this study was to compare the post-operative results of open and closed internal lateral sphincterotomies in the short and medium term. Patient and Methods: We carried out a prospective randomized comparative study in the digestive and visceral surgery departments of Central Hospital of Yaounde over a period of 15 months. Patients were evaluated for each technique by several variables, including duration of surgery, post-operative pain, recurrence, surgical wound infection, gas and/or stool incontinence, and healing time with follow-up up to 12 months postoperatively. Results: A total of 63 patients underwent surgery within them we had 32 open lateral internal sphincterotomies (group

关键词： Anal Fissure Internal Lateral Sphincterotomy Open Technique Close Technique

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Ligation of the Intersphincteric Fistula Traject with Placement of a Prosthesis: A New Technique in the Treatment of Fistula-in-Ano at Yaounde Central Hospital (Cameroon)

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Surgical Science 2022年第2期13卷 66-77页

作者： Eric Patrick Savom Georges Roger Bwelle Motto Guy Aristide Bang Joseph Cyrille Chopkeng Ricardo Fomene Ngouanet Ghislain Loïc Batimba Nolabia arthur essomba Yaounde General Hospital Yaounde Cameroon Faculty of Medicine and Biomedical Sciences of the University of Yaounde I Yaounde Cameroon Yaounde Central Hospital Yaounde Cameroon Yaounde Hospital and Teaching Centre Yaounde Cameroon Higher Institute of Medical Technologies of Yaounde Yaounde Cameroon

Background: Ligation of the inter-sphincter fistula tract associated with anal plug (LIFT-Plug) is a new anal fistula treatment procedure at the Yaoundé Central Hospital. A two-sided prosthesis piece bent in the shape of a cone is used here as an anal plug. The aim of this work was to evaluate the therapeutic results and the safety of this device. Patients and Methods: The clinical data of patients operated by the LIFT-Plug technique from January 1, 2020 to June 30, 2021 for a high anal fistula were analyzed prospectively. The variables evaluated were operative time, cure rate, postoperative complications and recurrence rate. Results: We included 28 patients with a mean age of 42 years. The sex ratio was 1.15. No patient presented preoperative continence disorder. The fistula was high trans-sphincteric in 89.3% of cases. The average duration of surgery was 55.2 minutes (45 to 66 minutes). The postoperative course was straightforward, although 60.7% of the patients had experienced tingling that resolved spontaneously. Three patients (10.7%) presented with transient gas incontinence (WIS of 4) which completely resolved after one month. All patients healed within a mean of 63.21 days (25 to 95 days). At the end of the 6-month follow-up, no case of recurrence had been recorded. Conclusion: The LIFT-Plug is a simple, safe and effective technique for the treatment of upper anal fistula without major impairment of continence despite delayed healing. The adapted two-sided prosthesis is a good alternative to the conventional anal plug.

关键词： High Anal Fistula LIFT-Plug Healing Postoperative Complications Recurrence

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Survival and Quality of Life of Patients after Rectal Cancer Surgery in a Low-Income Country: A Study in Cameroon, Sub-Saharan African Region

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Surgical Science 2021年第8期12卷 261-273页

作者： Guy Aristide Bang Eric Patrick Savom Georges Bwelle Moto Julienne Yambassa Fayam Yannick Mahamat Ekani Boukar Ousmana Oumarou arthur essomba Maurice Aurélien Sosso Department of Surgery and Subspecialties Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Surgery Unit Yaoundé University Teaching Hospital Yaoundé Cameroon Surgery Unit Yaoundé General Hospital Yaoundé Cameroon Digestive Surgery Unit Yaoundé Central Hospital Yaoundé Cameroon

Background: Survival of patients after rectal cancer surgery as well as their quality of life (QoL) has been little studied in Africa and never in our country in particular. Methods: We conducted a cross-sectional multicentre study in Yaoundé (Cameroon). We reviewed operating reports of the selected departments to identify patients operated from January 2010 to December 2019 for a rectal cancer. The outcome of patients enrolled had to be known until December 2020. Patients who were alive were contacted to evaluate their QoL using the EORTC QLQ C30 (European Organization for Research and Treatment of Cancer QoL questionnaire). Results: During the study period, rectal cancer was ranked 4th within the digestive cancers. We included 68 patients;their mean age was 49.74 years and 41.18% were under 45. The sex ratio was 1.19 in favour of males. The tumour was mainly located in the lower rectum (45.6%). The main surgical procedure implemented was abdomino-perineal resection (42.6%). Forty-one patients died, giving a mortality rate of 60.29%. The mean survival time was 13 months. The 5-year survival rate for the 32 patients operated from January 2010 to December 2015 was 21.87%. The overall QoL of the 27 living patients was good with a mean of 62.346 ± 15.907. Sexual complications and urinary disorders were found in 40.74% and 14.81% of patients, respectively. Conclusion: There is a low hospital incidence of rectal cancer in our context. The 5-year survival after rectal cancer surgery is poor while the QoL of living patients is good.

关键词： Rectal Cancer Survival Quality of Life Cameroon

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Surgical Management of Abdominal Trauma: Indications and Outcomes in Two Emergency Units with Limited Infrastructure Resources in Yaoundé(Cameroon)

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Surgical Science 2021年第10期12卷 339-349页

作者： Savom Eric Patrick Bang Guy Aristide Biwole Biwole Daniel Bitang A. Mafok Louis Joss Bwelle Motto Georges Roger Ekani Boukar Mahamat Yannick Ngo Nonga Bernadette essomba arthur Yaoundé General Hospital Yaoundé Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Yaoundé Teaching Hospital Yaoundé Cameroon Yaoundé Central Hospital Yaoundé Cameroon Yaoundé Emergency Centre Yaoundé Cameroon Faculty of Health Sciences University of Buea Yaoundé Cameroon

Introduction: Abdominal trauma is a major public health concern. Their management is controversial and difficult. Operative indications are not codified in all situations. Patients and Methods: This was a descriptive cross- sectional study over a period of 5 years, carried out in the surgical emergency department of the Central Hospital of Yaoundé and the Emergency Centre of Yaoundé. We reviewed retrospectively medical records of patients who had laparotomy after abdominal trauma. Results: We collected 115 files. There was a male predominance (83.47%) and the average age was 33.8 years. The average time to admission was 12.3 hours and the aetiologies were dominated by road traffic accidents (53%). Abdominal contusions represented 69.56% of cases and abdominal wounds 30.44% of cases. Indications for surgery were hemodynamic instability, evidence of a lesion of a hollow viscus, the presence of evisceration or a gunshot wound, and initial non-operative treatment failure. Postoperative morbidity was 9.56% and overall mortality was 3.47%. Conclusion: Surgical management of abdominal trauma is frequent in our setting, mainly indicated for hem

关键词： Abdominal Trauma Abdominal Contusion Abdominal Wound Surgical Indications Yaoundé

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