La Chirurgie Foraine : Une Solution Aux Problemes D’acces Aux Soins Chirurgicaux Des Populations Rurales

Assessment of the quality of care in surgical outreach programs is necessary to improve their reliability. Purpose: The purpose of this study is to evaluate the clinical results of a surgical outreach program involving large numbers of patients. Material and Method: Retrospective study of clinical data and outcomes of patients operated on within a surgical outreach held in Togo's Central Region was carried out. Data was collected from patient’s files with a follow-up, of 2 years. Results: Two hundred and seventy seven patients (277) underwent 304 surgical procedures within the surgical outreach. The conditions were essentially made of hernias of the abdominal wall (89%). Cases of hydroceles, endemic goiter and uterine myo-fibroids were also managed. Spinal anesthesia was the most common procedure of anesthesia (75%). Day case surgery involved 165 patients (59.5%). A post operative morbidity was observed in 31 patients (11%) essentially made of hematoma 28 cases (9.2%) and parietal abscesses 20 cases (6.5%).There were no postoperative deaths. Conclusion: outcomes in this study encourage surgical outreach programs as reliable means to address surgery accessibility issues of rural populations in low incomes countries

Traumatismes Balistiques en Zone Opérationnelle: Expérience de l’Hôpital Niveau 2 Togo de Kidal

Introduction : Les traumatismes balistiques sont à l’origine de lésions pluritissulaires variables dont la prise en charge est différente de la traumatologie civile. Le but de cette étude est de rapporter l’expérience de l’Hôpital Niveau 2 Togo de Kidal sur les traumatismes balistiques en zone opérationnelle au Nord-Mali. Méthodologie : Il s’est agi d’une étude rétrospective descriptive et transversale sur 22 mois couvrant la période du 1er Novembre 2015 au 31 Août 2017 ; incluant les blessés par projectiles admis à l’Hôpital Niveau 2 Togo de Kidal. Résultats : Cent cinquante-et-deux blessés dont 149 hommes et 3 femmes ont été enregistrés. L’âge médian était de 29,6 ans (extrêmes : 19 ans et 56 ans). Les militaires étaient les plus atteints (92,8%). Les lésions étaient provoquées par les éclats d’obus dans 73,7% des cas. Elles étaient dominées par les lésions des tissus mous (65,1%), suivies des fractures (15,1%). Les membres étaient les sites les plus touchés. La prise en charge consistait à la recherche et à la correction des détresses vitales, et à la prise en charge spécifique des lésions balistiques. L’évolution était favorable chez 115 blessés (75,6%). Vingt-et-un blessés (13,8%) avaient été évacués vers un hôpital de niveau supérieur. Il y avait 16 cas (10,5%) de décès dont 15 (9,8%) avant l’admission. Conclusion : La prise en charge des blessés selon les principes de la chirurgie de guerre conditionne le pronostic. Introduction : Ballistic trauma are responsible for variable multitissue lesions which management is different from the usual traumatology. The purpose of this study is to report the experience of Togo Level 2 Hospital of Kidal on ballistic trauma in operational zone in NorthMali. Methodology : It was a retrospective descriptive and transversal study on 22 months, from November 1, 2015 to August 31, 2017 ; including projectiles injured admitted to the Togo Level 2 Hospital of Kidal. Results : One hundred and fifty-two injured including 149 men and 3 women were registered. The average age was 29.6 years (extremes : 19 years and 56 years). The soldiers were the most affected (92.8%). Shrapnel were the main lesion agents (73.7%). Soft tissue lesions were predominant (65.1%), followed by fractures (15.1%). Members were the most affected sites. The management consisted of the search and the correction of the vital distress, and the specific care of ballistic lesions. The outcome was favorable for 115 injured (75.6%). 21 injured (13.8%) were evacuated to a higher level hospital. 16 cases (10.5%) of death including 15 (9.8%) before admission were registered. Conclusion : The management of injured according to the priciples of war surgery conditions the prognosis

Surgical management for squamous cell carcinoma of vulva

To analyze our surgical management and the result of squamous cell carcinoma (SCC) of vulva. Retrospectively, we collected 38 cases of SCC; 17 cases of them were early SCC and 21 cases were locally advanced. The patients underwent primary surgery. The survival was estimated using Kaplan-Meier analysis and the log rank test. The mean age was 60.78 years. Total vulvectomy was performed in all patients. Superficial and deep incision of bilateral inguinal lymphadenectomy was performed by separates incisions for SCC infiltrating more than 1mm. The average tumor size was 53 mm (10 to 140mm). Morbidity was 42.1%. Lateral resection margin ≥8mm was obtained in 57.1%. Eighteen patients benefited from adjuvant radiotherapy. The follow-up median was 19.4 months (6 to 61.5 month) with 05 recurrences in 12 months. The survival using the Kaplan-Meyer analysis at 5 years, was 62.1% (71.2%N- vs 46.7%N+; p = 0.13). We identified two groups for locally advanced vulva cancer. Primary surgery keeps its place. Neo adjuvant radio chemotherapy followed by surgery is the alternative treatment for locally extensive lesions. The Pan African Medical Journal 2016;2