Laparoscopic surgery for groin hernia in a third world country: a report of 9 cases of transabdominal pre-peritoneal (TAPP) repair in Yaoundé, Cameroon

Groin hernia repair is probably the most common procedure in general surgery. Today, in adult hernias, prosthetic repairs are accepted to be superior to "non-mesh" suture repairs. Concerning mesh repair, the (open) LICHENSTEIN and laparoscopic inguinal hernia techniques are recommended as the best evidence-based options. Nevertheless laparoscopic repair techniques still not currently practiced in sub-Saharan countries and particularly in Cameroon. From January 2011 to November 2014, a prospective laparoscopic groin hernia-specific database was queried for all adult patients in the visceral and laparoscopic surgery unit of the National Insurance Health Center of Essos (Yaoundé/Cameroon). Seven patients were recorded. All of them were male with a mean age of 49 years. Two cases were bilateral, 5 unilateral and all of them primary. There were 6 direct and 3 indirect hernias. They underwent 9 Transabdominal Pre-peritoneal (TAPP) repair and none Totally Extra-Peritoneal (TEP) procedure was done. A self-gripping overlapping flap was inserted in all cases. The mean length of the procedure was decreasing with time, from 150 min for our first procedure to 60 minutes for the last one. With a mean follow-up period of 20.2 months, the post-operatives courses were uneventful. Laparoscopic hernia repair in general and TAPP in particularly is a safe and reproducible procedure even in developing countries. African surgeons should be aware of this technique.Pan African Medical Journal 2016; 2

Double half-cone flap umbilicoplasty for proboscoid umbilical hernia in a 2 years old child with satisfactory results 2 years later

Surgical repair of large umbilical hernias may present a challenging surgical problem; standard surgical  techniques have proven to be inadequate for both closing the fascial defect of the umbilicus and providing a  satisfactory cosmetic result. We describe here a case of double half-cone flap umbilicoplasty that was  performed in a 2 years old boy. The case of a 2 years old child with proboscoid umbilical hernia. The protruding umbilical skin was excised sharply by two V-shaped cuts leaving two half cones, a short cephalic (0.5cm) and a long caudal (1cm). A classic herniotomy was carried out, with repair of the facial defect. The caudal half cone was sutured from its apex till half it's length upon itself with interrupted sutures and it was anchored deeply to the fascia. Then we inverted the cephalic half cone which was sutured to the caudal cone to form the new umbilicus. The early result was excellent with no complications and the result after 2years revealed a  cosmetically satisfactory shape of the umbilicus. this technique provides a good solution for reconstruction of the protruding umbilical skin and it is easy to learn, easy to be taught and perform in surgical environments and may be applicable for any kind of umbilical reconstruction.Key words: Double half-cone flap, proboscoid umbilical hernia, umbilicoplast

Mineurs (inces)-tués, parents complices ?

Ce travail a été entrepris afin d’estimer la prévalence de l’inceste, de dégager les caractéristiques sociodémographiques des victimes et des abuseurs, et de décrire la typologie des formes d’abus rencontrés dans une institution de prise en charge des enfants et de jeunes ayant subi des abus sexuels à Yaoundé (Cameroun). Il s’agit d’une étude rétrospective sur dossiers qui a eu lieu au Centre d’Écoute Pour Enfants et Adolescents. En 60 mois, l’étude a inclus 78 jeunes et mineurs ayant été victimes d’abus sexuels. Parmi eux, 27 étaient victimes d’abus sexuels de nature incestueuse (34,6 %). Leurs âges variaient de 1 mois à 20 ans avec une moyenne de 11,8 ans et un écart type de 5,19. Il y avait 19 filles (70,3 %) et 8 garçons (29,7 %). Le viol était le mode préférentiel d’abus sexuel avec 22 cas (81,5 %) contre 2 cas d’attouchements (7,4 %). Seulement 6 victimes sur 27 (22,2 %) vivaient avec leurs deux parents au moment de l’abus, 10 d’entre elles (37 %) vivaient avec l’un des deux parents dont une moitié avec le père et l’autre moitié avec la mère. Sur un total de 20 abuseurs, 19 étaient de sexe masculin (95 %) et 1 seul était de sexe féminin (5 %). Les âges des abuseurs variaient de 14 à 73 ans avec une moyenne de 32,2 ans et un écart type de 11,78. 6 abuseurs (30 %) sur 20 étaient des mineurs. L’abuseur était un oncle 10 fois (37,1 %), le père biologique 8 fois (29,6 %), un cousin 3 fois (11,1 %), un frère 2 fois (7,4 %). Le père était l’abuseur 3 fois sur 6 (50 %) quand l’enfant vivait avec les deux parents et 4 fois sur 5 (80 %) lorsque l’enfant vivait seul avec lui. Le phénomène des abus sexuels intrafamiliaux est bien réel au Cameroun. Il concerne les filles dans 2/3 des cas et les garçons dans l’autre tiers. Ce drame se déroule généralement dans un environnement silencieux et Les familles préfèrent souvent un arrangement à l’amiable à huis clos suivi de rites traditionnels de purification symbolique de la victime chez un guérisseur pour absoudre l’inceste à un déshonneur publiquement affiché au tribunal

Obstructive lithiasis of the lower bile duct discovered four decades after cholecystectomy and its management by ideal choledochotomy: a case report

Abstract Background Residual lithiasis is the presence of stones in the common bile duct, ignored after one or more biliary interventions. We report an atypical case of chronic symptomatic lithiasis of the lower bile duct occurring 41 years after biliary surgery, managed successfully by ideal choledochotomy. Case presentation A 68-year-old Black African female with several past laparotomies including a cholecystectomy forty-one years ago presented with hepatic colic-type pain that had been intermittent for several years but worsened recently. Her clinical, biological, and imaging test assessments were suggestive of a residual obstructive lithiasis of the lower common bile duct. Through an open right subcostal laparotomy approach, a dilated bile duct of approximately 3 cm was found and managed by transverse choledochotomy in which the stone was extracted in retrograde manner. After confirmation of disobstruction, a primitive bile duct suture without biliary drainage was performed and a tubular drain was positioned under the liver. The postoperative course was uneventful at follow-up of 30 days. Conclusion Residual choledocholithiasis can be avoided. We performed an ideal choledochotomy, of which the follow-up was simple

Complex Pulmonary Aspergilloma: Surgical Challenges in a Third World Setting

Background. Surgery for pulmonary aspergilloma (PA), especially complex forms, is greatly challenging in a resource-poor setting such as Cameroon. We report our experience of surgical management of PA in this environment. Method. We prospectively assessed patients who underwent surgery for PA from January 2012 to May 2015, at the University Hospital Center of Yaoundé. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures, and outcomes. The study has received approval from the institutional ethics committees. Results. In total, 20 patients (17 males and 3 females (sex ratio, 5.66); mean age, 30 years; range, 23–65 years) with a past history of tuberculosis were assessed. The median follow-up was 21.5 months. The primary symptom was hemoptysis, followed by cough and chest pain. All patients underwent surgical treatment and lung resection. Postoperative complications (bleeding, air leak, empyema, and severe anemia) occurred in 4 patients and 1 patient died. Although 3 patients were lost to follow-up, the survival rate was 80% with improvement of the preoperative symptoms. Conclusion. Although surgery for complex aspergilloma is very challenging in environments such as ours, we believe that it is the best treatment modality for symptomatic diseases in our setting

Perioperative outcomes of the surgical management of achalasia in two tertiary Cameroonian hospitals: a cohort study

Abstract Introduction Achalasia is a rare esophageal disease with potentially lethal complications. Knowledge of the outcomes of the different surgical treatment modalities for achalasia by Heller’s cardiomyotomy (HCM) helps to choose the safest and most effective option. However, data on the management of achalsia using a Heller myotomy is limited in Africa. Thus, our aim was to determine the perioperative morbidity, mortality and short-term functional outcomes of HCM in Cameroon. Methodology We conducted a cohort study throughout a 10-year chart review of patients who underwent HCM for achalasia and were followed up postoperatively for at least three months at two tertiary health centers in Cameroon. We analyzed demographic data, preoperative clinical and imaging data, treatment details, and outcomes at three to twelve months after HCM using the Eckardt score. Results We enrolled 29 patients with achalasia having a mean age of 24 ± 16 years and predominantly females (M/F of 1/3.8). The mean symptom duration was 51 ± 20 months. In 80% of cases, the diagnosis was made through a conventional x-ray contrast imaging or “barium swallow test” (93%) and/or an upper gastrointestinal endoscopy (86%). The gold standard diagnostic method via esophageal manometry was unavailable. Preoperatievly, all patients had symptoms suggestive of an active achalasia. HCM was performed via laparotomy in 75% as opposed to 25% laparoscopic HCM procedures. Dor’s anterior partial fundoplication was the main anti-reflux procedure performed (59%). Mucosal perforations were the only intraoperative complications in eight patients (2 during laparoscopy vs. 6 during laparotomy; p > 0.5) and were managed successfully by simple sutures. Postoperative complications were non-severe and occurred in 10% of patients all operated via laparotomy. The mean postoperative length of hospital stay was 7 ± 3 days for laparotomy vs. 5 ± 2 days for laparoscopy; p > 0.5. The perioperative mortality rate was nil. Overall, the short-term postoperative functional outcome was rated excellent; average Eckardt score of 1.5 ± 0.5 (vs. preoperative Eckardt Score of 9 ± 1; p < 0.0001). Conclusion Achalasia is diagnosed late in this resource-limited setting. HCM yields satisfactory outcomes, especially via laparoscopic management. An improvement in diagnostic esophageal manometry and mini-invasive surgical infrastructure and the required surgical training/skills are needed for optimal achalasia care

Is laparoscopy feasible and effective for acute postoperative small bowel obstruction in Africa? A case report in Yaoundé, Cameroon Case report Open Access

Abstract Laparoscopic management of acute adhesive small bowel obstruction has been shown to be feasible and advantageous. However, widespread acceptance and application is still not observed. We describe the case report of a 58-year-old male who presented with signs and symptoms of small bowel obstruction status twenty years after two consecutive open surgeries for complicated acute appendicitis. The patient underwent successfully a laparoscopic band lysis after failure of conservative management. This is the first report of laparoscopic management of adhesive small bowel obstruction in Cameroon. Laparoscopic adhesiolysis of acute adhesive small bowel obstruction is feasible and safe by skilled surgeons in selected patients even in developing countries

Épidémiologie descriptive et prise en charge du cancer colorectal au Cameroun. Série rétrospective de 103 cas à l’Hôpital Général de Yaoundé

Introduction : Les données sur l’épidémiologie descriptive et les modalités thérapeutiques du cancer colorectal demeurent insuffisantes dans notre contexte. Méthodologie : Nous avons conduit une étude observationnelle descriptive avec recueil rétrospectif de données dans le service d’oncologie de l’hôpital Général de Yaoundé. Tous les dossiers de patients suivis pour un cancer colorectal du 1er Janvier 2015 au 31 Décembre 2019 et dont le devenir était connu jusqu’au 31 Décembre 2020, ont été inclus.. Résultats : Nous avons colligé 103 patients parmi lesquels 60 (5782%) étaient de sexe masculin. L’âge moyen était de 40,9±16,6 ans. Un antécédent familial de cancer colorectal était retrouvé chez 16,5% des patients. Le délai de consultation était de 12±6,4 mois. Le colon gauche était la localisation tumorale la plus fréquente (30,1%) et il s’agissait le plus souvent d’un adénocarcinome Liberkühnien (46,6%). Les tumeurs étaient majoritairement au stade TNM 4 (39,8%) et 3 (25,2%) au moment du diagnostic. Le traitement a eu un but curatif dans 60,2% des cas ; il s’agissait de la chirurgie associée à une chimiothérapie néoadjuvante et adjuvante dans 59,7% et 64,5% des cas, respectivement. Aucun patient n’a reçu de radiothérapie. La survie à 5 ans était de 15,5%. Conclusion : Le cancer colorectal est majoritairement localisé dans le colon gauche et affecte le plus souvent les patients de sexe masculin dans la quarantaine. Le retard diagnostic est important et la prise en charge marquée par un faible accès des patients à la chimio/radiothérapie. Le pronostic à 5 ans est sombre. &nbsp; English title: Descriptive epidemiology and management of colorectal cancer in Cameroon. A retrospective series of 103 cases at Yaoundé General Hospital Introduction: Data on the descriptive epidemiology and treatment modalities of colorectal cancer remain insufficient in our context. Methodology: We conducted a descriptive observational study with retrospective data collection in the oncology department of the Yaoundé General Hospital. Were included, all patient records followed for colorectal cancer from January 1, 2015 to December 31, 2019 and whose outcome was known until December 31, 2020. Results: We collected 103 patients among whom 60 (5782%) were male. The mean age was 40.9 ± 16.6 years. A family history of colorectal cancer was found in 16.5% of patients. The delay between onset of symptoms and consultation was 12 ± 6.4 months. The left colon was the most common tumor location (30.1%) and the most frequent histologic type was Liberkühnian adenocarcinoma (46.6%). The tumors were predominantly at TNM stage 4 (39.8%) and 3 (25.2%) at the time of diagnosis. The treatment had a curative goal in 60.2% of cases; it was surgery combined with neoadjuvant and adjuvant chemotherapy in 59.7% and 64.5% of cases, respectively. No patient received radiotherapy. The 5-year survival was 15.5%. Conclusion: Colorectal cancer is predominantly localized in the left colon and most commonly affects male patients in their forties. There is a significant delay in diagnosis and treatment marked by poor patient access to chemo/radiotherapy. The prognosis at 5 years is grim

Laparoscopic surgery for groin hernia in a third world country: a report of 9 cases of transabdominal pre-peritoneal (TAPP) repair in Yaoundé, Cameroon Case series Open Access

Abstract Groin hernia repair is probably the most common procedure in general surgery. Today, in adult hernias, prosthetic repairs are accepted to be superior to &quot;non-mesh&quot; suture repairs. Concerning mesh repair, the (open) LICHENSTEIN and laparoscopic inguinal hernia techniques are recommended as the best evidence-based options. Nevertheless laparoscopic repair techniques still not currently practiced in sub-Saharan countries and particularly in Cameroon. From January 2011 to November 2014, a prospective laparoscopic groin hernia-specific database was queried for all adult patients in the visceral and laparoscopic surgery unit of the National Insurance Health Center of Essos (Yaoundé/Cameroon). Seven patients were recorded. All of them were male with a mean age of 49 years. Two cases were bilateral, 5 unilateral and all of them primary. There were 6 direct and 3 indirect hernias. They underwent 9 Transabdominal Pre-peritoneal (TAPP) repair and none Totally Extra-Peritoneal (TEP) procedure was done. A self-gripping overlapping flap was inserted in all cases. The mean length of the procedure was decreasing with time, from 150 min for our first procedure to 60 minutes for the last one. With a mean follow-up period of 20.2 months, the post-operatives courses were uneventful. Laparoscopic hernia repair in general and TAPP in particularly is a safe and reproducible procedure even in developing countries. African surgeons should be aware of this technique

Caractéristiques épidémiologiques, clinicopathologiques et évolutives des patients opérés de cancer de l’œsophage au Cameroun

Introduction : Le cancer de l'œsophage est une affection rare mais de pronostic sombre. Peu de données sont disponibles sur ce sujet dans notre milieu. Le but de ce travail était d’étudier les caractéristiques épidémiologiques, clinico-pathologiques et évolutives des patients opérés de cancer de l’œsophage au Cameroun. Patients et méthodes : Nous avons mené du 1er Décembre 2017 au 31 Mai 2020 de façon prospective une étude dans six formations sanitaires du pays. Les informations sur les données sociodémographiques, les caractéristiques clinico-pathologiques, les modalités thérapeutiques et les données de survie des patients opérés d’une tumeur maligne primitive de l’œsophage ont été recueillies. Résultats : Nous avons colligé 21 dossiers, soit une incidence annuelle moyenne de 1,4 patient par formation sanitaire. L’âge moyen était de 54,86 ans. Il y avait 76,2% d’hommes, soit un sex-ratio de 3,2. La consommation régulière d’alcool et de tabac était le principal facteur de risque. Le diagnostic a été posé chez des patients symptomatiques ou à la suite d’une complication dans 80,9% des cas. Les formes localement avancées ou métastatiques représentaient 94,5%. Il s'agissait d’un carcinome épidermoïde dans 57,1% des cas. Le principal geste opératoire était une entérostomie d’alimentation. Sept patients (33,3%) ont reçu la chimiothérapie ou la radiochimiothérapie. La survie médiane était de 5 mois. La localisation tumorale au bas œsophage étaitassociée à une diminution de la survie (p = 0,04). Conclusion : Le cancer de l'œsophage a une incidence hospitalière faible au Cameroun. Il est caractérisé par une prévalence élevée des formes avancées et la survie est médiocre. La localisation tumorale au bas œsophage serait un facteur de mauvais pronostic. &nbsp; English title: Epidemiological and clinicopathological characteristics and outcomes of patients operated for esophageal cancer in Cameroon Introduction: Esophageal cancer is a rare condition with a poor prognosis, linked to late diagnosis. Treatment standards are not always available in low incomes areas where very little data are available. The aim of this work was to study the epidemiological, clinico-pathological characteristics and outcomes of patients with cancer of the esophagus in Cameroon. Patients and methods: From December 1, 2017 to May 31, 2020, we prospectively conducted a study in six health facilities in the country. Informations on socio-demographic and clinico-pathological characteristics, treatment modalities and survival data of patients operated for a primary malignancy of the esophagus were collected. Results: We collected 21 files, for an average annual incidence of 1.4 patients per health facility. The average age was 54.86 years old. There were 76.2% of men, for a sex ratio of 3.2. Regular consumption of alcohol and tobacco was the main risk factor. The diagnosis was made in symptomatic patients or following a complication in 80.9% of cases. Locally advanced or metastatic forms represented 94.5%. It was a squamous cell carcinoma in 57.1% of cases. The main surgical procedure was a feeding enterostomy. Seven patients (33.3%) received chemotherapy or radiochemotherapy. The median survival was 5 months. Tumor localization in the lower esophagus was associated with decreased survival (p = 0.04). Conclusion: Esophageal cancer has a low hospital incidence in Cameroon. It is characterized by diagnostic delay with a high prevalence of advanced forms and poor survival. The tumor localization in the lower esophagus would be a factor of poor prognosis