Colon bypass with a colon-flap augmentation pharyngoesophagoplasty

Extensive caustic stricture of the upper aero-digestive system (oro- and hypo-pharynx) is a severe injury with limited surgical options. We adopted augmentation of the cicatrized upper aero-digestive tract with colon as our preferred management option. The aim of this report is to describe our initial experience with the technique of colon-flap augmentation pharyngo-esophagoplasty (CFAP) for selected patients with severe pharyngoesophageal stricture. Between October 2011 and June 2013, three male patients (aged 16, 4 and 18 years respectively) underwent CFAP following extensive pharyngo-esophageal stricture. Postoperative recovery was uneventful in all three cases and all started swallowing within 7 - 10 days after surgery without significant dysphagia. Colon-flap augmentation pharyngo-esophagoplasty is an effective procedure for reconstruction of the pharynx and the hypopharynx after extensive caustic pharyngoesophageal structure in selected cases

Surgical management of constrictive pericarditis

Background: Constrictive pericarditis is a disease characterized by marked thickening and dense scarring of the pericardium with pericardial sac obliteration, or calcification of the pericardium. Without treatment this disease is characterized by high morbidity and mortality.Objective: To review the surgical management of constructivepericarditis and the post operative challenges. Methods: Eleven patients who had pericardiectomy for constructive pericarditis between 2000 and 2005 were studied. Data was obtained from the operating theatre register, histopathological reports and patient’s casenotes. Results: The mean age was 33 years with a range of 14to 53 years. There were seven males (63.6%) and four females (36.4%). Seven (63.6%) out of the eleven patients operated were treated for pulmonary tuberculosis. The cause of pericardial constriction in four patients (36.4%) was undetermined. Follow up period was between 4-59 months. The mean follow up was 17.5 months. Seven patients (63.6%) were off diuretics and had no exercise intolerance. Patients were classified using the New York Heart Association (NYHA) n (NYHA) functional and therapeutic classification in class I-V. Two patients preoperatively in class III are now in class I after surgery on low dose diuretics. One patient who had calcific constrictive pericarditis and came in class III was now in class II with diuretics after 3 years of follow up. There was no postoperative mortality. One patient was lost to follow up. Conclusion: Pericardiectomy is a useful procedure for constrictive pericarditis and was beneficial to all thepatients in this study with an improvement in theirfunctional capacity. Intensive peri-operative monitoringand management reduced morbidity and mortality

Trachea stabilization with autologous costal cartilage in acquired tracheomalacia: report of two cases

(East African Medical Journal: 2001 78(6): 330-331

Acute normovolaemic haemodilution for gynaecological surgery in Korle Bu Teachning Hospital: how feasible it is?

No Abstract. Ghana Medical Journal Vol. 38(4) 2004: 127-13

Use of midazolam for conscious sedation in upper gastrointestinal endoscopy

No Abstract. Ghana Medical Journal Vol. 38(4) 2004: 141-14

The efficacy of pre-operative erythropoietin therapy

No Abstract. East African Medical Journal Vol. 84 (6) 2007: pp. 279-28

Pattern of Esophageal Injuries and Surgical Management: A Retrospective Review

Background: The consequence of significant injury to the esophagus is devastating. The initial management when timely and appropriate is  rewarding and often prevents lethal complications. The objective of this study is to describe the etiology of esophageal injury in our institution, the management procedures and the mid‑term results. Method: Consecutive patients diagnosed and managed for esophageal injury from January 2005 to March 2015 were retrospectively reviewed. Results: One hundred and eleven patients were seen and treated during this period; 85 (76.6%) predominantly children were corrosive esophageal injuries who accidentally ingested caustic soda and 26 (24.4%) were traumatic esophageal injuries. Patients with corrosive esophageal injuries were predominantly male (2:1), mean age 12.8 ± 14.2 years (2–58 years) and predominantly children (53% ≤5 years; 18.8% ≥ 18 years). Patients with non‑corrosive esophageal injury were also predominantly male (4:1) with a mean age of 34.4 ± 20.1 years (1–73 years). The treatment procedures for corrosive esophageal injuries included esophagocoloplasty 64 (75.3%), colopharyngoplasty 10 (11.8%), colon‑flap augmentation  pharyngo‑esophagoplasty 4 (4.7%), colopharyngoplasty with tracheostomy 4 (4.7%) and esophagoscopy and dilatation 3 (3.5%). Mortality was 5.9% and 5 patients were lost to follow‑up. In patients with noncorrosive esophageal injury, esophageal perforation from instrumentation accounted for 14 (53.9%), foreign body impaction 11 (42.3%) and spontaneous perforation 1 (3.8%) making up the rest. Management of these patients includedesophagotomy and removal of foreign body 7 (26.9%), esophagectomy, cervical esophagostomy and feeding gastrostomy 10 (38.6%), primary repair 7 (26.9%), Ivor Lewis procedure 1 (3.8%) and emergency esophagectomy with colon replacement 1 (3.8%). Mortality in this group of patients was 7.7% and 4 patients were lost to follow‑up. Conclusion: Corrosive esophageal injuries were the most frequent form of esophageal injury at our center due to unrestricted access to corrosive substances. Generally, appropriate surgical intervention in patients with esophageal injury based on individualization of care yields excellent early  and  mid‑term results. Keywords: Colon‑flap, colopharyngoplasty, esophageal injury, pharyngoesophagoplast