Polyester mosquito net mesh for inguinal hernia repair: A feasible option in resource limited settings in Cameroon?

BACKGROUND: In developing countries, most inguinal hernia repairs are performed using Bassini or Shouldice techniques resulting in higher recurrence rates than with mesh placement. Our study aimed to evaluate the postoperative course and quality of life of patients undergoing inguinal hernia repair with a polyester mosquito net meshes during non-governmental organization health campaigns in Cameroon. METHODS: Patients were prospectively included from January to November 2013. Meshes were made from a polyester non-impregnated mosquito net purchased at a local market in Yaounde and sterilized on site. RESULTS: The total cost of a mesh was 0.21 USD. Among the 41 patients included in the study, 33 (80.5%) were men, 30 (72%) were farmers and the median age was 52 (21-80) years. The time between the onset of symptoms and surgery was 24 (3-240) months. Eleven (26.8%) patients had a previous history of hernia repair: 4 (9.7%) had been operated on the contralateral side and 7 (17.1%) had a recurrence. No intraoperative event related to the meshes was recorded. Three patients (7.2%) had a postoperative uninfected scrotal seroma, and 1 patient (2.4%) experienced a superficial skin infection that was treated using local care and oral antibiotics. No allergic rejection or deep infection was observed. CONCLUSIONS: Meshes made from sterilized mosquito nets are safe and effective and provide a cost-effective alternative to commercially available meshes in countries with limited resources especially during non-governmental organization health campaigns.

[Analysis of operative indications and outcomes in 238 re-operations after abdominal surgery in an economically disadvantaged setting]. / Réinterventions de chirurgie abdominale en milieu défavorisé : indications et suites opératoires (238 cas).

AIM OF THE STUDY: We analyse aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes. PATIENTS AND METHODS: Retrospective chart review over a seven-year period of patients requiring re-operative surgery during the same hospitalization or within 30 days of initial surgery. RESULTS: During the study period, 7714 laparotomies were performed. Two hundred and seventy-seven (3.6%) required re-operation; of these, 238 charts (86%) were able to be reviewed. The decision for operative re-intervention was made mainly on the basis of clinical findings. Postoperative peritonitis (50.8%), adhesive bowel obstruction (23.9%), and intestinal fistula (10.9%) were the main indications for re-intervention. Complications occurred in 35% and included postoperative infection (n=70, 33%) and abdominal wall dehiscence (n=37, 15.5%). Mortality was 18% and increased significantly when the initial operative procedure was for peritonitis and re-operation was due to septic complications. CONCLUSION: In an economically disadvantaged environment, the re-operation rate after an abdominal surgery does not seem to be higher than that seen in series from developed countries, although there may be factors which bias this observation. The mortality rate for cases with postoperative peritonitis is high, but operative re-intervention based on clinical findings is still considered the favored strategy in our environment. Results may improve with better material medical conditions.

[Acute abdomens of parasitic origin: retrospective analysis of 135 cases]. / Les abdomens aigus d'étiologie parasitaire: analyse d'une série rétrospective de 135 cas.

OBJECTIVE: To assess acute abdomens incidence of parasitic origin at Yaounde (Cameroon) and evaluate their different management modalities. MATERIALS AND METHODS: Retrospective study from January 1973 to December 2002 of patients managed at Department of Surgery, Central Hospital, Yaounde (Cameroon). RESULTS: Among 3464 acute abdomens managed by laparotomy during this period, 135 patients (3.9%) had a parasitic origin. Ninety-seven patients (79%) were operated on before 1990. Among these 135 patients, 63 (47%) had peritonitis secondary to liver amoebic abscess intraperitoneal rupture, 24 (18%) had acute intestinal obstruction due to an ascaridioma, 21 (15%) had appendicitis of parasitic origin, 15 (11%) had amoebic typhlitis, 4 (3%) had pancreatitis and/or angiocholitis caused by the obstruction of ampulla of Vater by an adult ascaris worm, 4 (3%) had intestinal perforation by ascaris, and 4 (3%) had intussusception (tricocephalus). CONCLUSIONS: Incidence of abdominal emergencies of parasitic origin is unfrequent but not rare at Central Hospital, Yaounde, Cameroon. This incidence is decreasing over time. However, liver amoebic abscess intraperitoneal rupture is the most common cause of peritonitis and is still associated with postoperative high mortality rate. Preoperative diagnosis could lead to non-operative management that may be associated with better prognosis.

[Abdominal gunshot wound: description of 86 cases in Cameroon]. / La plaie abdominale par balle: à propos de 86 observations au Cameroun.

Abdominal gunshot wound (AGSW) is a trauma emergency. The purpose of this report is to describe our experience with managing AGSW largely without modem investigational modalities. Data was collected retrospectively by reviewing the surgical reports and clinical charts of patients admitted to live hospitals dealing with AGSW over a 5-year period. Incomplete files and wounds not involving the abdomen were not included. A total of 86 files were analyzed. Patients ranged in age from 10 to 63 years ivith mean age of 32 years and a sex ratio of 5.5. Most patients (87%) underwent surgical exploration. Laboratory revealed no lesions in 22.5% of cases, minor lesions in 9.5% and major lesions justifying surgical repair in 68%. A total of 86 visceral lesions were found in the patients who underwent surgical exploration. The lesion involved the small intestine in 31.5% of case, colon in 24.5%, liver in 23.5%, spleen in 7%, stomach in 6%, and uterus in 2%. The kidney, pancreas, mesenteries, large momentum, and transverse mescaline each accounted for 1% of lesions. Conventional operative techniques were used with a mortality of 5.5% and morbidity of 4%. Based on our findings we conclude that when investigational tools (CT-scan, peritoneal lavage and laparoscopy) are unavailable prolonged watchful waiting increases the risk of mortality and morbidity in patients presenting AGSW associated with suspicious clinical signs. Prompt surgical treatment improves prognosis but is associated with a high rate of cases showing no lesions.

[Traumatic jejuno-ileal ruptures: apropos of 18 cases at the Central Hospital of Yaounde]. / Les ruptures traumatiques jéjuno-iléales: àpropos de dix huit (18) observations àl'hôpital Central de Yaoundé

Eighteen blunt small bowel traumas were reviewed in this retrospective study (1986-1996) concerning 12.8% of laparotomies for blunt abdominal trauma. The clinical presentation at admission was peritonitis (9 cases) or hemoperitoneum (4 cases) whereas 5 cases were diagnosed lately because of non specific signs at the beginning. All patients underwent surgery: simple suture or suture after excision of edges (12 cases); resection anastomosis (6 cases). There were no post-operative complications in most of the cases. The mortality rate was 5%. Blunt small bowel traumas are not frequent in our practice. Their diagnostic is often per-operative. If the clinical signs of intraperitoneal lesion are not present, a clinical follow-up by repeated and thorough physical examination can permit an early diagnosis. The surgical treatment is simple, and the prognosis more linked to severe associated lesions than the bowel lesion.

[Blunt trauma of the liver. An analysis of a series of 29 cases]. / Traumatismes fermés du foie. Analyse d'une série de 29 cas.

Twenty nine patients with blunt liver trauma were recorded in the Central Hospital of Yaounde between 1986 and 1996. The average age was 23.4 years, with the 20 to 25 and 5 to 15 age groups being the most affected. The most characteristical clinical presentation was hemoperitoneum with shock. Twenty-three patients were operated (18 in emergency and 5 secondary). While 6 patients benefited from non operative treatment due to their stable hemodynamic state. Exploration of lesions revealed 16 grade I and grade II, 8 grade III and 5 grade IV and V lesions. The operation was a simple suture in 13 cases, selective ligature of hepatic artery in 2 cases and 2 tamponades while in 4 cases the treatment was inactive. The bleeding could not be controlled in 2 cases. Peri-operative mortality was 17.39% and morbidity 21.74%, made up mainly of parietal sepsis. In our practice, blunt liver trauma are generally benign and treatment should be conservative.

[Liver trauma: analysis of 42 cases in Yaounde]. / Traumatismes hépatiques: analyse d'une série de 42 cas à Yaoundé.

Forty-two cases of liver trauma were reviewed at the Central Hospital of Yaounde between 1984 and 1994. The mean patient age was 22 years, the most commonly involved age group being between 20 and 35 years. Trauma was blunt in 24 cases (57.1%) and penetrating in 18 cases (42.8%). Diagnosis was achieved most frequently by abdominal needle puncture confirming hemoperitoneum. Emergency surgery was performed in 38 cases. In the remaining 4 cases hemodynamic status was stable and surgery was not required. Lesions were classified as grade I and II in 24 cases, grade III in 5 cases, grade IV in 3 cases, and grade V in 1 case. In the remaining 9 cases the grade of the lesion was not mentioned. Management consisted of simple suture in 26 cases, debridement in one case, packing in 4 cases, and a watchful attitude in 4 cases. In 3 cases hemorrhage was uncontrollable. Overall perioperative mortality was 14.2%. The main complication was parietal sepsis which occurred in 6 cases. In the present African series liver trauma was most often benign. This finding suggests that a conservative surgical approach is indicated.

Perforation traumatique du grele et engagement occasionnel du taenia saginata : a propos de 2 observations. [Lettre]

L'engagement occasionnel de parasites a travers une breche intestinale; en dehors de l'ascaris; est un fait assez rare au Cameroun. La presence intraperitoneale du taenia saginata confirme l'hypothese d'une utilisation accidentelle par le parasite d'une perforation pre-existante. Cette presence ne modifie pas le cours de l'intervention. Le traitement antiparasitaire post-operatoire complete la destruction parasitaire mecanique peroperatoire

Interet du traitement chirurgical de la cryptorchidie a Yaounde

Une etude retrospective visant a evaluer l'interet du traitement chirurgical de la cryptorchidie a porte sur 123 patients operes a Yaounde pendant une periode de 10 ans allant de 1984 a 1994. L'analyse a revele que 93 patients (75;6 pour cent) avaient ete operes apres l'age de trois ans; au moment ou des alterations histologiques avaient deja compris le pronostic fonctionnel du testicule et augmente le risque de cancerisation. Des resultats comparables dans la litterature montrent l'insuffisance de l'information medicale sur l'age optimal de l'abaissement des testicules cryptorchides. L'etude fait des propositions pour un changement de comportement

Sequelles neurologiques des meningites bacteriennes chez le nourrisson et l'enfant a Yaounde

144 enfants ages de 1 mois a 14 ans ont ete hospitalises pour meningite bacterienne du 1er septembre 1992 au 31 juillet 1993. 43 sont decedes (29;86 pour cent) et 101 gueris ont fait l'objet d'une surveillance pluridisciplinaire (ORL; opthalmo; neuropediatrique) pendant une periode de 9 a 18 mois. 23;61 pour cent presentent des sequelles neurologiques: deficit auditif 25 pour cent; epilepsie 17;85 pour cent; deficit moteur 12;5 pour cent; trouble du comportement 10;71 pour cent; hydrocephalie 8;92 pour cent; cephalee 5;25 pour cent; trouble d'apprentissage scolaire 1;78 pour cent. La meningite purulente est la cinquieme cause d'hospitalisation et la troisieme cause de mortalite infantile a Yaounde. Les auteurs insistent sur la necessite de prendre en compte les facteurs de risques dans la prise en charge des meningites bacteriennes et la necessite d'une surveillance pluridisciplinaire

Maladie ulcereuse gastro-duodenale : acces aux moyens de diagnostic et de traitement en milieu tropical

Une etude prospective portant sur l'analyse des antecedents de 72 malades operes au CHU de Yaounde d'un ulcere gastro-duodenal complique avait pour but d'evaluer l'acces des malades aux moyens de diagnostic et de traitement pendant la maladie ulcereuse et pendant les complications. Les stenoses etaient la complication chirugicale la plus frequente (69;4 pour cent) devant les hemorragies (16;6 pour cent) et les perforations chez 43 malades (59;7 pour cent). Les examens diagnostiques avaient ete demandes chez 25 malades (34;7 pour cent); dont 9 TOGD et 6 fibroscopies; chez les 15 malades ayant eu une complication sur un ulcere connu; 5 malades (33;3 pour cent) avaient pu suivre dans le passe un traitement medical correct. Avec la survenue des complications; tous les malades ont eu acces aux moyens de diagnostic; dont 50 TOGD et 6 fibroscopies pour le diagnostic des hemorragies et et 8 radiographies de l'abdomen sans preparation pour le diagnostic des perforations. Apres le traitement chirurgical 6 malades (8;5 pour cent) ont poursuivi un traitement medical correct pendant 45 jours. En conclusion; cette etude montre que peu de malades souffrant de maladie ulcereuse gastro-duodenale ont acces aux moyens modernes de diagnostic et de traitement en milieu tropical. Une meilleure politique sanitaire s'impose en vue de controler cette maladie avant la survenue des complications

[Primary abscess of the psoas. A common disease in tropical countries. Apropos of 87 cases]. / Abcès primaires du psoas. Affection courante en milieu tropical. A propos de 87 cas.

Over a 4 years period, 87 cases of primary abscesses of the psoas were treated surgically at the Central Hospital in Yaoundé. The psoas muscle was involved in 10.17% of the cases with myositis. Most patients were in young male and the abscesses were in an advanced stage. Staphylococcus was the most frequently encountered germ (78.4%) and enterobacteria were only found in 3.07%. The diagnosis was based on clinical and echographic findings. There was 1 patient with acquired immunodeficiency syndrome (AIDS). Most cases were treated by extraperitoneal drainage. Morbidity and mortality were low and generally occurred in debilitated patients (AIDS, involvement of several muscle groups, diabetes).

[A rare complication of inguinal hernia. Evisceration by rupture of the scrotum secondary to blunt trauma of the abdomen]. / Une complication rare de hernie inguinale. Eviscération par rupture scrotale secondaire à un traumatisme appuyé de l'abdomen.

The authors present a case report of scrotal rupture with evisceration from abdominal contusion in a patient with a voluminous inguino-scrotal hernia. The mechanism and treatment of lesions are discussed.

[Ano-rectal injuries in civilian practice in Cameroon. 10 case reports]. / Les plaies ano-rectales en pratique civile camerounaise. A propos de 10 cas.

At the Central Hospital of Yaoundé, Cameroon, 10 ano-rectal injuries were treated over a period of 5 years. There were the same number of men and women and all patients were young (range: 7 to 35 years). The cause was illegal abortion in 2 cases and impalement following a fall from a tree in 3. The time lapse between injury and treatment was longer than 24 hours in 5 patients. In 2 cases the lesions were minor and simple debridement was possible. In the remaining 8 cases, construction of a colostomy was required using either the Hartmann terminal-type technique (n = 5) or the exclusion technique (n = 3). Three patients died: one from traumatic shock and two from septic shock. Complications were observed in 4 patients: 2 infections and 2 mechanical complications. Two patients presented permanent sequels including one with partial fecal incontinence. This study confirms the difficulty in management of ano-rectal injuries with limited facilities and reveals the variety of situations that can lead to these injuries especially in children in Africa.

[Typhoid perforations: experiences in a surgical setting in Cameroon. Apropos of 49 cases]. / Perforations typhiques: expérience en milieu chirurgical Camerounais. A propos de 49 cas.

Over a period of 3 years, 49 typhoid perforations of the small intestine were treated at Yaoundé Central Hospital. These 34 men and 15 women with a mean age of 29.6 years presented sthenic peritonitis in 20 cases and more difficult to diagnose asthenic peritonitis in 29 cases. The perforation was always located at the end of the ileum and was single in 40 cases, double in 6 cases and triple in 3 cases. Surgical management in association with intensive care and multiple agent antimicrobial therapy consisted in sleeve resection in 29 cases, resections with an exteriorized anastomosis in 15 cases, and ileocolonic intubation in 5 cases. The postoperative complications were suppuration of the wall (n = 4), intestinal fistula (n = 3), evisceration, and residual abscess. There were 9 deaths (18.4%) including 4 after sleeve resection and 5 after resection with an exteriorized anastomosis. On the basis of this experience, the authors describe the diagnostic difficulties posed by typhoid perforations, discuss surgical techniques proposed in the literature, and emphasize the value of sleeve resection.

Une demarche diagnostique des cancers du pancreas exocrine en milieu tropical

Il s'agit d'une etude sur 14 patients et visant a proposer a des malades a faible pouvoir d'achat une demarche diagnostique adaptee a un environnement sous-equipe en materiel et en personnel specialise. Les sequences clinique-echographie-cytoponction percutanee et clinique-echographie-laparotomie ont permis le diagnostic de 13 cancers du pancreas; ce diagnostic etait utilement complete par les donnees d'une laparotomie permettant un traitement palliatif sans aggravation du pronostic