East and Central African Journal of Surgery

Artificial Intelligence for Surgical Trainees: A Tool for Equity, Efficiency, and Evolution in East, Central, and Southern Africa

2025-03-29T13:14:26+00:00

Challenges of Providing Surgical Care in Eastern Zambia

2025-03-28T07:11:19+00:00

Background

Surgery is an integral part of the universal health coverage as there can never be universal health coverage without surgical care. There is little known about what type of surgical procedures are done in the district hospitals and which carder operates on what type of cases. Zambia formulated the national surgical, obstetrics, and anaesthesia Plans (NSOAPs) in 2017 which is a strategic plan aimed at improving surgical services in order to achieve Universal Health Coverage (UHC).

Methods

We conducted an analytical study on the surgical services available in the six major districts, across the province as we conducted surgical camps. We booked patients before the scheduled surgical camps through radio announcements and other established channels. We analyzed the local booking lists and theatre records, assessed the surgical services, accessibility and interviewed the local teams on the challenges being faced.

Results

There were no booking lists in all facilities. 68% of cases done in the district hospitals are caesarian sections with very few other surgical cases. We conducted 219 cases, 63% elective cases and 37% emergency cases of which 53% were obstetric cases. The majority of elective cases were excisions at 40% and hernias were 35%. The lack of human resource was the number one reason why basic surgical procedures were not being done followed by lack of supply of medical and surgical supplies.

Conclusion

There is very little surgery that happens in the district hospitals, apart from caesarian sections which exhaust the operating teams in the facilities. The lack of staff, medical equipment, and poor medical - surgical supplies are the top challenges advanced. There is a lot of work to be done as we thrive to achieve UHC in the Eastern region of Zambia.

Mini-cholecystectomy, A Standard of Care and Training in Limited Resource Health Facilities: An Example From Sudan

2025-03-28T07:18:35+00:00

Background

Gallstone disease is a common surgical condition, particularly in low- and middle-income countries (LMICs) where access to laparoscopic cholecystectomy (LC) may be limited by cost and equipment availability. Mini-cholecystectomy (MC) offers a viable alternative for gallstone management in similar settings. Objectives: This study assessed the safety, efficacy, and educational value of MC performed by consultants and trainee registrars in a resource-limited setting, evaluating clinical outcomes across different operator experience levels.

Methods

A single-blinded, prospective, descriptive, and analytical study was conducted in surgical facilities in Kassala State, Sudan, from January 2018 to December 2021. All patients undergoing MC for gallstone disease during this period were included. Data were collected on demographics, comorbidities, diagnosis, hospital stay, postoperative outcomes, and pain management. Outcomes were compared between consultants and trainee registrars using the chi-square test, with significance set at P < 0.05.

Results

600 patients underwent MC, with consultants performing 58% of procedures. The mean patient age was 43 years, and the male-to-female ratio was 1:4.9. Hospital stay averaged 2.9 days, with registrars performing more surgeries in patients requiring longer stays (P < 0.0001). Postoperative vomiting was more common in registrar cases (P < 0.0001), and registrar patients reported slightly higher pain scores (P < 0.0001). Biliary injury occurred in three cases. Mini-cholecystectomy demonstrated safety and efficacy in the surgical training unit, with a low biliary injury rate (0.5%) and manageable postoperative pain (mean score of 5.4). It also proved a valuable training standard, as registrars performed 42% of procedures with acceptable outcomes.

Conclusions

Mini-cholecystectomy is a safe, effective, and accessible alternative to LC in LMICs. It also serves as a valuable training tool for surgical registrars. This study supports the expanded use of MC in resource-limited settings to improve access to gallstone management while providing effective training for surgical residents.

Gangrenous Colon in a Congenital Diaphragmatic Hernia at 23 years: A Case Report

2025-03-28T06:46:53+00:00

Diaphragmatic hernias are congenital and commonly occur in neonates. A gangrenous transverse colon in a congenital diaphragmatic hernia is even rarer in adults. The study aims to demonstrate a gangrenous colon in congenital diaphragmatic hernia at 23 years.

The patient presented with features of intestinal obstruction and respiratory distress. The chest radiograph indicated a large bowel in the left chest cavity. CT scan of the chest confirmed a diaphragmatic hernia with its complications. The histological diagnosis was gangrenous colon in keeping with strangulated hernia. At laparotomy, a left diaphragmatic defect of 4-5 cm and a gangrenous transverse colon in the left chest cavity were found. The gangrenous colon was resected and created a transverse colostomy. A left thoracostomy tube was inserted. After 3 months the colostomy reversal was done and the recovery was uneventful.

The report demonstrated a rare case of gangrenous colon in a congenital diaphragmatic hernia at 23 years managed by surgery via an abdominal approach.

Management of a Synovial Sarcoma at The Level of The Diaphragmatic Hiatus: A Case Report

2025-03-28T06:56:15+00:00

Synovial sarcoma arising from or involving the pleura (PPSS) is rare but is thought to have a more clinically aggressive behavior than synovial sarcoma occurring in the extremities. Optimal management of PPSS is not fully defined though complete resection is generally considered a key component of treatment. Here we report the surgical approach to an unusual PPSS bridging the upper retroperitoneum and lower posterior mediastinum and discuss care in the context of the published literature.