Thoracic Surgery in Limited Resource Settings – Experience at Three Referral Hospitals In Rwanda. Case Series
Michael C. Sinclair, Isaie Sibomana, University of Rwanda, Butare, Rwanda
OBJECTIVE: OBJECTIVE: to describe the thoracic surgical procedures performed by a thoracic surgeon at three referral hospitals in Rwanda
METHODS: A case series study was conducted in patients with chest diseases operated on at three teaching hospitals in Rwanda from September 2015 through July 2017. This study included only major thoracic procedures. Data were collected from the faculty logbook and patient files. The information collected included basic demographic data, clinical presentation, radiological and intraoperative findings, and outcomes.
RESULTS: Thirty-one patients underwent operations in the twenty-one months of the study. Twenty-one of the patients were male (68%) and ten were female (332%). Patients ages ranged between 13 and 77 years with mean age 44.2 years. Infectious chest pathologies (mostly tuberculosis related) were common indications for the thoracic surgery. Fifteen cases (48.4%) were empyema thoracic which required either thoracotomy and pulmonary decortication or open thoracostomy (modified Eloesser flap). Other operations performed were anterior mediastinostomy for mediastinal mass (4 cases), pericardial window for pericardial tamponade (2 cases), resection of lung aspergilloma (2 cases), resection of lung tumor (2 cases), pericardiectomy, repair of a diaphragmatic rupture, thoracotomy and attempted repair of traumatic trachea-esophageal fistula and others. (Table 1). Mortality was 6.5% (2 cases) and three patients had complications which were surgical site infection in one patient and ineffective thoracotomy in two patients.
CONCLUSIONS: This study shows a burden of thoracic infections, especially tuberculosis-related which require surgical intervention in a developing country. Major thoracic surgery can be performed in low-resource settings with acceptable morbidity and mortality.