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

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.

Clinical epidemiology and mortality risk factors of gastric cancer in a sub-Saharan African setting: a retrospective analysis of 120 cases in Yaoundé (Cameroon).

INTRODUCTION: in sub-Saharan Africa, there is scare published data on cancer in general and gastric cancer in particular. METHODS: we conducted a multicenter retrospective analysis of the medical records of patients followed for gastric cancer in 5 hospital departments in the city of Yaoundé (Cameroon) over 6 years. RESULTS: we recorded a total of 120 patients with a mean age of 53.4 ± 13.7 years. There were 62 females (51.7%). The most common risk factors for gastric cancer in our patients was Helicobacter pylori infection (59 cases, 49.1%). Seventy-six patients (63.3%) consulted within 1 to 6 months of symptoms on set at the forefront of which chronic epigastralgia (74.1%). At endoscopy, the tumor was mostly located at the antrum and was locally advanced or metastatic in 25.8% and 58.4 of cases respectively. Adenocarcinoma was the main histologic type found in 105 (87.5%) cases. Curative treatment could only be implemented in 26.7% of patients. We noted a total of 85 deaths (70.8%) with a mean survival time of 5.91 ± 7.51 months. Survival rate at 3 and 5 years was 10.1% and 4.6%, respectively. On multivariable analysis, variables independently associated with overall survival included: WHO stage 3 performance status (p = 0.042), palpable epigastric mass on examination (p = 0.042), pyloric localization (p = 0.007), and liver metastasis (p = 0.012). CONCLUSION: clinical epidemiology of gastric cancer in our study is comparable to those of other African studies with a predominance of locally advanced/metastatic forms. Prognosis is grim with diagnostic delay behind all of the identified mortality risk factors.

Paediatric fractures in a sub-saharan tertiary care center: a cohort analysis of demographic characteristics, clinical presentation, therapeutic patterns and outcomes.

INTRODUCTION: Paediatric fractures are often of good prognosis due to auto-correction of insufficient fracture reduction by bone remodeling. In sub-Saharan Africa, traditional healers are renowned for managing fractures and there is a neglect for specialized pediatric fracture care. We aimed to determine the demographic characteristics, clinical presentation, treatment patterns and outcomes of paediatric fractures in a tertiary health care centre in Yaoundé. METHODS: We conducted a prospective cohort study of all consenting consecutive cases of fractures in patients younger than 16 years managed between January 2011 and June 2015 at the University Teaching Hospital, Cameroon. We analysed demographic data, injury characteristics, fracture patterns, treatment details, therapeutic challenges and outcome of treatment at 12 months of follow-up. RESULTS: We enrolled 147 fractures from 145 children with a mean age of 7 years and male-to-female sex ratio of 2.5:1. The main mechanisms of injury were games (53%) and accidental falls (20.7%). Forearm fractures were the most common fractures (38%). The mainstay of management was non-operative in 130 (88.5%) fractures, with 29.3% manipulations under anesthesia and 17 (11.5%) open reductions with internal fixation. The most surgically reduced fractures were supracondylar humeral fractures. Major difficulties were long therapeutic delay, lack of diligent anaesthesia and the lack of fluoroscopy. The outcome of treatment was favorable in 146 (99.3%) paediatric fractures. CONCLUSION: With the growing population of sub-Saharan Africa and the objective of becoming an emergent region, public policies should match the technical realities.