Experience Of Thoracic Surgery Performed Under Difficult Conditions in Somalia.

Objective: To review the outcome of thoracic surgery performed at Medina Hospital over last two years under situations of constraints and to assess its feasibility in such conditions.
Design And Settings: Case series study in Medina Hospital, Mogadishu - Somalia.
Subject and Methods. Thoracotomies were performed in thirty-two patients with traumatic and nontraumatic conditions. No proper pre-operative investigations were available such as spirometry, haemogasanalysis, bronchoscopy and CT scan.
We relied only on clinical evaluation and plain x-rays. Operations were performed under general anaesthesia with no inhalation substance; no anaesthetic machine was used. We simply used ketamine, Suxamethonium, Diazepam and Atropine. We did not use post-operative suction drainage but simple "under water seal" bottle drainage.
Results: Thoracic surgery was performed in 32 patients in Medina Hospital. Most of these cases underwent pleural decortications for chronic empyema (18 patients), 7 patients had removal of bronchial foreign bodies, 4 patients had resection of oesophageal cancer, 2 patients had pericardiectomy for constrictive pericarditis and 1 had lobectomy for lobar consolidation. We had two post-operative complications and 2 patients died after having surgery for carcinoma of the oesophagus.
Conclusion: Thoracic surgery can be performed under constrains with good results in skilled and experienced hands.