Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Pointers for American Surgeons Going to the Developing World
Figure 4. “Essential equipment”. Every hospital, whether in the developed or developing
world, needs pulse oximeters, especially in the OR and recovery room.
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American general surgeons are comfortable handling most intra-abdominal problems
in the DW. One unfamiliar problem, however, is perforated typhoid enteritis.
These patients have usually been ill for over a week and are grossly septic, volume
depleted, and malnourished. The best plan of attack is volume repletion, antibiotics
(whatever is available), and operation. The simplest operation is debridement and
primary closure of the perforation. If perforations are multiple, resection of the
affected segment should be considered. These patients are ill for several days postoperatively,
and many of them go on to develop multisystem organ failure. The mortality
rate is as high as 35%.
Inguinal hernias are ubiquitous in the DW, many of them quite large. The American
surgeon going to a DW country needs to forget that Dr. Lichtenstein ever existed.
A good Bassini or Cooper’s ligament repair in the DW is much more appropriate
than sticking in a piece of mesh. Utilize a generous relaxing incision to decrease
tension. If a prosthetic patch is absolutely required, harvest the appropriate size of
fascia lata from the patient’s ipsilateral thigh. Fascia lata is available, affordable, sterile,
and versatile. (Additionally, we have utilized fascia lata additionally to close chest
wall defects and dural deficits).
Patients with malignancies tend to come late in the course of their disease. Chemoand
radiotherapy are often not physically or economically available, and operation
is the only chance for cure. However, because of late presentation, most operations
are directed at palliation i.e., toilet mastectomy for breast cancer and bypass procedures
for pancreatic or gastric carcinoma (Fig. 5).
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