Hepatobiliary and pancreatic surgery in a low budget country: experience from Ayder Referral Hospital, Northern Ethiopia.

Abstract

Background: Ayder Referral Hospital is located in Northern Ethiopia, rendering service to a population of over 8 million people. Up to 2013 HBP surgery in Ethiopia was restricted mainly to Addis Abbeba, located 800 km from Ayder. Methods: Starting in 2012 a team of German doctors regularly visited Ayder and established a HBP surgery training program. In addition, they provided equipment for the operating rooms and the intensive care unit. HPB training commenced in 2013 with external support by one experienced HBP surgeon (MWH). It was the aim to establish a self-sustaining HBP surgical program. Results: HBP training included lectures, hands-on surgical training as well as clinical pathways for HBP procedures and complication management. One surgeon (RE) received additional training in Germany and India to advance HBP surgical skills. To date 3 liver resections and 11 pancreatic head resections (10 without external support) were performed with one patient death from PTE two months postoperatively. Conclusion: A training program and clinical knowledge transfer have successfully been established at Ayder hospital. Complex HBP procedures are now being performed independently by a local team of surgeons. Further efforts strive to increase patient numbers, as well as to improve postoperative patient care in the intensive care unit and after discharge from the hospital. Our experience demonstrates that advanced HPB procedures can safely be performed after training “on the spot”.