Advancing complex hepato-pancreato-biliary surgery in Uganda: Challenges and outcomes

Introduction: Uganda has until recently mostly referred patients for complex hepato-pancreato-biliary (HPB) surgery abroad due to lack of local expertize. We report indications and a spectrum of surgeries performed in the first 4 years following the establishment of a routine HPB service at Lubaga Hospital (LH), Kampala, Uganda. We also detailed the challenges encountered in setting up this service.

Methods: Demographic, clinical parameters, surgery indications, procedures performed, and outcomes of consecutive patients that underwent HPB surgeries at LH from December 2018 to October 2022 were analyzed.

Results: Majority were females 72 (57.6%) with a median age of 50 (6-88) years. Forty-one (32.8%) underwent surgery on the pancreas (PS), 34 (27.2%) on the liver (LS), and 50 (40.0%) on the bile ducts (CBS). The most common symptom was abdominal pain. Benign disease was present in 37 patients (29.6%) while 88 (70.4%) had malignancy. A total of 34 patients (27.2%) had unresectable pancreatic head cancer and distal cholangiocarcinoma missed at preoperative imaging and discovered intraoperatively thus underwent palliative hepaticojejunostomy. Only 34 (27.2%) patients received postoperative ICU care. In-hospital mortality for this heterogenous group of patients was 6 (4.8%) for PS, 3 (2.4%) for LS, and 8 (6.4%) for CBS.

Conclusion: Despite many challenges like limited access to ERCP accessories, lack of endoscopic ultrasound scans and PET-CT scans in the whole country, late presentation, and low quality imaging especially in preoperative determination of resectability of hepato-pancreato-biliary cancers, we managed to establish a functional HPB service. Patient results achieved were good in spite of these limitations.