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Hepato-pancreato-biliary surgery in sub-saharan Africa: challenges and charting the way forward
Ibelema Datubo-Brown1, Prudence U Ikejiofor1, Ibrahim U Garzali2
1Department of Surgery, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.
Background:
Hepato-pancreato-biliary (HPB) surgery is highly specialized, requiring advanced training and infrastructure. Despite significant disease burden, sub-Saharan Africa has limited HPB capacity. This survey evaluated current HPB surgical practice across the region.
Methods:
A cross-sectional survey targeting surgeons in sub-Saharan Africa assessed training background, institutional infrastructure, surgical capabilities, equipment availability, and surgical volume.
Results:
Fifty-seven valid responses from 43 institutions across 11 countries were analyzed. Most respondents (71.9%) were based in tertiary hospitals. Only 24.6% received HPB training; ERCP training was 12.3%. Training prevalence increased significantly with surgical experience (≤5 years: 14.3% vs > 10 years: 60.0%, p = 0.012). CT scanning was available in 80.7%, but advanced imaging was scarce (EUS 8.8%, PET 7.0%). Laparoscopic capability was reported by 66.7%, though open surgery predominated (77.2% for biliary procedures). Nearly half (48.2%) lacked suitable retraction systems. Access to advanced energy devices was significantly associated with training status (71.4% trained vs 27.9% untrained, p = 0.010).
Conclusion:
HPB surgical capacity in sub-Saharan Africa shows critical deficits in training, infrastructure, and equipment, with regional heterogeneity. Associations between experience, training, and equipment reveal concentration patterns demanding coordinated capacity-building.
