Establishing a Hepatobiliary Surgical Service in a Refugee Town in the Midst of a Civil War

Abstract Background: There is to date no report of refugee healthcare professionals setting up a self-sustained surgical healthcare system in the midst of a civil war. For the first time, an algorithmic approach and travails of setting up an advanced surgical unit in a refugee town in a strife-torn impoverished African country are presented. Methods: Of all hepatobiliary–pancreatic–biliary (HPB) surgeries performed at the newly setup unit at refugee town over a 6-month period (commencement of services to when the town was evacuated), patients who underwent Whipple’s pancreatoduodenectomy (WPD) were included. Their data were analyzed and outcomes were presented. Results: A total of 149 HPB surgeries were performed including 15 major liver resections and 49 biliary surgeries. Of 60 patients who underwent pancreatic surgery, 51 patients underwent WPD. Over a third (39%) were displaced from Khartoum. Intraoperative variables included an estimated blood loss of 229.2 ± 103.7 ml and an operative time of 278.6 ± 38.3 min. Three (5.9%) patients had Grade B postoperative pancreatic fistula, all of which recovered with conservative management. Major complications (Clavien-Dindo ≥3b) occurred in 17.6%. Thirty-day mortality was 5.9%. Conclusions: We show the success of a perseverant effort of self-reliance by refugees and professionals at establishing a dependable tertiary care unit in the midst of armed conflict.