Capacity building for the modified filarial hydrocelectomy technique in West Africa

▶ Microfilaria of Wuchereria Bancrofti are injected into the blood stream of man by the bite of the anopheles mosquitoe. ▶ The Microfilaria mature in the lymphatics of the genitourinary tract into adult worms. ▶ The adult worms cause dilatation of the genitourinary lymphatics. ▶ The dilated genitourinary lymphatics eventually lead to formation of Filarial Hydrocele. ▶ Filarial hydrocele is operated using the technique of total tunical resection without drainage. To harmonise the technique of filarial hydrocelectomy throughout the West African subregion, training workshops were organized in 10 endemic West African countries involving surgeries on Filarial hydrocele patients (Filariceles). Countries included Ghana, Nigeria, Niger, Burkina Faso, Senegal, Mali, Liberia, Gambia, Sierra Leone and Togo. Patients were recruited by the Filariasis programme managers in all these countries and workshops were done to train surgeons from teaching, government and district hospitals with funding mainly from the West African Filariasis Project. A total of 16 workshops were held in 10 West African Countries, and a total of 500 filarial hydrocele/chylocele cases were operated using the technique of total tunical resection without drainage with excellent postoperative results. The average operating time for a unilateral hydrocele was 45min to 1h and for bilateral hydrocele was 1½h to 2h depending on the size of the hydrocele .All patients were admitted for a minimum of 5 days postoperative. Training workshops were successfully organized in 10 out of the envisaged 12 west African Countries with 214 surgeons trained. Since 2004 till date the trained surgeons have also operated 2500 filaricele cases bringing it to a total of 3000 cases operated so far. Evaluation studies revealed that the infection rates in one country was initially 60% and then it later dropped to 20% and this was actually attributed to poor follow up by the selected National Coordinator. However complication rates in all the Countries where workshops were done ranged between 5% and 7% made up of infection, haematoma and or delayed wound healing. Recurrence rates have been very low about 3–5% per Country.