Surgical training in precarious conditions: Advantages of caecostomy for surgical treatment of obstructing left colon cancer

Objective. The objective of the French NGO, Chirurgie Solidaire (CS), is to learn « simple » surgery in developing countries, given absence of specialists, to general practitioner or health officer who are in charge of emergency and surgical care at isolated and precarious district hospital.Methods. An example is given concerning the treatment of left-sided obstructing colon cancer which demonstrates that western surgical strategies cannot be duplicated elsewhere. Advantages of lateral caecostomy are emphasized as the first stage of a « three stages-three weeks » protocol.Results. A series of 19 patients operated on with a 5% operative mortality clearly demonstrate that caecostomy is an efficient, harmless and easily achieved procedure.Conclusion. In developing countries, teaching and teachers have to be adapted to precarious conditions and specific pathologies which could imply the creation of a chair of tropical surgery.