Outcome of myelomeningocoele repair in sub-Saharan Africa: the Nigerian experience

Objective Early repair of myelomeningocoele (MM) is associated with decreased morbidity and mortality. In sub-Saharan Africa, the peculiar harsh economic and social realities make late presentation, malnutrition and sepsis at presentation prevalent. As these factors may affect surgical repair, the aim of this study was to review the outcome of repair of MM in this peculiar patient population. Materials and Methods A prospective study of patients with MM who presented at the Lagos State University Teaching Hospital, Lagos, Nigeria over a 12 month period was studied. Follow up ranged from 8 weeks to 1 year. Results Five patients died while awaiting surgery. Thirty-six patients, 24 males and 12 female infants with MM were operated on during the study period. Majority of the patients were operated on or after the seventh day of life. The median age at surgery was 11th day of life (range second day-2 years). The mean surface area of the myelomeningocoele was 26.4 cm(2) (range 12.6-62.9 cm(2)). The post-operative morbidity and mortality was five and one, respectively. Conclusions Intracranial sepsis is the main cause of death in MM patients who are not operated on time. The patients we are seeing are probably those that survived to present at the hospital; by that time primary closure is usual without the need for complex plastic procedures. Delay in presentation even with associated malnutrition and local sepsis seems not to significantly affect the outcome of MM repair.