South African Journal of Surgery最新文献

Summary: Tailgut cyst is an exceedingly rare congenital anomaly originating from embryonic remnants of the tailgut. Owing to its asymptomatic nature in the early stages, it is prone to clinical misdiagnosis. We present a case of a 55-year-old female with initial symptoms manifesting as sacrococcygeal pain. Magnetic resonance imaging (MRI) revealed a multilocular cystic lesion, prompting preoperative suspicion of an enormous tailgut cyst. Following a comprehensive assessment, an open posterior approach with coccygectomy was chosen, proving to be a safe and effective surgical technique, particularly for large, low-lying tailgut cysts.

Background: COVID-19 was first identified in Wuhan, China, in December 2019, where it spread over a wide geographic area until it reached the status of a pandemic in 2020. We postulated that patients who were diagnosed with incidental COVID-19, and underwent surgery, did not have a worse outcome due to the COVID-19 virus compared to their counterparts who did not have the virus.

Methods: This retrospective study included surgical patients (COVID-19 incidentals and COVID-19 negatives) who were admitted to the surgical intensive care unit (SICU) at Tygerberg Academic Hospital between 1 May 2020 and 31 December 2021.

Results: The sample consisted of 578 patients. Forty-one (41) patients had incidental COVID-19 infection, and 537 patients were COVID-19 naïve. The mean age was 43.9 years (SD = 16.7 years; range = 13.0-82.0 years) and 181 (31.3%) were female. The rates of complications in patients with COVID-19 infection (7.3%) and those without (5.0%) were similar (p = 0.64). Grades of complications, as measured using the Clavien-Dindo classification were also similar between patients with and without COVID-19 infection (p = 0.19). The mortality rates of patients with COVID-19 infection (17.1%) and those without (13.6%) were similar (p = 0.53).

Conclusion: This study demonstrates that surgery among asymptomatic PCR-positive patients was not associated with increased mortality or morbidity in the SICU. This also adds a valuable contribution to the growing body of literature regarding COVID-19 infections. Further prospective and multicentred studies are required to provide more robust results.

Background: District hospitals in South Africa have limited surgical capacity and regional hospitals treat most essential surgical conditions. This study aimed to describe the pathway and time to regional hospital surgical care for persons with general surgery conditions (PSC) in South Africa.

Methods: This was a retrospective audit of all persons referred on the Vula Mobile App to the general surgery service at Worcester Regional Hospital (WRH) from 1 January 2019 to 31 December 2019. Outcomes were time to care and the proportion lost to follow-up. Reasons for the proportion lost to follow-up were not reported.

Results: There were 617 index PSC referrals to WRH from 23 health facilities. Of these, 472 (76.5%) were referred from district hospitals and 88 (14.3%) from health clinics. Overall, 171 (27.7%) PSC referrals were handled via online-consultation only, 249 (40.4%) were referred to the WRH outpatient clinic, and 197 (31.9%) for inpatient admission. 133 (53.4%) outpatient referrals were lost to follow-up. One hundred and seventy-nine (29.0%) PSC had an operation at WRH. The median number of days from referral to operation was 28 days (IQR:10-86) for those evaluated in the outpatient clinic and 10 days (IQR: 1-125) for those directly admitted as inpatients.

Conclusion: Most surgical referrals to this South African regional hospital came from district hospitals and were for outpatient conditions. The use of telemedicine allowed triage of one quarter of referrals without the need for face-to-face consultation. Median time to operation was less than a month for outpatients; however, there was a high loss to follow-up. Further studies are needed to understand why many PSC did not access outpatient care.

Summary: Endoscopy is widely used for diagnostic and therapeutic purposes in modern clinical practice. Two of the less common complications are barotrauma and benign pneumoperitoneum. In isolation, these two complications have been successfully managed conservatively. We report a case of concomitant insufflation-induced complication of barotrauma and benign pneumoperitoneum following endoscopy on a 74-year-old female who was admitted for lower gastrointestinal (GIT) bleeding. A non-therapeutic laparotomy was performed, and she had an uneventful postoperative course. Although conservative management has been documented, in confounding findings, there should be a low threshold for intervention.

Despite the title and content of my talk, I am optimistic for the future of healthcare research. I will return to that sense of optimism in my conclusion. But to cheer you up at the end of my talk I first must depress you. I have included one intentional lie in my talk. See if you can spot it.

Background: Short-stay thyroid surgery is still nascent in developing nations like Nigeria. With the increasing cost of healthcare, there is consistently the need to reduce healthcare delivery costs. Short-stay services in selected cases meet this goal, in addition to other benefits of short hospital stays. This study aimed to highlight the feasibility of the practice of short-stay thyroidectomy in a rural tertiary hospital in Nigeria.

Methods: The study is a retrospective review of all patients who had short-stay thyroidectomy in a rural tertiary hospital in Nigeria from January 2017 to December 2021.

Results: The study reviewed 73 patients admitted for thyroidectomy on a short-stay basis within the study period. There were 70 (95.9%) females and three (4.1%) males, giving a ratio of 23:1 and a mean age of 39.8 years. Sixty-eight (93.2%) patients had no complications, and the others had minor complications that did not otherwise prolong their hospitalisation. Seventy-one (97.3%) patients were discharged within 24 hours of surgery, while two (2.7%) were discharged within 48 hours. There were no readmissions, and no mortality was recorded.

Conclusion: Short-stay hospitalisation for thyroid surgery is feasible and a viable alternative to the conventional 72-hour postoperative hospital stay in our setting.

Summary: Small bowel volvulus (SBV) is a rare cause of bowel obstruction, specifically in adults, accounting for approximately 1% of bowel obstruction in the adult population in North America. It is more common in the neonatal and paediatric population, mostly due to congenital abnormalities such as malrotation, atresia and congenital bands. We present two cases of SBV managed at a level 2 provincial hospital within a 2-month period. In the first case no primary cause could be found and in the second case adhesions following midline laparotomy resulted in SBV.

Background: Workplace-based assessment (WBA) is being introduced across postgraduate training in South Africa. This study was undertaken to inform the selection of the core procedures for WBA, by determining the most frequently performed procedures in general surgery practice. These findings may also assist academic centres undertaking curriculum review to determine whether or not they are training surgeons who are competent to meet the current local needs of society.

Methods: This study was a cross-sectional observational study using a self-administered survey. General surgeons who passed the final fellowship examinations of the College of Surgeons of South Africa between 2017-2022, working in fulltime specialist practice, were eligible for participation.

Results: The study included 111 surgeons of which the majority (53%) were working full time in government practice, 23% were in private practice and 24% were in a combination of both government and private practice. The 10 most frequently listed procedures were - hernia repair (95%), appendicectomy (91%), emergency laparotomy (88%), laparoscopic cholecystectomy (80%), gastroscopy (80%), colonoscopy (61%), colectomy (55%), lower limb amputation (48%), mastectomy (40%) and intestinal stoma formation (31%). Fifty-seven (51%) participants reported that they felt prepared to independently perform the full range of most frequently listed procedures. Of the 49% who reported feeling unprepared for one or more procedures on completion of training, the most frequently listed procedure was colonoscopy.

Conclusion: This study identified a list of procedures that may be considered as core procedural activities for WBA of South African general surgery trainees.

Background: Serum albumin levels decrease following major trauma, for various reasons. We postulated that the serum albumin nadir (SAN) level would correlate negatively with severity of physiological insult.

Methodology: This retrospective cohort study included all patients with abdominal trauma admitted to the Trauma Intensive Care Unit at Inkosi Albert Luthuli Central Hospital during 2017 and 2018.

Results: Of the 87 patients, 70 (80.5%) were male. Mean age was 32.48 years (SD 11.65; range 12-73). Blunt trauma comprised 54 patients (62.1%). Median SAN level was 23 g/L (IQR 20-27; range 10-38). Median SAN level was not different between patients with blunt versus penetrating trauma (p = 0.69), patients in whom inotropic support had been used/not used (p = 0.0502), and no different between patients on the various modes of feeding at the time of SAN (p = 0.14). However, median SAN level was lower for patients with hollow visceral injury (p = 0.004), for patients who had undergone laparotomy (p = 0.0006), for those who had received damage control surgery (p = 0.001), those who had received blood transfusions (p = 0.03), and patients who died compared to survivors (p = 0.02). Univariate regression analysis revealed negative coefficients for the following in relation to SAN level: blood transfusion (-2.77; p = 0.023), hollow viscus injury (-3.21; p = 0.008), laparotomy (-4.5; p < 0.001), damage control surgery (-3.60; p = 0.02), day of SAN (-0.39; p = 0.001), ICU length of stay (-0.12; p = 0.002), and death (-3.27; p = 0.03).

Conclusion: Greater physiological insults lead to lower levels of SAN. Serum albumin nadir level may therefore have value as a prognostic indicator in the acute trauma setting.

Background: Predicting complete closure of large ventral hernias without component separation (CS) could have clinical value. The utility of multidetector computed tomography (MDCT)-based component separation index (CSI) was derived and evaluated for these hernias.

Methods: In 60 patients with a ventral hernia, a CSI was calculated based on their MDCT. In group I (first 30 patients), hernia repair was performed by an open approach and operative assessment determined the need for CS to effect complete closure. A CSI value above which defect closure needed CS was taken as the CSI reference point. In group II (second 30 patients), the hernia repair was done laparoscopically. Patients with a CSI at or below the reference point of group I underwent intraperitoneal onlay mesh (IPOM) after direct closure of the defect (IPOM-plus). The other patients had bilateral endoscopic component separation (ECS) before entry into the peritoneal cavity for an intended IPOM-plus.

Results: A CSI above 0.067 and 0.044 in open and laparoscopic approaches respectively required CS for complete defect closure. A CSI above 0.25 and 0.125 in open and laparoscopic approaches respectively, despite CS, predicted complete closure of defect was not possible.

Conclusion: CSI is a more comprehensive parameter for evaluation of ventral hernia than the conventional twodimensional parameters and can predict the need of component separation prior to complete closure of the defect in both laparoscopic and open approach.