South African Journal of Surgery最新文献_第2页

Preventing the preventable: Adolescent hepatocellular carcinoma and implications for hepatitis B virus prevention policy in South Africa. 预防可预防的：南非青少年肝细胞癌及其对乙型肝炎病毒预防政策的影响。

IF 0.6 4区医学

South African Journal of Surgery Pub Date : 2026-03-01 DOI: 10.36303/SAJS.03249

I Kim, E Jonas, K Venter, U Kotze, M Emmamally, C W Spearman, M W Sonderup, M Bernon, S Sobnach

{"title":"Preventing the preventable: Adolescent hepatocellular carcinoma and implications for hepatitis B virus prevention policy in South Africa.","authors":"I Kim, E Jonas, K Venter, U Kotze, M Emmamally, C W Spearman, M W Sonderup, M Bernon, S Sobnach","doi":"10.36303/SAJS.03249","DOIUrl":"10.36303/SAJS.03249","url":null,"abstract":"Background: Hepatocellular carcinoma (HCC) is a fatal disease of the young in sub-Saharan Africa (SSA) and chronic hepatitis B virus (HBV) infection remains the predominant aetiology. There is paucity of data regarding HCC in the adolescent population globally.Methods: Adolescents, defined as individuals aged 10 to 19 years according to the World Health Organization (WHO), with HCC treated at Groote Schuur Hospital (GSH) in South Africa from 1 January 2012 and 31 December 2024 were studied.Results: Five (0.5%) of the 726 HCC patients managed at GSH during the study period were adolescents. The median age was 18 (13-19) years and three were female. All five had chronic HBV infection and most presented with pain (60%) and/ or an abdominal mass (40%). All had advanced disease, with four (80%) having Barcelona Clinic Liver Cancer (BCLC) stage C and one (20%) with BCLC stage D. Two (40%) had extrahepatic metastases and three (60%) had portal vein tumour thrombosis. Treatment included liver resection (1), sorafenib (1), lenvatinib (1), and best supportive care (2). At the time of the study, only one patient was alive. The median survival was 137 (25-425) days.Conclusion: Despite national HBV vaccination programmes in South Africa, in our experience adolescent HCC was HBV-related in all five patients. Extrahepatic metastases and macrovascular invasion were frequently reported and restricted patient access to curative-intended therapies (ablation, liver resection, transplantation). These findings highlight the urgent need for improved early detection and prevention strategies against perinatal HBV transmission in South Africa, including the rollout of the WHO-recommended universal hepatitis B birth-dose vaccination rather than the current targeted prevention approach.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"64 1","pages":"35-38"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Roux-en-Y gastric bypass: Pilot study results from a resource constrained setting. Roux-en-Y胃旁路术：资源受限情况下的初步研究结果。

IF 0.6 4区医学

South African Journal of Surgery Pub Date : 2026-03-01 DOI: 10.36303/SAJS.01350

A Khamajeet, A Diab, T Biesman-Simons, C de Lange, F Noor, D Luchoo, A Melitan, H Bougard

{"title":"Roux-en-Y gastric bypass: Pilot study results from a resource constrained setting.","authors":"A Khamajeet, A Diab, T Biesman-Simons, C de Lange, F Noor, D Luchoo, A Melitan, H Bougard","doi":"10.36303/SAJS.01350","DOIUrl":"10.36303/SAJS.01350","url":null,"abstract":"Background: Obesity is a growing global health issue, with significant implications for comorbid conditions and overall mortality. Metabolic and bariatric surgery (MBS), particularly Roux-en-Y gastric bypass (RYGB), has proven effective in achieving sustained weight loss and improving comorbidity resolution. MBS is limited in the public sector within South Africa due to cost. This pilot study, taking into consideration the resource constrained setting in South Africa, aims to assess the outcomes of RYGB surgery in a low resource setting, focusing on weight loss, comorbidity resolution, and complications over a 3-year period.Methods: A retrospective analysis was conducted on 17 patients who underwent RYGB at New Somerset Hospital, South Africa, between August 2017 and February 2020. The primary outcomes included percentage total weight loss (%TWL), excess weight loss (%EWL), and excess body mass index (BMI) loss (%EBMIL), while secondary outcomes involved the resolution of type 2 diabetes, hypertension, gastro‑oesophageal reflux disease (GERD), and dyslipidaemia.Results: At 3 years, the mean BMI decreased from 48.3 kg/m² to 38.35 kg/m², with a mean %TWL of 20.3%, %EWL of 42.5%, and %EBMIL of 43.2%. Notably, there were significant improvements in comorbidities, with a 50% resolution of type 2 diabetes, 71.4% resolution of GERD, and 66.7% resolution of dyslipidaemia. The complication rate was low, with one reported port site hernia.Conclusion: This study highlights the feasibility and effectiveness of MBS in a resource-constrained setting and demonstrates its potential for improving patient outcomes in the context of the obesity epidemic in South Africa. Further studies with larger cohorts and longer follow-up are needed to validate these findings and explore the long-term impact of MBS on public health.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"64 1","pages":"39-47"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The performance of fine needle aspiration cytology (FNAC) compared to histology in the preoperative diagnosis of thyroid cancer: a single centre study. 细针穿刺细胞学（FNAC）与组织学在甲状腺癌术前诊断中的比较：一项单中心研究。

IF 0.6 4区医学

South African Journal of Surgery Pub Date : 2026-03-01 DOI: 10.36303/SAJS.02294

S Pillay, T Ntrama, G Muthen, C Trainer, Y Varachia, M Mmutlane, T Luvhengo, N Sishuba

{"title":"The performance of fine needle aspiration cytology (FNAC) compared to histology in the preoperative diagnosis of thyroid cancer: a single centre study.","authors":"S Pillay, T Ntrama, G Muthen, C Trainer, Y Varachia, M Mmutlane, T Luvhengo, N Sishuba","doi":"10.36303/SAJS.02294","DOIUrl":"10.36303/SAJS.02294","url":null,"abstract":"Background: Thyroid cancer is the most common endocrine malignancy globally. Fine needle aspiration cytology (FNAC) is used in the diagnostic workup of thyroid nodules. There have been discrepancies between FNAC and histology at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). This prompted a study to determine the performance of FNAC compared to histology in diagnosing thyroid cancer at CMJAH.Methods: A retrospective review of patients who underwent thyroid surgery at CMJAH between 1 January 2015 and 1 September 2022 was conducted. Patient details were accessed via the theatre registry and the department of nuclear medicine. FNAC and histology results were accessed using the National Health Laboratory Service (NHLS) website. The data was collected and entered into a Microsoft excel spreadsheet. STATA statistical software was used to analyse the data.Results: A total of 369 patients were screened, of which 222 were included in the study. We found the prevalence of thyroid cancer at CMJAH to be 35.6%. FNAC was found to have a sensitivity of 83.6% and a specificity of 88.7%. Its accuracy was 0.861 and it had a PPV of 81.2% and a NPV of 90.3%. The likelihood ratio generated was 7.39. PTC was found to be the most prevalent subtype with the FNAC malignancy detection rate of 85%.Conclusion: Our study showed that FNAC performed well in diagnosing thyroid cancer preoperatively. Therefore, it should continue to be used in the diagnostic workup of thyroid nodules at CMJAH.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"64 1","pages":"5-9"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cumulative incidence and management of enterocutaneous fistulas owing to laparotomy for penetrating abdominal trauma: a single centre experience. 腹腔穿透性创伤开腹手术后肠皮瘘的累积发生率和处理：单一中心经验。

IF 0.6 4区医学

South African Journal of Surgery Pub Date : 2026-03-01 DOI: 10.36303/SAJS.03743

A Sekason, L Moschides, Y H Docrat, A Boutall, P H Navsaria

{"title":"Cumulative incidence and management of enterocutaneous fistulas owing to laparotomy for penetrating abdominal trauma: a single centre experience.","authors":"A Sekason, L Moschides, Y H Docrat, A Boutall, P H Navsaria","doi":"10.36303/SAJS.03743","DOIUrl":"10.36303/SAJS.03743","url":null,"abstract":"Background: Enterocutaneous fistula (ECF) owing to laparotomy for penetrating abdominal trauma (PAT) is rarely reported. The quoted incidence in two recent publications is 1.9% and 1.5%, in 2224 and 2373 patients, respectively. Advances in trauma surgery including damage control surgery and the use of open abdomen techniques, have led to concerns of increasing fistula rates in trauma patients. The purpose of this study was to determine the incidence and outcomes of patients with ECF resulting from penetrating abdominal trauma.Methods: A retrospective study including patients who underwent laparotomies for PAT between 01 January 2015 and 31 August 2018 (44 months) was performed. The Groote Schuur Hospital (GSH) Trauma Centre RedCap, GSH Intestinal Failure Unit and the Stoma Therapy department databases were scrutinised by folder review.Results: Of a total of 965 patients with PAT, 597 underwent laparotomies and 586 had hollow viscus injury (HVI). Twenty-six patients (4.4%) developed an ECF or an anastomotic leak. Thirteen (50%) patients underwent damage control laparotomy. Fistulas and leaks occurred in small bowel 13 (50%), large bowel 7 (26.9%), and duodenum 6 (23.1%). Five patients with ECF spontaneously resolved with medical treatment. Six patients (42.9%) with ECF were managed in the intestinal failure unit and required surgical intervention. Five anastomotic leaks were addressed at early relook laparotomy, with a mortality rate of 58.3%.Conclusion: The anastomotic leak/ECF rate in PAT in our centre is 4.4% and is associated with a high mortality of 30.8%.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"64 1","pages":"53-57"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Follicular thyroid carcinoma in South Africa: Insights from 103 cases. 南非滤泡性甲状腺癌：103例分析。

IF 0.6 4区医学

South African Journal of Surgery Pub Date : 2026-03-01 DOI: 10.36303/SAJS.02669

Z Pienaar, L Martin, T Luvhengo, J A Lübbe, A Bestbier, M Bhuiyan, I Bombil, S R Čačala, L Cairncross, C Changfoot, B S Jackson, H S Jehle, L Jonas, M R Lukusa, M Makgoka, A Yeo, N T Sishuba, R Razack, K Baatjes, W Conradie

{"title":"Follicular thyroid carcinoma in South Africa: Insights from 103 cases.","authors":"Z Pienaar, L Martin, T Luvhengo, J A Lübbe, A Bestbier, M Bhuiyan, I Bombil, S R Čačala, L Cairncross, C Changfoot, B S Jackson, H S Jehle, L Jonas, M R Lukusa, M Makgoka, A Yeo, N T Sishuba, R Razack, K Baatjes, W Conradie","doi":"10.36303/SAJS.02669","DOIUrl":"10.36303/SAJS.02669","url":null,"abstract":"Background: Follicular thyroid carcinoma (FTC) accounts for approximately 17-20% of well-differentiated thyroid cancer (WDTC) worldwide. In South Africa (SA), FTC is more common than reported internationally, however, available SA studies included small patient numbers. This multi-institutional study comprehensively describes FTC patients who underwent surgery over a 5-year period, focusing on presentation, diagnosis, and management.Methods: A retrospective review of all patients with FTC operated at 13 academic hospitals throughout SA between January 2015 and December 2019 was conducted. The Thyroid Cancer Group of South Africa collectively entered data on the presentation, diagnosis, management, and short-term outcomes of 464 thyroid cancer patients into a REDCap database. Descriptive statistical analysis was performed.Results: Of 464 cases captured in the database, 103 (22.1%) were FTCs. WDTC was reported in 87.9% (408/464) of operations, with FTC comprising 25.2% (103/408). Of the 103 FTC patients, 82.5% (n = 85) were female and 16.5% (n = 17) male. The mean age was 51.8 years (SD 17.3). In cases where staging was reported, more than half (53.9%) presented with T3 tumours. Distant metastases were found in 12.6% of patients. Thyroid lobectomy was the most performed procedure (57.4%), followed by total thyroidectomy (37.6%).Conclusion: SA presents a multifaceted picture of FTC, with a higher incidence than in developed countries but lower than some other African nations. Patients are frequently symptomatic, which may predict worse outcomes. Standardised reporting and a national thyroid registry could assist in treatment planning and consistency of care.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"64 1","pages":"10-17"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Stakeholder engagement towards establishing a national thyroid cancer registry in South Africa. 利益攸关方参与建立南非国家甲状腺癌登记处。

IF 0.6 4区医学

South African Journal of Surgery Pub Date : 2025-11-01 DOI: 10.36303/SAJS.03031

W Conradie, K J Baatjes, L Martin, T Luvhengo, J Lübbe, E Archer

{"title":"Stakeholder engagement towards establishing a national thyroid cancer registry in South Africa.","authors":"W Conradie, K J Baatjes, L Martin, T Luvhengo, J Lübbe, E Archer","doi":"10.36303/SAJS.03031","DOIUrl":"10.36303/SAJS.03031","url":null,"abstract":"Background: Patient registries in South Africa (SA) are not common. This study explored the perceptions and experiences of thyroid clinicians and members of existing patient registries in SA, aiming to establish a national thyroid cancer registry.Methods: This was an exploratory qualitative study based on surveys and semi-structured interviews of participants' experiences treating thyroid cancer and using registries in general. Convenience sampling was performed for the surveys (n = 27) and purposive sampling for the interviews (n = 20). Data collection and analysis were conducted concurrently, facilitating an iterative process. The thematic analysis followed the steps outlined by Braun and Clarke.Results: Four themes were identified. The South African healthcare system, the perceived value of a patient registry, the role of various stakeholders, and barriers to registry implementation. Participants expressed the value of registries in SA for both clinical and research purposes. However, concerns were raised regarding perceived challenges, such as resource and time constraints.Conclusion: Developing a national thyroid cancer registry in SA requires responsiveness to national and local challenges and opportunities, necessitating an adaptable registry format. The principle of a registry is strongly supported by clinician stakeholders. The registry, as a clinical note-keeping system, will optimise clinicians' time efficiency in patient care, and standardisation of radiology and pathology reporting across a uniform platform will enhance patient care and data entry. The benefits of a registry strongly outweigh the challenges as it facilitates the development of local guidelines, improves patient outcomes, and promotes collaborative research among endocrine clinicians.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 4","pages":"212-221"},"PeriodicalIF":0.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Damage control surgery: Trauma. 损伤控制外科：创伤。

IF 0.6 4区医学

South African Journal of Surgery Pub Date : 2025-11-01 DOI: 10.36303/SAJS.03268

H Wain

引用次数: 0

Audit to evaluate the clinical presentation and surgical management of acute appendicitis at a secondary-level hospital in the Western Cape. 审计以评估西开普省一家二级医院急性阑尾炎的临床表现和外科治疗。

IF 0.6 4区医学

South African Journal of Surgery Pub Date : 2025-11-01 DOI: 10.36303/SAJS.02727

I N Palkowski, K Polden, C Claasen, Y Lee, A H Stark

{"title":"Audit to evaluate the clinical presentation and surgical management of acute appendicitis at a secondary-level hospital in the Western Cape.","authors":"I N Palkowski, K Polden, C Claasen, Y Lee, A H Stark","doi":"10.36303/SAJS.02727","DOIUrl":"10.36303/SAJS.02727","url":null,"abstract":"Background: Acute appendicitis is a frequent cause of abdominal emergencies, with delayed presentation and diagnosis increasing the risk of perforation and postoperative morbidity. In South Africa, the accessibility to healthcare and referral to surgical services can impact patient outcomes.Methods: All patients treated for acute appendicitis at George Regional Hospital during the period January 2024 - December 2024 (1 year) were included in the study. Patients who were admitted with acute appendicitis but discharged with an alternative diagnosis were excluded.Results: The sample consisted of 218 patients. The majority (88.5%) underwent surgical management, with the remainder managed conservatively. Patients referred from district hospitals had a significantly higher rate of perforated appendicitis compared to local patients (57.9% vs 40.2%, p = 0.014). Delayed presentation with symptoms beyond 72 hours was strongly associated with perforation (IQR 2.0-4.5; p = 0.034). Laparoscopic appendicectomy was performed in 66.3% of cases, with a 20.3% conversion rate to open surgery, predominantly in cases of perforation. The median length of stay was longer in patients with perforated appendicitis (IQR 3-6 days; p < 0.001). No in-hospital mortality was observed.Conclusion: Delayed presentation was significantly associated with a higher risk of perforated appendicitis and greater operative complexity. Patients referred from district hospitals experienced higher rates of perforation likely due to delays in recognition, referral, and access to surgical care. Improving early diagnosis and streamlining referral pathways may reduce the incidence of complicated appendicitis and improve patient outcomes in our region.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 4","pages":"252-256"},"PeriodicalIF":0.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editorial commentary: Abbreviated laparotomy: advantages and disadvantages in South African practice. 编辑评论：缩短剖腹手术：优缺点在南非的做法。

IF 0.6 4区医学

South African Journal of Surgery Pub Date : 2025-11-01 DOI: 10.36303/SAJS.03689

M S Moeng, T C Hardcastle

引用次数: 0

Preliminary experience of reverse lymphatic mapping technique using indocyanine green dye lymphangiography and patent blue dye in melanoma patients undergoing sentinel lymph node biopsies: a case series. 用吲哚菁绿染色淋巴管造影和专利蓝染色在接受前哨淋巴结活检的黑色素瘤患者中的反向淋巴作图技术的初步经验：一个病例系列。

IF 0.6 4区医学

South African Journal of Surgery Pub Date : 2025-11-01 DOI: 10.36303/SAJS.02845

C K Hsu, F Y Hsu

引用次数: 0