South African Journal of Surgery最新文献

{"title":"A case report on lingual schwannoma.","authors":"D P Ramyead, J Enslin, M J Chokoe Maluleke, M White","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Summary: </strong>Schwannomas are benign tumours of peripheral nerves originating in the nerve sheaths. Only 1% are reported in the oral cavity. We report a 24-year-old female who presented with a 10-year history of a mass at the base of the tongue with associated odynodysphagia, referred otalgia and loss of weight. Oral examination revealed a large left sided base of tongue mass extending into the vallecula. An open transcervical suprahyoid resection was performed with a good outcome.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"62 3","pages":"54-57"},"PeriodicalIF":0.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570141","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}

{"title":"Pneumatosis intestinalis - an illusive disease.","authors":"A Skotsimara, A Mylonakis, D Schizas, L Karydakis, C Vergadis, M Peroulis, N Koliakos, A Bakopoulos","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Summary: </strong>Pneumatosis intestinalis (PI) is characterised by pathological gas infiltration into the submucosa and subserosa of the gastrointestinal tract, sometimes with an unclear pathogenesis. The clinical presentation of PI varies, with the diagnosis established via computed tomography (CT), where PI manifests as linear or bubbly gas patterns within the bowel wall. Management often necessitates surgical intervention to address potential life-threatening causes like mesenteric ischemia or bowel necrosis. This case report discusses a 69-year-old male who presented with abdominal pain and distension alongside worrisome radiological features indicative of extensive PI, who underwent an exploratory laparotomy that revealed no pathological findings and with an eventual uneventful recovery.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"62 3","pages":"51-53"},"PeriodicalIF":0.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570271","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}

{"title":"Late presentation of Bochdalek hernia in children - experience at a single centre.","authors":"S Arslan, M H Okur, M Azizoğlu, E Basuguy, B Aydoğdu, I Akbudak, M K Ciğdem, A Onen, S Otcu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to present our experience with late presentation Bochdalek hernia (BH), focussing on clinical presentation diagnostic and therapeutic approaches, and their outcomes.</p><p><strong>Methods: </strong>Patients with late presenting BH 1 month of age between 1983 and 2022 were studied. We retrospectively collected and analysed the following data: age, sex, side of herniation, presenting symptoms and signs, associated anomalies, radiographic findings, intraoperative findings, postoperative course, complications, and mortality.</p><p><strong>Results: </strong>Of 175 diaphragmatic hernias 46 (26%) were late presenting BH. Fifty-seven per cent (26/46) were males. Laparotomy was performed in 85% (39/46) of the patients, and a laparoscopy or thoracoscopy was performed in 15% (7/46). The mean hospital stay was 7.6 days, and the mean surgery time was 131 minutes. When the two groups were compared, the duration of surgery and hospitalisation was significantly shorter in the minimally invasive surgery (MIS) group (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>The clinical characteristics of late presenting BH are variable, either acute or chronic. A laparoscopic or thoracoscopic approach in selected patients is feasible.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"62 3","pages":"24-29"},"PeriodicalIF":0.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570266","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}

{"title":"Symptomatic omphalomesenteric duct anomalies in children.","authors":"G Gerçel, A I Anadolulu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>We aimed to present our experience with children with symptomatic omphalomesenteric duct (OMD) anomalies and evaluate the patients' characteristics, treatment, and outcomes.</p><p><strong>Methods: </strong>Records of children who were operated for symptomatic OMD anomalies in Şanlıurfa Training and Research Hospital between October 2018 and November 2022 were retrospectively analysed.</p><p><strong>Results: </strong>There were 35 patients with a median age of 31.7 (1 day-17 years) weeks, 29 (82.8%) males and six (17.2%) females. The presenting signs were gastrointestinal tract (GIT) obstruction in 17 (48.6%) patients, acute abdomen in 11 (31.4%), umbilical abnormalities in four (11.4%) and rectal bleeding in three (8.6%). All patients presenting with umbilical abnormalities were newborn. These were OMD fistula to skin (<i>n</i> = 1), OMD fistula to umbilical cord hernia sac (<i>n</i> = 1), OMD cyst in umbilical cord hernia (<i>n</i> = 1) and OMD band adherence to umbilical cord hernia sac (<i>n</i> = 1). Meckel's scan was positive in all three patients with rectal bleeding. Surgical findings in patients other than umbilical abnormalities were diverticulitis (with/without perforation) (<i>n</i> = 14), intussusception due to diverticulum (<i>n</i> = 9) and Meckel's band obstruction (<i>n</i> = 8). At surgery, an ileal resection was performed in 19 cases, wedge resection in 10 cases, resection with stapler in five cases and ileocolonic resection in one patient. On histopathological examination, ectopic gastric mucosa was detected in 11 specimens and both gastric and pancreatic tissue in two. There were only two cases of postoperative complications (incisional hernia, <i>n</i> = 1, postoperative colon perforation due to forced manual reduction of intussusception, <i>n</i> = 1) and all patients survived in good condition.</p><p><strong>Conclusion: </strong>In the present study, GIT obstruction is the primary symptom in patients with symptomatic OMD anomalies, with umbilical anomalies exclusively found in newborns. Surgery is confirmed as the definitive treatment, with wedge resection and simple diverticulectomy being safe but sometimes insufficient. A significant portion of patients might need more complex segmental bowel resections due to severe complications. With ectopic tissue found in about one-third of cases, managing OMD anomalies presents distinct challenges.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"62 3","pages":"30-34"},"PeriodicalIF":0.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570314","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}

{"title":"Perioperative antibiotic practices amongst otorhinolaryngologists (ear, nose and throat surgeons) in South Africa.","authors":"M White, J McGuire, S Peer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The primary goal of perioperative antibiotics is to reduce the rate of surgical site infections (SSI); however, in certain surgical procedures, the use of perioperative antibiotics has been shown to have no impact on the rate of SSI. Inappropriate use of antimicrobials increases cost, potential side effects and further promotes antibiotic resistance. This study aims to provide insight into the adherence of South African otorhinolaryngologists to available evidence-based international guidelines.</p><p><strong>Methods: </strong>An electronic survey was sent to otorhinolaryngologists in South Africa.</p><p><strong>Results: </strong>Ninety-two respondents indicated that they utilise the following resources to guide their decisions regarding perioperative antibiotic prescribing - anecdotal evidence 27% (25/92), practices of the surgeon's postgraduate training unit 28% (26/92), published international guidelines 28% (26/92), recommendation of their local hospital's microbiologists 14% (13/92). Respondents indicated they take the following factors into consideration to guide decisions regarding perioperative antimicrobial use - 48% (35/92) duration of surgery, 85% (78/92) degree of contamination of the surgical field, 8% (7/92) patient's age, 8% (7/92) degree of blood loss, 22% (20/92) HIV status of patient, and 22% (20/92) patient's access to hospital. Thirty-five per cent (32/92) of respondents indicated they audit their own rate of wound complications.</p><p><strong>Conclusion: </strong>There is significant heterogeneity in the use of perioperative antibiotic prescribing practices and variable adherence to international consensus guidelines amongst ENT surgeons in South Africa. In light of the global increase in antibiotic resistance, this study highlights the need for increased awareness regarding the principles of antibiotic stewardship, pre-existing evidence-based guidelines and the need for a locally-generated South African otorhinolaryngology consensus guideline that promotes safe and rational use of perioperative antibiotic prophylaxis.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"62 3","pages":"17-23"},"PeriodicalIF":0.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570269","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}

{"title":"The accuracy of white cell count and C-reactive protein in diagnosing acute appendicitis at a tertiary hospital.","authors":"N Tshuga, V C Ntola, R Naidoo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic accuracy in acute appendicitis (AA) may be improved by using inflammatory markers. This study assessed the reliability of inflammatory markers in diagnosing AA in our patient population.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted at King Edward Hospital (KEH) from January 2020 to June 2021. Data was collected on all patients with AA who underwent appendicectomy. Variables of age, gender, comorbidities, HIV status Alvarado score histology, C-reactive protein (CRP), and white cell count (WCC) were reviewed. A <i>p</i>-value of < 0.05 is deemed as statistically significant.</p><p><strong>Results: </strong>The study cohort was comprised of 150 patients - 58(39%) females and 92(61%) males. Thirty-two (21.3%) patients had a normal appendix, of whom 19 had a normal WCC. The majority of patients 80 (53.3%) had inflamed appendix, and 38 (25.3%) had ruptured appendix. The sensitivity and specificity of WCC and the CRP were 81% and 46% and 100% and 18.6% respectively. No patient with a ruptured appendix had normal CRP. The CRP correlated with the ruptured appendix with a median of 141.5 and, <i>p</i>-value of 0.01. The level of WCC and the presence of a ruptured appendix had a significant correlation with a <i>p</i>-value of 0.002, median of 15.2.</p><p><strong>Conclusion: </strong>A combination of WCC and CRP tests improves the diagnostic accuracy. There is a correlation between CRP level and ruptured appendicitis. In our setting, AA is likely to present late once it has already ruptured. The reasons behind this late presentation need to be explored and addressed.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"62 3","pages":"45-49"},"PeriodicalIF":0.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570279","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}

{"title":"Solitary fibrous tumour presenting as intussusception.","authors":"S Khurana, N A R Rao","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 49-year-old male with no comorbidities presented with acute colicky lower abdominal pain for one day, alongside three months of intermittent abdominal pain, loose stools, and melena. A contrast-enhanced computed tomography scan revealed an intussusception. During exploratory laparotomy, an ileo-ileal intussusception with a 3 cm polypoid lesion 10 cm from the ileo-caecal junction was found. The intussusception was reduced, followed by ileal resection and anastomosis. Histopathology and immunohistochemistry (positive for STAT6, CD34, Vimentin, and SMA) confirmed a solitary fibrous tumour (SFT) of the ileum. The patient recovered well and was discharged eight days postoperatively. He is on annual follow-up.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"62 3","pages":"50"},"PeriodicalIF":0.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570312","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}

{"title":"30-day outcomes in 1 000 consecutive laparoscopic cholecystectomies undertaken in four Cape metropole public hospitals.","authors":"M Kariem, F Gool, N Kariem, N Karimbocus, J C Kloppers","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic cholecystectomy (LC) is the standard of care for symptomatic gallstone disease. The procedure has a steep learning curve and may result in significant postoperative morbidity and mortality. LC carries a morbidity of 1.6-5.3%, a mortality of 0.05-0.14% and readmission rates of 3.3% (0-11.7%). We aimed to evaluate the 30-day outcomes of LC across four metropole hospitals in the Western Cape (WC) including mortality, length of stay, readmissions and complications according to the Clavien-Dindo classification system.</p><p><strong>Methods: </strong>A retrospective review of a prospective database was performed. Data were collected between September 2019 and July 2022. Relative clinical, operative findings and postoperative outcomes were analysed.</p><p><strong>Results: </strong>There were 1 000 consecutive LCs included in this study. The mean postoperative length of stay was 1.92 days. Forty surgical complications were noted of which the most common were a bile leak (<i>n</i> = 14) and intra-abdominal collections (<i>n</i> = 11). Seven patients with bile leaks required reintervention. Four (0.4%) bile duct injuries (BDI) were reported in our series. Twenty-five percent of postoperative complications were graded as Clavien-Dindo IIIa and 28% were graded as Clavien-Dindo IIIb. The 30-day readmission rate was 3.8% (<i>n</i> = 38). Thirty-five patients were readmitted with surgical complications. There were three reported deaths (0.3%).</p><p><strong>Conclusion: </strong>Laparoscopic cholecystectomy is considered the standard of treatment for gallstone disease but a small percentage may have serious complications. The outcomes reported in this series are similar to that of other reported studies.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"62 2","pages":"69"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263269","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}

{"title":"Does the textbook outcome in pancreatic surgery score after pancreaticoduodenectomy for ampullary carcinoma have prognostic value?","authors":"N Leech, J E J Krige, S Sobnach, J C Kloppers, M M Bernon, S Burmeister, E G Jonas","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The value of the textbook outcome in pancreatic surgery (TOPS) score, a composite measure of surgical performance for quality assurance, was evaluated in a South African tertiary hospital cohort of pancreaticoduodenectomies (PD) performed for adenocarcinoma of the ampulla of Vater (AAV).</p><p><strong>Methods: </strong>A review of all patients undergoing a PD for AAV at a single centre between January 1999 and December 2023 was performed. Demographic, operative, pathological and postoperative variables were recorded. Ten clinical and histological variables were used to construct a TOPS score. These included an R0 resection, no postoperative pancreatic fistula (POPF), no bile leak, no post-pancreatectomy haemorrhage, no delayed gastric emptying, no major postoperative complications (< Gr 3 Clavien-Dindo), no readmission to ICU, length of stay ≤ 10 days, no 30-day readmission or intervention and no 30-day mortality. A textbook outcome (TO) was defined as the fulfilment of all 10 variables. In patients in whom TO was not achieved, the reasons for failure were identified. In addition, the number of patients who had major complications and died were categorised as failure to rescue (FTR).</p><p><strong>Results: </strong>A positive TOPS score was achieved in 27 of 79 (34.2%) patients undergoing a PD. Overall five-year survival after PD was 33.9%. TOPS conferred a significant 1-year survival benefit, 88.9% vs 66.7% (OR 4.12, 95% CI 1.08-15.67, <i>p</i> = 0.038). There was no significant difference in 5-year survival between TOPS and non-TOPS patients, 40.0% vs 32.4% (OR 1.39, 95% CI 0.48-3.99, <i>p</i> = 0.54). A POPF occurred in 31.6% patients, resulting in a significantly longer hospital admission, 17 vs 10 days (95% CI 2.66-11.34, <i>p</i> = 0.0019). Twenty-one (26.6%) patients developed a major complication, five of whom died (FTR = 6.3%).</p><p><strong>Conclusion: </strong>This study confirmed the value of TOPS as a useful measurement to assess hospital quality metrics and short-term survival after PD for AAV. One quarter of patients developed a major complication with a 6.3% FTR.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"62 2","pages":"33-38"},"PeriodicalIF":0.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263316","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}

{"title":"Effect of preoperative biliary drainage on intraoperative biliary cultures and surgical outcomes after pancreatic resection.","authors":"M M Bernon, S Steenkamp, S Dlamini, M Miller, S Sobnach, N Leech, U Kotze, J E J Krige, E G Jonas","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Prolonged obstructive jaundice (OJ), associated with resectable pancreatic pathology, has many deleterious effects that are potentially rectifiable by preoperative biliary drainage (POBD) at the cost of increased postoperative infective complications. The aim of this study is to assess the impact of POBD on intraoperative biliary cultures (IBCs) and surgical outcomes in patients undergoing pancreatic resection.</p><p><strong>Methods: </strong>Data from patients at Groote Schuur Hospital, Cape Town, between October 2008 and May 2019 were analysed. Demographic, clinical, and outcome variables were evaluated, including perioperative morbidity, mortality, and 5-year survival.</p><p><strong>Results: </strong>Among 128 patients, 69.5% underwent POBD. The overall perioperative mortality in this study was 8.8%. The POBD group had a significantly lower perioperative mortality rate compared to the non-drainage group (5.6% vs. 25.6%). POBD patients had a higher incidence of surgical site infections (55.1% vs. 23.1%), polymicrobial growth from IBCs and were more likely to culture resistant organisms. Five-year survival was similar in the two groups.</p><p><strong>Conclusion: </strong>POBD was associated with a high incidence of resistant organisms on the IBCs, a high incidence of surgical site infections and a high correlation between cultures from the surgical site infection and the IBCs.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"62 2","pages":"63-67"},"PeriodicalIF":0.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263328","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}