South African Journal of Surgery最新文献

{"title":"The profile and outcomes of patients in a newly established acute surgical care unit in a teaching tertiary hospital in Botswana.","authors":"A G Bedada, N Tlotlo, D Bogosi, T Tumisang, B Mogomotsi, M G Collen, H E Sleamsaw","doi":"10.36303/SAJS.02691","DOIUrl":"10.36303/SAJS.02691","url":null,"abstract":"<p><strong>Background: </strong>The scope of emergency general surgical care services varies among health institutions and countries. The burden, profile, and outcomes of patients in many low- to middle-income countries is not adequately investigated.</p><p><strong>Methods: </strong>Medical records of patients admitted to acute surgical care (ASC) team were reviewed for a year. Demographics, diagnosis, dates of admission and discharges, comorbidities, operative procedures and operative care providers, outcomes, and factors associated with outcomes were analysed.</p><p><strong>Results: </strong>During the study period, 278 ASC admissions were made. The median age was 32 years. Males constituted 52.5%. The common admissions were acute appendicitis (57.2%), intestinal obstructions (15.5%), and soft-tissue infections (6.1%). Twenty-one point two per cent of the admissions had comorbidities and HIV infection was the commonest comorbidity. Seventy-one point nine per cent of the patients underwent operations. Appendicectomies (72.0%) were the commonest operations. Most of the operations (60.5%) were performed by residents. Complications occurred in 9.7% of the cases of which 6.5% were surgical site infection (SSI) and 2.2% resulted in mortality. Patients with complications had a significantly higher rate of mortality, <i>p</i> < 0.001. For all admissions and operated patients longer onset of illness was associated with longer hospital stays (<i>p</i> = 0.002 and 0.031) and mortality (<i>p</i> = 0.014 and 0.019) respectively. Patients operated by surgeons and residents together had a longer hospital stay than only by residents, <i>p</i> < 0.001. Similarly, when surgeons operated alone the hospital stay was longer than residents, <i>p</i> = 0.002.</p><p><strong>Conclusion: </strong>The commonest ASC pathology was acute appendicitis. Longer onset of symptoms was associated with longer hospital stay and mortality. This study provides foundational data relevant to surgical education and unit organisation, including the development of clinical guidelines, resident supervision, and workforce planning.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 4","pages":"245-251"},"PeriodicalIF":0.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349732","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":"Development and implementation of the online undergraduate surgical teaching module at the University of KwaZulu-Natal during COVID-19.","authors":"S Ebrahim, M Motala, J M Van Wyk","doi":"10.36303/SAJS.02544","DOIUrl":"10.36303/SAJS.02544","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic prompted the transition of all teaching and learning of final-year General Surgery students to an online platform.</p><p><strong>Methods: </strong>A document review was conducted to determine the essential aspects of the teaching and learning programme that needed to be retained, and proposed modifications and implementation of an online surgical module. We followed the \"READ\" approach to analyse the documents, and the steps included readying the materials, extracting and analysing the data, and distilling the findings.</p><p><strong>Results: </strong>Thirty-three curriculum and policy documents were reviewed, including General Surgery module templates, assessment policies, and institutional and external stakeholder guidance on the transition to remote learning and implementation plans. The main online instructional methods comprised video-based instruction on core surgical topics, including lectures, case-based discussion, pre-recorded clinical and procedural skills videos delivered via the Moodle Learning Management System (LMS) and an assessment of knowledge and skills (weekly quizzes on Moodle). The assessment format for the clinical component also changed from a clinical case examination and oral viva voce examination pre-COVID-19 to a written, structured clinical case scenario examination.</p><p><strong>Conclusion: </strong>This document review provided a comprehensive understanding of the existing General Surgery curriculum at our institution and the events and policies that influenced the changes implemented due to the COVID-19 pandemic. It does not reflect the teaching and learning experiences of faculty and students; however, it provides a valuable point of departure for further studies to understand the teaching and learning experiences better.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 4","pages":"262-269"},"PeriodicalIF":0.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349614","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":"Pan CT for blunt polytrauma - Is there a need for more selective indications?","authors":"H A W Palmer, L Martin, D L Clarke, G V Oosthuizen","doi":"10.36303/SAJS.02940","DOIUrl":"10.36303/SAJS.02940","url":null,"abstract":"<p><strong>Background: </strong>Pan computed tomography (CT) has become ubiquitous in the evaluation of patients with blunt polytrauma. The indications for Pan CT were previously evaluated in our unit and judicious use was demonstrated. Since CT has become increasingly readily available, we questioned whether \"indication creep\" has occurred in our unit. We aimed to determine, based on local imaging criteria, whether Pan CT is being over-utilised within our trauma service.</p><p><strong>Methods: </strong>We performed a retrospective review of all pan scans conducted in our unit in Pietermaritzburg, South Africa, during a 5-year period, January 2017 to December 2021. Data was analysed to determine injuries identified on Pan CT and how these findings influenced patient management.</p><p><strong>Results: </strong>Of 301 pan scans, 269 (89.4%) prompted an intervention, including brain scans (47.2%), cervical spine scans (9.3%), chest scans (22.7%) and abdominal scans (20.8%). The remaining 32 pan scans (10.6%) did not influence management. Many of these \"clinically negative\" scans were clinically important, ruling out injury in patients in whom clinical assessment was regarded as unreliable: 5 patients (1.7%) were hypoxic and had to be sedated, intubated and ventilated; 8 (2.7%) had a Glasgow Coma Score < 15; and 4 (1.3%) had major distracting injuries. This left only 15 pan scans (4.98%) that were not regarded as clinically helpful.</p><p><strong>Conclusion: </strong>In comparison with the results from a previous report from our unit, \"indication creep\" has not occurred. We continue to have fewer than 5% of patients who may be considered for imaging modalities other than Pan CT.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 4","pages":"240-244"},"PeriodicalIF":0.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349646","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":"Epidemiological and histopathological features of colorectal adenocarcinoma in the Western Cape public health sector between 2018 and 2020.","authors":"K Naidoo, W Begg, A C van Wyk, R S Ramesar","doi":"10.36303/SAJS.02652","DOIUrl":"https://doi.org/10.36303/SAJS.02652","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of epidemiological colorectal adenocarcinoma data in sub-Saharan Africa. This deficiency coupled with the rising trends of colorectal cancer (CRC) incidence and mortality necessitated the need for an epidemiological colorectal adenocarcinoma study to be conducted in the South African setting.</p><p><strong>Methods: </strong>A retrospective analysis of demographic and histopathological data of colorectal adenocarcinoma patients diagnosed in the Western Cape public health sector was performed through the utilisation of the National Health Laboratory Services (NHLS) Academic Affairs and Research Management System (AARMS) database.</p><p><strong>Results: </strong>A total of 612 patients were diagnosed with colorectal carcinoma in the Western Cape during the study period. 595/612 (97.2%) were diagnosed with adenocarcinoma, of these 284 (48%) of patients with primary rectal adenocarcinoma, 304 (51%) with primary colon adenocarcinoma and 7 (1%) with synchronous colorectal adenocarcinoma or a lesion involving both the colon and the rectum. Rectal adenocarcinoma most commonly occurred in 99/284 (34.9%), in the > 60-70 age group, while colon adenocarcinoma occurred most commonly in the > 50-60 age group, 78/304 (25.7%). The commonest stage of rectal adenocarcinoma patients was IIA 35/119 (29.4%), whereas stage IIIB was the commonest colon adenocarcinoma stage comprising 66/212 (31.3%) patients. Forty patients had mutations of mismatch repair genes, 7 of which had a positive BRAF mutation.</p><p><strong>Conclusion: </strong>The study showed an even distribution of colorectal adenocarcinoma incidence between males and females, with the highest rates of diagnosis in patients aged more than 50 years. Patients with stage III and IV disease had a higher rate of serum CEA elevation as compared to stage I and II.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 3","pages":"170-175"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240398","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":"Time to operative care for breast cancer in the Cape Metro West region.","authors":"E O Owolabi, F Malherbe, L Cairncross, J Fargher, I Schamrel, G A Smith, T Ngcobo, T Esterhuizen, K Chu","doi":"10.36303/SAJS.01276","DOIUrl":"https://doi.org/10.36303/SAJS.01276","url":null,"abstract":"<p><strong>Background: </strong>Time from diagnosis to operative care is a quality indicator in breast cancer (BCA) care. The recommended time from diagnosis to definitive treatment in South Africa (SA) is 31 days. The primary objective of this study was to determine the time to operative care (TOC) for BCA patients attending a multidisciplinary breast clinic at a tertiary hospital in Cape Town, SA.</p><p><strong>Methods: </strong>This was a retrospective review of women with BCA reviewed by the BCA multidisciplinary unit at Groote Schuur Hospital, SA, from 1 January 2018 to 31 December 2019.</p><p><strong>Results: </strong>Of 563 women who underwent BCA operations, 370 (65.7%) had surgery as the primary treatment modality. The median TOC for those who had surgery first was 86 days (IQR: 63-109). Of the 370 who had surgery first, 20 (5.4%) were operated on within the recommended 31 days. TOC at the district hospital was 35.1 days shorter (<i>p</i> < 0.001), and at the regional hospital, it was 16.3 days (<i>p</i> = 0.008) shorter than at the tertiary hospital after controlling for age, district, and stage of cancer.</p><p><strong>Conclusion: </strong>A low proportion of women with BCA had definitive surgery within the 31-day recommended waiting period. Decentralisation of operative care allowed faster access to surgery at district hospitals for women who did not need sentinel node biopsy or advanced anaesthesia care. Identifying additional resources needed to decrease TOC for BCA patients could improve access to timeous surgical care.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 3","pages":"127-132"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240417","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 of the parapharyngeal space - a case report.","authors":"H Melariri, A Mukhtar, S Labuschagne, E Joseph, N Siyeka, J F Opperman","doi":"10.36303/SAJS.02498","DOIUrl":"10.36303/SAJS.02498","url":null,"abstract":"<p><strong>Summary: </strong>We present a case of a female patient with solitary fibrous tumour (SFT) originating in the parapharyngeal space which was successfully resected using an open transoral approach. The patient presented with a worsening airway obstruction, obstructive sleep apnoea, and dysphagia for three years. Rhinolaryngoscopy revealed a right nasopharynx and oropharynx lateral pharyngeal wall submucosal mass. Histopathological analysis was consistent with an SFT. This uncommon site of a rare tumour often presents diagnostic challenges or leads to overt misdiagnosis. We interrogated the literature in respect of the diagnostic and therapeutic approaches for this rare condition.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 3","pages":"184-186"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240372","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":"A retrospective review of the management and outcome of patients with retained intrathoracic foreign bodies.","authors":"B Manicum, T C Hardcastle","doi":"10.36303/SAJS.01341","DOIUrl":"10.36303/SAJS.01341","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery has transformed surgery. Video-assisted thoracoscopic surgery (VATS) has been used for a few specific acute indications, however there is a paucity of data describing the management of intrathoracic foreign body removal compared to open thoracotomy.</p><p><strong>Methods: </strong>A retrospective observational chart review of patients requiring surgical management of retained intrathoracic FB during the period of January 2005 to December 2021 at Inkosi Albert Luthuli Central Hospital was undertaken. This was approved as a sub-study of BCA207-09 by the UZKN BREC.</p><p><strong>Results: </strong>Forty-two patients were identified. Sixteen (38%) were paediatric patients and 26 (62%) adults, with average age of 24 years (6 months-69 years) and a male predominance (78.6%). VATS was used initially in 33 patients, successfully in 11 (26%) and 12 (28%) required conversion to thoracotomy, while in 15 (36%) a thoracotomy was the initial procedure. Four (10%) required other surgical options. Median hospital stay was 7 days. Fourteen patients required postoperative ICU admission, 50% being those post-aspiration injury. Mechanistically, 13 were FB aspiration (31%), 25 trauma (60%) and 4 iatrogenic (9%) causes. Aspiration occurred only in paediatric patients. Among the trauma patients, 23 were adult and 2 paediatric. These included 12 retained knife blades, 8 with bullets or bullet fragments in situ, 1 nail and 2 sewing needles. Of these, 8 were managed successfully with VATS (1 bullet and 7 knife blade extractions) and 12 required conversion to thoracotomy or sternotomy. Both paediatric patients with sewing needle FB required thoracotomy. Regarding the iatrogenic FB, two Malecot® drains were removed with VATS and one patient required bilateral thoracotomies for removal of intercostal drain caps.</p><p><strong>Conclusion: </strong>Approximately 25% of all intrathoracic retained FB can be successfully removed by VATS, while many still require thoracotomy. Most patients will recover without sequelae.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 3","pages":"151-156"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240283","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":"Preoperative dietitian-led calorie-restricted diet: impact on left hepatic lobe volume and laparoscopic upper GIT surgery visibility.","authors":"F M Price, L van den Berg, F N Schutte, A Bezuidenhout, J G M Smit, E Francis, R Nel, L Robb","doi":"10.36303/SAJS.02611","DOIUrl":"https://doi.org/10.36303/SAJS.02611","url":null,"abstract":"<p><strong>Background: </strong>The surgical benefits of preoperative low- or very low-calorie diets (LCDs or VLCDs) in bariatric surgery patients have been widely studied. This study aimed to observe the changes in body composition and left hepatic lobe volume (LHLV) following a two-week dietitian-led calorie-restricted diet in non-bariatric laparoscopic surgery patients, where fatty liver often complicates the surgery.</p><p><strong>Methods: </strong>The study included 47 patients scheduled for a hiatus hernia repair with an anti-reflux procedure. Participants underwent bioelectrical impedance measurements and abdominal ultrasounds to determine changes in LHLV at baseline and again pre-surgery after following a calorie-restricted diet (800-1000 kcal daily) for two weeks.</p><p><strong>Results: </strong>Participants (median baseline body mass index [BMI]: 33.4 (30.9-36.0) kg/m2) experienced statistically significant (<i>p</i> < 0.05) decreases in body mass, BMI, waist circumference, body fat mass, body fat percentage, abdominal fat and muscle mass on the two-week calorie-restricted diet. A median LHLV reduction of 33% (IQR 12.8-49.6%, <i>p</i> < 0.05) was noted. The outcomes of the ultrasound were unknown to the surgeons at the time of the surgery, and they subjectively reported good surgical visibility of the oesophagogastric (EG) junction in 86.5% of cases.</p><p><strong>Conclusion: </strong>The findings suggest that in obese patients, losing 2.2 kg of body fat and 2.5 cm in waist circumference on a two-week dietitian-led calorie-restricted diet may significantly reduce LHLV that could potentially improve surgical visibility. Further research should determine if these changes in body composition may be used as a proxy for liver sonar.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 3","pages":"165-169"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240419","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":"Letter: Taking the bull of competency assessment by the horns.","authors":"S R Thomson","doi":"10.36303/SAJS.02374","DOIUrl":"10.36303/SAJS.02374","url":null,"abstract":"<p><p>I read with interest the survey by Nel et al.¹ \"Procedures most frequently performed by South African-trained general surgeons - implications for training and assessment\". I am heartened to see the long overdue move towards workbased assessment (WBA) and procedural competency as key elements of the assessment of fitness to practise as a consultant surgeon. The survey of recently trained surgeons found that 49% of the respondents felt unprepared to undertake one or more of the 10 procedures they most frequently perform. Of these, the procedure they felt most untrained to perform was colonoscopy. Even more revealing is that those who had gone directly into private practice had a 100% expectation that they should be able to perform colonoscopy.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 3","pages":"112-113"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240394","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":"Video-assisted thoracoscopic surgery in a high-volume urban trauma centre.","authors":"S Makhadi, L Mohlala, E E Nweke, N Elebo, M S Moeng","doi":"10.36303/SAJS.02692","DOIUrl":"https://doi.org/10.36303/SAJS.02692","url":null,"abstract":"<p><strong>Background: </strong>Tube thoracostomy (TT) is the standard treatment for haemothorax, but 5-30% of cases may result in retained haemothorax. Video-assisted thoracoscopy surgery (VATS) is a recognised treatment for retained haemothorax, although its timing and feasibility can be challenging in resource-limited settings with restricted theatre access. The objective was to evaluate and describe our experience with VATS at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa.</p><p><strong>Methods: </strong>This was a retrospective study over seven years (1 January 2017 - 31 December 2023). All adult trauma patients with retained haemothorax who underwent VATS were included. Data were collected from hospital databases, focusing on patient demographics, mechanism of injury, vital signs, radiological findings, indications for VATS, and clinical outcomes.</p><p><strong>Results: </strong>A total of 71 patients underwent VATS, with 98.6% being male and an average age of 34 years. The procedure was performed for retained haemothorax in 97% (<i>n</i> = 69) of cases and empyema in two patients. Penetrating trauma was the most common cause, with 82% of patients suffering stab wounds and 18% gunshot wounds. The median time to surgery was 5 days, with a median operating time of 77 minutes. Conversion to thoracotomy occurred in 14% (<i>n</i> = 10) of cases. Intraoperative findings included clots (42%), retained blood (42%), and pus (2.8%). Postoperative complications occurred in 12.7% (<i>n</i> = 9), including pneumonia (2.8%), drain site infections (5.6%), and recurrence of haemothorax (4.2%). The median length of hospital stay after VATS was 6 days, with no in-hospital mortalities.</p><p><strong>Conclusion: </strong>VATS is a safe and feasible option for managing penetrating chest trauma in resource-constrained environments, with low complication rates and low in-hospital mortality rates.</p>","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":"63 3","pages":"161-164"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240337","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}