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Management of Groin Hernias in the Department of General Surgery at Boke Regional Hospital (Guinea)
Loua Moise,
Camara Keoulen,
Fofana Naby,
Kondano Saa Yao,
Diawara Mohamed Albert,
Soumaoro Labile Togba,
Toure Aboubacar,
Diallo Aissatou Taran
Issue:
Volume 10, Issue 1, February 2022
Pages:
1-3
Received:
9 November 2021
Accepted:
27 November 2021
Published:
12 January 2022
Abstract: Background: Groin hernia is one of the most common conditions in surgical pathology. Worldwide, more than 20 million patients undergo groin hernia repair annually with a prevalence 4.6% in Africa. The purpose of this study was to describe the epidemiological, clinical and management aspects of groin hernias in the general surgery department of the regional hospital of Boke. Material and methods: This was a prospective cross-sectional descriptive study of 24 months (January 2019 to December 2020), conducted at the regional hospital of Boke, on consecutive patients who had surgery for groin hernia. Results: During these two years, groin hernias represented 19.90% (n=418) of all surgical admissions (n=2100). The mean age of the patients was 46.05 years. The male gender was the most predominant (87.08%). The average time to consultation was 36.4 months. In 17.83% of cases, the hernia was strangulated. The Bassini technique was the most used method of cure (87.56%). Morbidity was dominated by surgical site infection (26.08%), persistent groin pain (14.11%). Mortality was nil. At six months postoperative follow-up, we observed 29 recurrences (6.94%). Conclusion: Groin hernias are still a concern in our rural populations and their adequate management requires continuous training of surgical staff on tension-free cure techniques and acquisition of prosthetic materials.
Abstract: Background: Groin hernia is one of the most common conditions in surgical pathology. Worldwide, more than 20 million patients undergo groin hernia repair annually with a prevalence 4.6% in Africa. The purpose of this study was to describe the epidemiological, clinical and management aspects of groin hernias in the general surgery department of the ...
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Postoperative Enterocutaneous Fistula: A Severe and Desperate Complication in a Disadvantaged Surgical Setting
Soumaoro Labile Togba,
Fofana Houssein,
Fofana Naby,
Kondano Saa Yawo,
Thea Kokolype,
Toure Aboubacar,
Diallo Aissatou Taran
Issue:
Volume 10, Issue 1, February 2022
Pages:
4-7
Received:
15 November 2021
Accepted:
1 December 2021
Published:
12 January 2022
Abstract: Purpose: Digestive or gastrointestinal fistula is one of the most feared postoperative complication along with dehiscence and infection. The aim of this study was to determine the etiological, clinical and therapeutic aspects of enterocutaneous fistulas in a disadvantaged surgical setting. Methods: This was a retrospective study covering a period of three years (January 2018 to December 2020) including records of patients managed for postoperative enterocutaneous fistula in the general surgery department of the Ignace DEEN national hospital in Conakry (Guinea). Results: During the three years of study, we compiled 69 records of patients with postoperative enterocutaneous fistulas, representing 14.68% of all postoperative abdominal complications registered in the department (n=468). The mean age of the patients was 29.61±17.32 years. In this series, 53 patients (76.81%) were initially operated in private health facilities and then referred to our department after the occurrence of the fistula. The most frequent indications for initial surgery were typhoid ileal perforation (37.68%) followed by appendicitis (26.09%) and sigmoid colon volvulus (15.94%). Spontaneous closure of the fistula was obtained in 41 patients (59.42%) with a mean time of 23 days. We noted 18 deaths (26.09%). Conclusion: Postoperative enterocutaneous fistula is a severe complication whose management in our environment is difficult and desperate for both patient and surgeon.
Abstract: Purpose: Digestive or gastrointestinal fistula is one of the most feared postoperative complication along with dehiscence and infection. The aim of this study was to determine the etiological, clinical and therapeutic aspects of enterocutaneous fistulas in a disadvantaged surgical setting. Methods: This was a retrospective study covering a period o...
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Fournier Gangrene and Retroperitoneal Abscess Secondary to Perforated Appendicitis: A Case Report
Mustafa Abdullah Abbas,
Maryam Tawfiq Aburezq,
Amal Hassan Elsabbagh
Issue:
Volume 10, Issue 1, February 2022
Pages:
8-14
Received:
24 December 2021
Accepted:
13 January 2022
Published:
20 January 2022
Abstract: Fournier’s gangrene and retroperitoneal abscess are rare complications of late presentation of perforated acute appendicitis. This case report discusses the case of a 46-year-old male patient who presented with 5 days history of progressive abdominal pain and was admitted to our department as a case of complicated perforated acute appendicitis followed by retroperitoneal abscess formation and Fournier’s Gangrene few days later. The patient had a hospital stay of 53 days, during which he underwent diagnostic laparoscopy and appendectomy, computerized tomography guided percutaneous abscess incision and drainage for the retroperitoneal abscess and multiple scrotal debridement surgeries for the Fournier’s gangrene, in addition to the drain care and intravenous antibiotic course he received. Diabetes mellitus is one of the most common risk factors of Fournier’s gangrene, which was newly detected in our patient six months earlier. Fournier’s gangrene is ten times more common in males than in females, especially in their third and sixth decade of life. It is life-threatening and has unfavorable prognosis that indicates early detection and aggressive surgical and medical intervention with a multidisciplinary approach, including fluid resuscitation, immediate initiation of broad-spectrum antibiotics and aggressive debridement of the necrotic tissue; in addition to the respiratory and hemodynamic support to improve the prognosis and overall outcome and to maximize the chances of survival.
Abstract: Fournier’s gangrene and retroperitoneal abscess are rare complications of late presentation of perforated acute appendicitis. This case report discusses the case of a 46-year-old male patient who presented with 5 days history of progressive abdominal pain and was admitted to our department as a case of complicated perforated acute appendicitis foll...
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Limited Excised Functional Liver Tissue in Hepatectomy for Large Hepatic Tumors Proved by a Three-Dimensional Reconstruction Technique
Chong Huang,
Yawei Fang,
Wei Wang,
Shuilin Dong
Issue:
Volume 10, Issue 1, February 2022
Pages:
15-22
Received:
4 January 2022
Accepted:
18 January 2022
Published:
24 January 2022
Abstract: Three-dimensional (3D) reconstruction techniques have been widely used in the preoperative evaluation of hepatectomy. Here we used a 3D reconstruction technique to estimate the remnant liver volume and clarify a clinical speculation that limited functional liver tissue would be excised in hepatectomy for large hepatic tumors. Hepatectomy simulation by IQQA-Liver software was applied to 108 patients of hemihepatectomy divided into two groups (tumor diameter ≥ 10 cm vs.<10 cm). Liver volume (LV), standard liver volume (SLV), tumor volume (TV), functional liver volume (FLV), excised liver volume (ELV), excised functional liver volume (EFLV) and residual liver volume (RLV) were measured. Then we compared the rate of total liver resection (ELV/LV), the rate of functional liver resection (EFLV/FLV), and the relative rate of future liver remnant (RLV/FLV and RLV/SLV) between the two groups. The ELV calculated by the 3D reconstruction procedure were highly consistent with the actual liver excised volume (r=0.994, p<0.001), showing the accuracy of the simulation. Significantly smaller EFLV/FLV was seen in patients with a tumor diameter ≥ 10 cm than in patients with a tumor diameter<10 cm (p<0.01), in both the right and left hemihepatectomy subgroup. In contrast, significantly larger RLV/FLV was seen (p<0.01), and there was no difference of the RLV/SLV (p>0.05). Twenty-five patients had RLV/LV<30%, a recognized ratio of future liver remnant for safe hepatectomy. However, only one patient had RLV/SLV<30%. 97.2% of the patients had RLV/FLV>40%, and 98.1% had RLV/SLV>40%, accounting for the overwhelming majority of all patients. There was no hepatic failure or death within 30 days of surgery. In summary, it is better to use a 3D reconstruction method for preoperative safety assessment of liver resection for large hepatic tumors, through the hepatectomy simulation and volume calculation. In the same range of anatomical hepatectomy, a larger tumor mass meant less excised functional liver volume and more remnant liver volume. Our results indicated that neither ELV nor RLV/LV, but RLV/SLV was the better determinant of safety of hepatectomy.
Abstract: Three-dimensional (3D) reconstruction techniques have been widely used in the preoperative evaluation of hepatectomy. Here we used a 3D reconstruction technique to estimate the remnant liver volume and clarify a clinical speculation that limited functional liver tissue would be excised in hepatectomy for large hepatic tumors. Hepatectomy simulation...
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Physiopathology, Microbics and Administration of the Pleural Space with Empyema Following Left Pneumonectomy: A Case Report and Discussion
Colaut Flavio,
Piazza Aurelio,
Baldasso Francesco,
Stecca Tommaso,
Massani Marco
Issue:
Volume 10, Issue 1, February 2022
Pages:
23-26
Received:
27 December 2021
Accepted:
19 January 2022
Published:
9 February 2022
Abstract: In 2016 a middle age man has been operated urgently of left pneumonectomy because of bronchiectasiae with life-threating emoptysis. The Patologist described the entire lung destroyied by a massive inflammatory process. Almost a year later from intervention patient developped broncho - pleural fistula (BPF) on the left main bronchial stump with the onset of a dramatic empyema. After an unsuccessful attempt of endoscopic proceeding to fix the bronchial fistula with cyanoacrylate an Open Window Thoracostomy (OWT) was opened and infection disappeared. Afterwards patient went on outpatient for regular medications. Unfortunately despite of local treatment with antibiotics the pleural space resulted continuously infected and no indication to close the pleural cavity has been considered. Today patient is well and has a normal quality of life. For a patient with an OWT in good health condition also regular medications on outpatient seem reasonable and acceptable if surgery is not appropriate or refused.
Abstract: In 2016 a middle age man has been operated urgently of left pneumonectomy because of bronchiectasiae with life-threating emoptysis. The Patologist described the entire lung destroyied by a massive inflammatory process. Almost a year later from intervention patient developped broncho - pleural fistula (BPF) on the left main bronchial stump with the ...
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Delivering Urgent Elective Surgery at a COVID Clean Facility During Phase 1 of the UK Lockdown and Developing a Contingency Plan for Potential Future Waves
Shafaque Shaikh,
Lok Ka Cheung,
Shanju Rai,
Thenmalar Vadiveloo,
David Lawrie,
Abdul Qadir
Issue:
Volume 10, Issue 1, February 2022
Pages:
27-33
Received:
1 January 2022
Accepted:
25 January 2022
Published:
9 February 2022
Abstract: Background: The COVID-19 pandemic has resulted in unprecedented disruption in the delivery of elective surgical care and fears of ongoing waves exist. Our organisation explored a model of care to enable safe delivery of urgent elective surgical care for the diagnosis of cancer across various specialties. This study presents the results of this model and the development of a contingency plan for a future wave of the COVID-19 pandemic. Methods: Early on during phase-1 of the UK lockdown, a clean facility fit for purpose for delivering elective surgical care was identified and measures implemented to ensure safety across the process. Results: A total of 499 patients were booked between 20/03/2020 to 18/06/2020 (Phase-1), 44 were cancelled because 7 developed symptoms of COVID-19 pre-operatively, household members of 2 patients became symptomatic, 4 failed to attend and 31 were unsuitable due to co-morbidities. There was no mortality at 7 or 30 days. Twenty two patients developed complications post-operatively, 4 required escalation of care, 5 required transfer to the parent site, 13 were readmitted and 4 required a re-operation. None of the patients developed COVID-19 in the post-operative period up to 30 days. Thirty-one patients developed symptoms suggestive of COVID-19 all of whom tested negative on a swab test. Overall, patient satisfaction was good. Conclusion: It was possible to safely deliver urgent elective surgical care at a COVID clean facility in our population. This strategy may facilitate the continued delivery of urgent elective surgical care during potential further waves of COVID-19 pandemic or similar future health crisis.
Abstract: Background: The COVID-19 pandemic has resulted in unprecedented disruption in the delivery of elective surgical care and fears of ongoing waves exist. Our organisation explored a model of care to enable safe delivery of urgent elective surgical care for the diagnosis of cancer across various specialties. This study presents the results of this mode...
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Palliative Surgery in Pancreatic Head Cancer at the University Hospital of Bouaké
Mamadou Traore,
Bernadette Ahou N’Dri,
Ibrahim Kouakou Anzoua,
Bernadin Kouame Kouakou,
Ismael Kalou Leh Bi,
Amos Serge Ekra,
Amos Blaise Kouakou,
Alassane Binate,
Venance Alloka,
Inza Bamba,
Ezechiel Akowendo,
Roger Lebeau,
Bamourou Diane
Issue:
Volume 10, Issue 1, February 2022
Pages:
34-39
Received:
9 January 2022
Accepted:
4 February 2022
Published:
16 February 2022
Abstract: Introduction: Cancer of the head of the pancreas is increasing in incidence. It represents 3% of all cancers and 20% of digestive cancers. Diagnosis is most often late. Indeed, 80% of these cancers are discovered at an advanced stage. In this case, the treatment is essentially palliative. The reference treatment is chemotherapy associated with endoscopic treatment if there is obstruction of the bile duct. Palliative surgery is only indicated in the case of intraoperative discovery of a contraindication to a curative surgical procedure. However, this palliative surgery is still in the forefront in low-income countries with limited technical facilities. The aim of this work was to determine the frequency and modalities of palliative surgery in unresectable pancreatic head cancer and to evaluate the results. Methods: Retrospective and descriptive study of the files of patients who underwent palliative surgery for a malignant tumour of the head of the pancreas; operated at the University Hospital of Bouake from January 2011 to December 2020. Results: Palliative surgery was performed in 71 patients, or 80.6% of patients with locally advanced pancreatic head tumour. We performed a double biliary and digestive bypass systematically. The digestive bypass was a gastrojejunal anastomosis in all cases. For the biliary-digestive diversion, different modalities were performed, notably a choledocho-jejunal anastomosis in 53.6% (n=38), a cholecysto-jejunal anastomosis in 38.0% (n=27) and a choledochodenal anastomosis in 8.4% (n=6). The overall morbidity was 22.5% (n=16). Morbidity related to the surgical procedure was 18.3% (n=13). These were biliary leakage (n=6; 8.4%) and parietal bleeding (n=4; 5.6%). Three patients died immediately postoperatively, giving an operative mortality of 4.2%. The mean survival of the patients was 5.8±2.2 months. Conclusion: Palliative surgery occupies a privileged place in our practice, allowing an improvement in the quality of life of the patients without apparent influence on the long-term prognosis which remains appalling. The hope of improving the prognosis lies in early diagnosis and strengthening the technical platform.
Abstract: Introduction: Cancer of the head of the pancreas is increasing in incidence. It represents 3% of all cancers and 20% of digestive cancers. Diagnosis is most often late. Indeed, 80% of these cancers are discovered at an advanced stage. In this case, the treatment is essentially palliative. The reference treatment is chemotherapy associated with endo...
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Surgical Treatment of Acute Cholecystitis in Patients over 80 Years: 10-Year Experience
Kadir Yildirim,
Ilhan Karabicak,
Mahmut Fikret Gursel,
Zafer Malazgirt
Issue:
Volume 10, Issue 1, February 2022
Pages:
40-43
Received:
23 January 2022
Accepted:
13 February 2022
Published:
25 February 2022
Abstract: The prevalence of gallstones ranges from 20% to 30% in patients ≥ 60 years of age whereas it is higher in individuals ≥ 90 years of age. Elderly patients with gallstones tend to develop more complications such as gallbladder hydrops, empyema or perforation. Although perioperative morbidity and mortality is slightly high in elderly patients with acute cholecystitis, cholecystectomy is successfully performed for acute cholecystitis with regard to improvement in patients care. In this study, we aimed to evaluate the results of patients over 80 years of age who had cholecystectomy. The data of the 196 patients over 80 years of age who underwent cholecystectomy for acute cholecystitits between Jan 2011and August 2020 were retrospectively reviewed. The age of the patients in this study ranged from 80 to 97 years. The number of female patients was 111 and male patients was 85. 109 patients underwent laparoscopic cholecystectomy and 77 patients underwent open cholecystectomy. 10 patients converted from laparoscopic to open surgery. One patient who underwent open cholecystectomy died. We observed more wound infection in open cholecystectomy group. Laparoscopic cholecystectomy patients were discharged earlier. Age is not a contraindication for cholecystectomy in patients with acute cholecystitits. Cholecystectomy is a safe procedure in elderly patients with accepted morbidity.
Abstract: The prevalence of gallstones ranges from 20% to 30% in patients ≥ 60 years of age whereas it is higher in individuals ≥ 90 years of age. Elderly patients with gallstones tend to develop more complications such as gallbladder hydrops, empyema or perforation. Although perioperative morbidity and mortality is slightly high in elderly patients with acu...
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Nosocomial Infections in Surgical Patients at a Central Academic Hospital in South Africa
Hassan Nazeerah,
De Oliveira Bianca,
Fraser Simon,
Govender Sameshan,
Madzinga Maano,
Mpati Nokolinah,
Rahiman Fathima-Zahra,
Kalla Zahra,
Malebati William Khabe,
Luvhengo Thifhelimbilu Emmanuel
Issue:
Volume 10, Issue 1, February 2022
Pages:
44-51
Received:
23 January 2022
Accepted:
13 February 2022
Published:
28 February 2022
Abstract: Nosocomial infections are infections that develop after 48 hours of admission or within 30 days of discharge from a healthcare facility. The aim of the study was to investigate the rate of occurrence and types of nosocomial infections in patients admitted to the surgical wards. An audit based on records of patients who developed nosocomial infections was conducted. Data extracted included patients’ demography, comorbidities, the organisms cultured, and their resistance patterns. A total of 574 records from 421 patients were found. Seventy percent (69.8%: 294/421) of the patients were males and 66.3% (279/431) were less than 51 years old. Ninety-four (22.3%: 94/421) patients were found to have polymicrobial infections. The records included 62 species of bacteria and 7 candida species. Around 74.7% (429/574) of the cultured organisms were ESKAPE pathogens. The most cultured organism was K. pneumoniae at 18.6% (107/574). Fifty-one percent of the cultured bacteria were resistant to antimicrobials. The overall rate of nosocomial infection was 8.7% with an incidence density of 468.20 per 100 000 patient days. Nosocomial infections were more prevalent in vascular, trauma and neurosurgery patients.
Abstract: Nosocomial infections are infections that develop after 48 hours of admission or within 30 days of discharge from a healthcare facility. The aim of the study was to investigate the rate of occurrence and types of nosocomial infections in patients admitted to the surgical wards. An audit based on records of patients who developed nosocomial infectio...
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Clinical and Biological Effects and Quality of Life After Parathyroidectomy in Patients with Hyperparathyroidism Secondary to Chronic Renal Failure
Hadj Omar El Malki,
Nisrine Hikki,
Al Montacer Charif Chefchaouni,
Lahcen Ifrine,
Abdelkader Belkouchi,
Loubna Benamar,
Rabia Bayahia,
Naima Ouzeddoun
Issue:
Volume 10, Issue 1, February 2022
Pages:
52-56
Received:
29 January 2022
Accepted:
17 February 2022
Published:
28 February 2022
Abstract: Surgical treatment of hyperparathyroidism secondary to chronic renal failure still finds its place despite advances in dialysis and medical treatment. After a certain period of development, surgical management takes place on forms that are particularly symptomatic and resistant to medical treatment. The aim of our study is to evaluate the clinical and biological effects of parathyroidectomy and to correlate the results with a questionnaire on the quality of life. Through a retrospective study of 32 patients, operated over a period of 10 years in the Department of Surgery "A" of Ibn Sina Hospital in Rabat. We evaluated the clinical and biological effects of parathyroidectomy at the 3-year followup. The gesture achieved consists of parathyroidectomy 7/8e in the majority of cases after research and identification of the parathyroid glands. Postoperative hypocalcaemia was present in 22 cases (68.75%), and was symptomatic in 04 cases. Medium and long-term outcomes were satisfactory for the majority of patients clinically and biologically. The clinical improvement evaluated by a PAS (Parathyroidectomy Assessment of Symptoms) questionnaire before and one year after parathyroidectomy was statistically significant. Biologically, hematocrit improvement, decreased parathyroid hormone and alkaline phosphatase were statistically significant between 3 months and 3 years after parathyroidectomy.
Abstract: Surgical treatment of hyperparathyroidism secondary to chronic renal failure still finds its place despite advances in dialysis and medical treatment. After a certain period of development, surgical management takes place on forms that are particularly symptomatic and resistant to medical treatment. The aim of our study is to evaluate the clinical ...
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