South African Journal of Surgery - Volume 50, Issue 4, 2012
Volume 50, Issue 4, 2012
Picking flowers in the breast cancer field - 30th D J du Plessis Lecture of the Surgical Research Society of Southern Africa, delivered in Stellenbosch, July 2012 : D J du Plessis lectureAuthor R.S. Du ToitSource: South African Journal of Surgery 50, pp 110 –114 (2012)More Less
Surgical research in our country was already well developed 40 years ago, and a forum was needed where researchers could present their work, in addition to the already established biennial Association of Surgeons of Southern Africa meeting. A further incentive to found a Surgical Research Society was the wish to stimulate surgical research even further. Motivated by these ideas, the late Professor Sonny du Plessis, Head of Surgery at the University of the Witwatersrand in Johannesburg, founded the Surgical Research Society of Southern Africa in 1972. Despite challenges over the years, the society has prevailed. Today it stands proud and occupies a pivotal position on our academic calendar each year. It is a southern African society, which invites all researchers in our region to become members and to present their work at its annual meetings.
Outcome of laparoscopic inguinal hernia repair in a South African private practice setting : general surgerySource: South African Journal of Surgery 50, pp 115 –118 (2012)More Less
Objectives. The aim of this study was to determine the recurrence and complication rates of laparoscopic inguinal hernia repair performed in a private practice in Cape Town.
Design and subjects. An unselected cohort of 507 patients who underwent laparoscopic totally extraperitoneal (TEP) inguinal hernia repair before September 2005 were included in this study, thus ensuring a minimum 5-year follow-up. Patient demographic data, clinical notes, operating notes and outpatient follow-up notes were studied. Patients were interviewed telephonically regarding hernia recurrence, chronic pain and technique preference if they had previously undergone an open repair. All data collected were recorded on an electronic spreadsheet. The primary outcome parameter was recurrence. The secondary outcome parameters were postoperative and long-term complications.
Results. Of the 507 patients, 267 were contactable telephonically. There were 384 hernia repairs with a mean follow-up of 8.8 years. There were 9 recurrences (2.3%). The overall complication rate was 7.9%. Two per cent of patients suffered from chronic groin pain with gradual improvement since surgery. Sixteen per cent of patients had had previous open repair of an inguinal hernia, either on the ipsilateral or the contralateral side, and all judged the open repair to have been more painful.
Conclusions. The recurrence and complication rates for laparoscopic TEP inguinal hernia repair in this practice are low and comparable to the best reported series. There is a low incidence of persistent postoperative pain with the laparoscopic technique, and it is the technique preferred by patients who previously underwent an open repair.
Source: South African Journal of Surgery 50, pp 119 –123 (2012)More Less
Background. Civilian popliteal artery injuries are associated with significant amputation rates.
Aim. The aim of this study was to identify factors associated with limb loss in patients with popliteal artery injuries.
Patients and methods. We performed a retrospective chart review of prospectively collected data on patients with popliteal artery injuries presenting to the Trauma Centre at Groote Schuur Hospital, Cape Town, from 1 January 1999 to 31 December 2008. Demographic data, mechanism of injury, haemodynamic status, limb viability, special investigations, associated injuries, ischaemic time, surgical treatment and amputation rates were analysed.
Results. One hundred and thirty-six patients with popliteal artery injuries were identified. Penetrating and blunt trauma accounted for 81 (59.6%) and 55 (40.4%) injuries, respectively. Associated injuries included fractures in 66 patients (48.6%), knee dislocations in 29 (21.3%) and popliteal vein injuries in 59 (43.4%). Fifty-seven patients (41.9%) presented with a compartment syndrome. Arterial injuries were treated with reversed vein grafting in 68 patients, primary anastomosis in 33, prosthetic graft insertion in 11, and primary amputation in 7. Thirty-two patients underwent delayed amputation, giving an overall amputation rate of 37.5%. A delay of more than 7 hours of ischaemic time between injury and definitive repair (p=0.0236) and the presence of a compartment syndrome (p=0.003) were significantly associated with an increased amputation rate.
Conclusion. The most significant factors associated with the high amputation rate of 37.5% were an ischaemic time longer than 7 hours, and the presence of a compartment syndrome.
The dynamic continence challenge - a simple test to predict faecal continence before colostomy closure : general surgerySource: South African Journal of Surgery 50, pp 125 –126 (2012)More Less
Background. A common problem in clinical practice is predicting whether a patient will be continent after treatment of a severe perineal injury. Several tests have been described. Anal manometry is unreliable; continence can be normal with low pressures, and poor with high or normal pressures. Endo-anal ultrasound only illustrates anatomical sphincter integrity. The saline continence test involves the quite unphysiological instilling of saline into the rectum, and assessing seepage. What is needed in the prediction of continence is a normal stool simulator.
Method. We propose the use of powdered instant mashed potato reconstituted with water to the consistency of faeces. About 100 - 150 ml is introduced into the rectum using a catheter-tipped syringe. The patient is instructed to walk around for half an hour. On return the underwear is examined for any soiling. If there is no leakage the colostomy may be reversed.
Results. Over the past 15 years, 53 patients have undergone this test. In 47 patients there was no leakage, all had their stomas reversed, and none was incontinent during follow-up.
Conclusion. The dynamic continence challenge is an accurate physiological test that allows clinicians to simulate the effects of colostomy reversal and assess a patient's continence before actually proceeding to the reversal.
Prevalence of histological prostatitis in men with benign prostatic hyperplasia or adenocarcinoma of the prostate presenting without urinary retention : urologySource: South African Journal of Surgery 50, pp 127 –130 (2012)More Less
Objective. To determine the prevalence of prostatitis on histopathological evaluation of prostatic tissue in men without urinary retention.
Design, setting and subjects. The clinical data and histopathology reports of men seen from January 1999 through March 2009 at our institution were analysed using Student's t-test, the Mann-Whitney test and Fisher's exact test where appropriate. Values were expressed as means, medians and ranges (p<0.05 accepted as statistically significant).
Outcome measures. Data collected included patient age, duration of lower urinary tract symptoms and hospitalisation, findings on digital rectal examination, prostate volume, haemoglobin concentration, serum creatinine and prostate-specific antigen (PSA) levels, and histological findings.
Results. Prostatic tissue of 385 men without urinary retention at presentation was obtained via biopsy (48.3% of cases), transurethral prostatectomy (62.9%), retropubic prostatectomy (6.8%) or radical prostatectomy (28.3%). On histological examination, benign prostatic hyperplasia (BPH) was found to be present in 213 patients (55.3%) and adenocarcinoma of the prostate (ACP) in 172 (44.7%). Histological prostatitis was present in 130 patients (61.0%) with BPH and 51 (29.7%) with ACP (p<0.001). A previous study of 405 men presenting with urinary retention at our institution showed histological prostatitis in 98/204 (48.0%) with BPH and in 51/201 (25.4%) with ACP. The group of men with BPH alone had a significantly lower mean serum PSA at presentation (4.5 ng/ml, range 0.3 - 20.8 ng/ml) compared with the group with BPH and prostatitis (11.2 ng/ml, range 0.2 - 145 ng/ml, p=0.011). The mean PSA level at presentation did not differ significantly between the group with ACP only (40.9 ng/ml, range 0 - 255 ng/ml) and the group with ACP plus prostatitis (1 672 ng/ml, range 0.3 - 38 169 ng/ml, p=0.076).
Conclusions. Among men presenting without urinary retention, histological prostatitis was significantly more prevalent in those with BPH than in those with ACP (61% v. 30%), similar to the previous study of men presenting with retention at our institution, in which histological prostatitis was significantly more prevalent in BPH than in ACP (48% v. 25%). This finding suggests that histological prostatitis is not significantly associated with the causation of ACP or urinary retention. Serum PSA at presentation was significantly higher in the group with BPH plus prostatitis compared with BPH alone, but not in the group with ACP plus prostatitis compared with ACP alone.
Source: South African Journal of Surgery 50, pp 131 –133 (2012)More Less
Two cases of gastric volvulus are presented to highlight the predisposing factors, mechanism and different types of volvulus, and the role of imaging in making the diagnosis.
Eventration of the diaphragm and hiatus hernia are precipitating factors for developing organo-axial and mesentero-axial volvulus. Imaging is key to making the diagnosis and distinguishing the types of volvulus in order to decide on management.
Author F.A. AbogunrinSource: South African Journal of Surgery 50, pp 134 –135 (2012)More Less
Renal arteriovenous fistula (rAVF) is an uncommon condition, usually iatrogenic and in most cases caused by percutaneous renal needle biopsy. This is a report of rAVF following flexible ureteroscopic electro-hydraulic lithotripsy of a lower pole renal calculus and its subsequent management. A high index of suspicion is required for the diagnosis of this rare complication, which is easily treated by radiological intervention.
Source: South African Journal of Surgery 50, pp 136 –137 (2012)More Less
Source: South African Journal of Surgery 50, pp 137 –139 (2012)More Less
Retropharyngeal abscesses are infections deep in the neck space that can pose an immediate life-threatening emergency, with potential for airway compromise and other catastrophic complications. In adults these abscesses can develop as a result of vertebral pyogenic osteomyelitis, tuberculosis of the spine, or external injuries caused by endoscopes or foreign bodies (e.g. fish bones). Tuberculosis of the retropharyngeal space is one of the rare forms of extrapulmonary tuberculosis. Early diagnosis and treatment are necessary to prevent the serious complications of the disease.
We present a case of tuberculous retropharyngeal abscess in an adult woman without tuberculosis of the cervical spine who was managed surgically by aspirating the retropharyngeal abscess transorally, together with antituberculosis treatment.
Source: South African Journal of Surgery 50 (2012)More Less
Eugen Ulrich Schmid was born on 30 July 1927, the youngest of 5 children of a devoted Lutheran family. After a happy childhood in South-West Africa (now Namibia), he left for Pretoria where he qualified as a medical doctor in 1952. After an extended period in private practice in his home country, he returned to Pretoria where he obtained his master's degree in surgery before he entered the missionary field.