Ambulatory Epigastric Hernia Repair Using Local Anaesthesia: A Pragmatic Approach In A Resource Poor Society

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Surgical Abdomen in School Age Children: A Prospective Review From Two Centers In SouthWestern Nigeria

Background: Surgical abdomen traverses all age groups. We sought to define the aetiology, patients’ characteristics, and outcome of management amongst children Methods: Two years prospective review of patients aged 5-15 years managed for surgical abdomen at the Wesley Guilds Hospital Ilesa and Mishmael Medical Centre Akure, Nigeria. Results: Fifty two patients were treated. The male: female ratio was 1:1. The age range was 5years to 15years (mean=11.25 ±2.24years). Mean duration of illness was 29.5hours (range 2-72hours). Gut perforation was the most common aetiology (n=39; 75%); with perforations due to infections most prevalent (n= 34; 87.2%). Ten cases (19.2%) were trauma related and showed male predominance. Obstructed gut accounted for 15.4% (n=8) of cases; and showed female predominance. Five out of the eight small bowel obstructions (62.5%) were due to post operation adhesions. Pre-operative and post-operative diagnoses were congruent in 90.4% (n=47) of cases. Major post-operative complications were surgical site infection (20; 38.5%), and pneumonia (5; 9.6%). The average hospital stay was 9days (range 4-21days). Mortality rate was 1.9% (n=1). Conclusion: Acute abdomen requiring surgical intervention is mainly infective origin. The male child is more at risk of abdominal trauma while gut obstruction was more common in females.Keywords: Surgical, Abdomen, Children, Emergenc

Safety of the surgeon: ‘Double-gloving’ during surgical procedures

Background. In the face of increasing HIV/AIDS prevalence in subSaharan Africa, we evaluate the effectiveness of ‘double-gloving’ during surgery as a means of protecting the surgeon operating on patients with a known or unknown HIV status.Methods. A prospective study was conducted to determine the rate of glove puncture and intraoperative injury in categories of patients with known positive, known negative or unknown HIV status.Results. The surgeon and the first assistant double-gloved in all the 1 050 procedures performed between 2009 and 2013, and a total of 8 400 surgical gloves were used. Sixty-nine patients (6.6%) were HIV-positive, 29 patients (2.8%) were HIV-negative, and the HIV status was unknown for the remaining 952 patients (90.7%). The overall glove puncture rate in the study was 14.5%. The glove puncture rate was 0%, 31% and 15% for HIV-positive, HIV-negative and HIV status unknown, respectively, and this difference was statistically significant. The mean operating time in the group with glove punctures was 148 min (95% confidence interval (CI) 135 - 161), while mean operating time in the group without glove puncture was 88 min (95% CI 84 - 92). Conclusion. Double-gloving offers protection against intraoperative injury. Knowing the HIV status of the patient offers additional protection to the operating surgeon. While we recommend routine double-gloving for surgeons working in HIV-prevalent patient populations, we also advocate for the routine screening for HIV in all surgical patients

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The West African dwarf sheep. 1. Reproductive performance and growth

The reproductive performance and growth rate of West African Dwarf sheep under improved management condition were investigated. Data on productivity, breeding efficiency, weight gain, lambing characteristics and mortality included

Open hemorrhoidectomy under local anesthesia for symptomatic hemorrhoids; our experience in Ile \u2013Ife, Nigeria

Background: Ligation-excision hemorrhoidectomy is considered the gold-standard treatment for prolapsed hemorrhoids. The procedure is commonly done under general or regional anesthesia. This study is aimed to assess the feasibility and tolerability of open \u2013 hemorrhoidectomy under local anaesthesia in our setting. Methods: This is a prospective study carried out in Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria, over a 5-year period. All consenting adult patients with prolapsing hemorrhoids were o\ufb00ered Milligan \u2013 Morgan hemorrhoidectomy under local anesthesia. They were assessed for tolerance and complications. Results: More than 95% of patients tolerated the procedure with manageable complications. Conclusions: Open excisional hemorrhoidectomy under local anesthesia is feasible, safe and well tolerated in our environment and may encourage early presentation of patients with piles to hospital

Open hemorrhoidectomy under local anesthesia for symptomatic hemorrhoids; our experience in Ile –Ife, Nigeria

Background: Ligation-excision hemorrhoidectomy is considered the gold-standard treatment for prolapsed hemorrhoids. The procedure is commonly done under general or regional anesthesia. This study is aimed to assess the feasibility and tolerability of open – hemorrhoidectomy under local anaesthesia in our setting. Methods: This is a prospective study carried out in Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria, over a 5-year period. All consenting adult patients with prolapsing hemorrhoids were offered Milligan – Morgan hemorrhoidectomy under local anesthesia. They were assessed for tolerance and complications. Results: More than 95% of patients tolerated the procedure with manageable complications. Conclusions: Open excisional hemorrhoidectomy under local anesthesia is feasible, safe and well tolerated in our environment and may encourage early presentation of patients with piles to hospital