Management of Obesity: The Surgical Perspective

Background: Obesity which is one of the most prevalent diseases worldwide continues to increase with its associated complications. Bariatric surgeries have been described as the preferred method of treatment for morbidobesity. The objective of this review is to give an overview of bariatric surgical procedures and the possible outcomes.Method: Literature review was conducted using Goggle Search Engine and Highwire Press. Selected papers were taken and books from the author's collection were used for further reference.Results: Bariatric surgery is the most effective treatment for morbid obesity producing long lasting weight loss and remission of co-morbidities. Restrictive procedures are more commonly performed because they are simpler and achieve good weight loss in addition to the avoidance ofmetabolic complications associated with malabsorptive procedures.Conclusion: Specific criteria must be met and the patient must be motivated and fully informed before performance of bariatric surgery for obesity preferably with restrictive procedures.Key Words: Obesity; bariatric surgery; restrictive; malabsorptiv

Gall bladder cancer: a review

Introduction: Gall bladder cancer is the most aggressive cancer and the commonest malignant tumor of the biliary tract worldwide.The incidence increases with age and women are more commonly affected. Surgical resection is the only chance for complete cure,however only 10% of patients are candidates for curative surgery at initial presentation.Objective: To review the current concepts and key issues in the diagnosis and management of gallbladder cancer.Methodology: A systematic review of published literature was done using search Google Search Engine, Highwire press and Springer Link selected papers were taken and books from author's collection used for further reference.Results: The risk factors of gallbladder cancer include race (like India), cholelithiasis,polyps, pancreatico-biliary maljunction anomalies, chronic inflammation, exposures to heavy metals and chemicals and infections (e.g. liver flukes). It may present as mass lesion, localized wall thickening or polypoid growth. Adenocarcinoma is the commonest histological type.The clinical presentation is divided into 5 syndromes namely acute cholecystitis, chronic cholecystitis, biliary tract disease, non specific symptomatology and symptoms related to metastatic disease.Complete surgical treatment is the only curative treatment for gallbladder cancer but only a few cases are seen at this curative stage.Conclusion: Gallbladder cancer is relatively uncommon with high mortality rate. Risk factors include advance age, female gender, cholelithiasis, porcelain gallbladder, gallbladder polyps, congenital biliary cysts, chronic infection and smoking.Most are discovered incidentally at routine cholecystectomy or present at advance stage of the disease. Surgery is the only curative therapy for gallbladder cancer and the extent is dependent on the TNM stage. However, at diagnosis, only 10% of patients are candidates for curative surgery.Keywords: Gallbladder, Cance

The Pattern of Surgically Treatable Anorectal Diseases in University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

INTRODUCTION: Disorders of the anus and rectum occur commonly in surgical practice. Common anorectal disorders include haemorrhoids, carcinoma of the rectum, anal fissures, anorectal fistulae and abscesses. Less frequently encountered disorders include perineal injuries, anal cancers and rectal polyps. The purpose of this study is to determine the pattern of anorectal diseases which were surgically treated in University of Port Harcourt Teaching Hospital.PATIENTS AND METHODS: This is a 4 year retrospective study of all adult patients with anorectal diseases who were admitted into the surgical wards of University of Port Harcourt Teaching Hospital. Relevant data were retrieved and analyzed.RESULTS: One hundred and fifty cases were seen over the 4 year period. There were 92 (61.33%) males and 58 (38.67%) females making a male to female ratio of 1.6:1. The peak age incidence was 31-40 years. The commonest anorectal disorder was haemorrhoids. Other commonly encountered conditions in decreasing order were carcinoma of the rectum, anorectal fistulae, anal fissures and rectal prolapsed. Five patients died and they all had carcinoma of the rectum.CONCLUSION: Haemorrhoids remain the commonest anorectal disorder in University of Port Harcourt Teaching Hospital. Carcinoma of the rectum which was not noted among the studied population in our centre 10 years ago now assumes the second position and this reflects an increasing incidence of the disease. Therefore, early diagnosis and treatment are imperative for increase in survival rate.KEY WORDS:Pattern; Anorectal diseases; University of Port Harcourt Teaching Hospital

Sigmoidopexy And Tube Sigmoidostomy In Sigmoid Volvulus: A Case Report

Background: Sigmoid volvulus is a surgical condition with high recurrence and mortality rates following non operative decompression of the colon. It is for this reason that definitive surgery is required for effective treatment.The aim of this report is to present the outcome following sigmoidopexy and tube sigmoidostomy in a patient with sigmoid volvulus.Method: The case records of a 46 year old man who presented with abdominal pain, absolute constipation, abdominal distension and bilous vomiting as well as literature of the subject using available journals and books in addition to online search through goggle and Medline were utilized.Results: Examination showed abdominal distension with generalized and absent bowel sounds. Plain abdominal xray (erect and supine), showed evidence of sigmoid volvulus. Sigmoidopexy and tube sigmoidostomy (using foley catheter) were subsequently done. Surgery and post operative recovery were uneventful. Sigmoidostomy became functional on the first post operative day with a th reduction in the volume of the discharge by the 4 post th operative day. Catheter was removed by the 10 day and theth patient discharged on the 11 day after surgery. He has been followed up for 6 months now on outpatient basis and remains in a good state of health without any symptoms.Conclusion: Sigmoidopexy and tube sigmoidostomy should be considered as an effective option for the surgical treatment of patients who present with sigmoid volvulus without gangrene.Key words: Sigmoid volvulus; sigmoidopexy; tube sigmoidostomy; Nigeri

Appendicitis in University of Port Harcourt Teaching Hospital, Nigeria

Background: Acute appendicitis is the most common cause of acute abdomen worldwide with increasing incidence in developing countries. The diagnosis is mainly clinical and wound infection remains the most common post-operative complication.Objective: To determine the pattern of presentation of acute appendicitis.Design: Hospital based retrospective study.Setting: Department of Surgery, University of Port Harcourt Teaching Hospital, Nigeria.Subjects: Patients with histologically confirmed acute appendicitis.Results: A total of 130 patients who had appendicectomy for acute appendicitis were included in the study. There were 62 males and 68 females (M:F 1:1.1). Their ages ranged from 14 to 67 years with a peak age incidence of 21-30 years. The highest incidence was in the month of July while the lowest was in February. All the patients presented with right iliac fossa pain and tenderness. Post-operative complication rate was 10% and wound infection was the most common (7.7%).Conclusion: The presentation of acute appendicitis in UPTH is similar to that in other parts of the West African sub-region but with a slight female preponderance in our centre. Early diagnosis and prompt surgical intervention is the key to successful management

Abdominal Injuries in University of Port Harcourt Teaching Hospital

Background: Abdominal injury is relatively common in both civilian and military casualties and remains a major source of morbidity and mortality. The mechanism of injury may be blunt or penetrating. Some would require operative intervention, whereas others may be managed conservatively. Objective: The aim was to determine the pattern and outcome of management of abdominal injuries in the University of Port Harcourt Teaching Hospital (UPTH). Patients and Methods: This was a prospective study of all patients with abdominal injuries seen and managed in UPTH over a 4‑year period (from January 1, 2009 to December 31, 2012). Relevant data were recorded and analyzed using Statistical Package for Social Sciences version 16. Results: Forty‑five patients were seen during the study period. There were 40 males (88.9%) and five females (11.1%) making a male to female ratio of 8:1. Their ages ranged from 15 to 45 years with a mean of 27.8 ± 1.6 years and 21 to 30 years was the most commonly affected age group. The mechanism of injury was penetrating in 33 patients (73.3%) and blunt in 12 patients (26.7%). Thirty‑four patients (75.6%) had an exploratory laparotomy after resuscitation, while 11 (24.4%) were managed conservatively. Small bowel was the most commonly injured organ following penetrating injury, seen in 14 patients (42.4%) while spleen was the most common in blunt injuries, seen in five patients (41.7%). The most common postoperative complication was surgical site infection, seen in four patients (8.9%). Two patients died giving a mortality rate of 4.4%. Conclusion: Gunshot to the abdomen is the most common cause of abdominal injury in UPTH. Serious campaign and legislation against militant and criminal activities would help to reduce the incidence.Keywords: Abdominal injuries blunt, penetrating, University of Port Harcourt Teaching Hospita

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Tuberculosis of the breast

BACKGROUND: Tuberculosis of the breast is a rare disease with non specific manifestations. It should be included in the differential diagnosis of breast lesions in immune compromised patients especially in tuberculosis endemic areas of the world.CASE REPORT: We report a case of a 31 year old HIV positive lady who presented with an ulcerated mass on the left breast of 3 months' duration. Incision biopsy of the lesion confirmed tuberculosis of the breast. Treatment with standard anti tuberculous drugs resultedIn complete resolution.CONCLUSION: A high index of suspicion is required to make a diagnosis of breast tuberculosis. The disease can be treated conservatively with standard anti tuberculous drugs while surgery is reserved for rare cases.KEY WORDS: Tuberculosis, breast, HI

Adult intestinal obstruction in Braithwaite Memorial Specialist Hospital, Port Harcourt, Nigeria: a 3-year review

Background: Globally, intestinal obstruction is a common cause of acute abdomen and the  pattern varies  from place to place. This is a report of the pattern of adult  intestinal obstruction in Braithwaite Memorial Specialist  Hospital (BMSH), Port Harcourt, Nigeria.Methods: A retrospective study of adult patients who presented with intestinal obstruction from 1st January 2008 to 31st December 2010. Their demographic data, duration  of symptoms, length of stay in hospital before surgery ,intra operative diagnosis and outcome of treatment were recorded and analyzed using the Statistical Package for Social Sciences (SPSS) version 11.  Results: A total of 38 patients were studied. The male to female ratio was 2.2:1 and the mean age was 53.4±2.6 years. Obstructed hernia was the commonest cause which was found in 50% of the patients, followed by adhesions in 28.9% of the patients. The average duration of symptoms before presentation was 6.9±1.2 days and overall mortality rate was 13.2%.Conclusion: Obstructed hernia still remains the commonest cause of intestinal obstruction among the studied population. However, its incidence is decreasing while that of adhesive intestinal obstruction is increasing.Keywords: Intestinal obstruction, Adult, Braithwaite Memorial Specialist Hospita

Predispositions of carcinoma of the breast: A review

BACKGROUND: Breast cancer is an ancient disease and the leading malignancy affecting women. The incidence is high in developed countries while it is low but increasing in developing countries. The aim of this review is to update and summarize the predisposing factors of breast cancer.METHODS: Literature review was conducted using goggle search engine and hinari. Selected papers were taken for further reference and using books from author's collection.RESULTS: The cause of breast cancer is unknown but predisposing factors have been identified to indicate increase susceptibility to developing the disease.CONCLUSION:Breast is the commonest malignancy affecting women worldwide.KEY WORDS:Breast, cancer, predisposing factor