Outcome of Ventriculoperitoneal shunt insertion at Myungsung Christian Medical Centre in Ethiopia

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Experience of Pericardiectomy in Tikur Anbessa University Hospital, Ethiopia

Background: Pericardiectomy is the only accepted curative treatment for improving cardiac haemodynamics in chronic constrictive pericarditis (CCP). This study was aimed at reviewing the experience and functional outcome of patients undergoing Pericardiectomy in Tikur Anbessa Hospital between January 1996 and December 2005.Methods: This was a retrospective Analysis done at the Thoracic Surgical unit, Tikur Anbessa Hospital, Department of Surgery, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia. During the period under review, 26 patients underwent Pericardiectomy for CCP. Medical records and operation theatre registers of 19 patients were retrieved and analysed.Results: Thirteen of the patients were males and six were females (M: F=2.2:1) The ages ranged from 14 to 42 years (mean 24.3±7). The duration of illness ranged between 2 and 36 months with a mean of 15.2±10.8). Diagnosis of constrictive pericarditis was based on the clinical picture of right sided heart failure along with chest roentgenogram, electrocardiogram, echocardiography and histological examinations. The most common presenting symptoms were dyspnea in 19 (100%) patients, abdominal discomfort in 14 (73.7%) and abdominal distension in 11 (68.4%) patients. Onphysical examination raised JVP, peripheral edema, hepatomegaly and ascites w 63.2%) patients, enlarged cardiac silhouette in 9 (47.4%) and pericardial calcification in 7 (36.8%). ECG showed low QRS voltage and T wave abnormality in 10 (52.6%) and 9 (42.1%) cases respectively. Pericardial thickening/calcification (52.6%), left ventricular septa motion abnormality (42.1%) and pericardial effusion (36.8%) were seen by echocardiography. The surgical approach was mainly median sternotomy in 15 (79%) patients, and the mean operation time was 112 (range 90-135±18.9) minutes. Fifteen (79%) patients had uneventful postoperative course. Two patients developed pneumonia and one a hydropneumothorax. There was one death in the immediate postoperative period. Long–term mortality of 10.5% was noted. Mean hospital stay and follow-up time were 14.3±5.3 (range 7-24) days and 12.8±6.9 (range 3-24) months respectively.Conclusion: Pericardiectomy can be performed without the use of CPB and with low mortality, and can result in an improved functional capacity in the majority of the patients

A 2-years description of traumatic brain injury admissions in Tikur Anbessa Specialized Hospital

Background: Traumatic brain injury (TBI) is a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.This study was aimed at describing the pattern of TBI at TASH during the two- years period.Methods: This is a hospital based retrospective study of patients with traumatic brain injury admitted to TASH in the period between September 2011 and September 2013. Patients’ demographic data, type and, mechanism of injury, Glasgow Coma Scale, length of hospital stays, complications and outcomes were recorded in a pre-formed questionnaire. Data entry and analysis carried out using SPSS version 20.0. The association between categorical variables was calculated using Chi-square test.Results: A total of 201 patients were included in the present study. Male-to-female ratio being 12.4:1 with and mean age 36.1. ± SD 16.2 years. Fight accidents were the major contributor of neurotrauma admissions and operations (53.2%). Seventy-One (35.3%) patients had depressed skull fracture followed by acute epidural hematoma seen in 51(25.4 %). Of the 165 operations performed for patients with head injury, 53 (26.4%) were craniotomy and evacuation of hematoma; 55 (27.4%) elevation of the depressed skull fracture, senior resident involvement as a first surgeon accounted for 79.1%.  83.1 % of the admitted patients’ have shown improvement on the time of discharge and 15.4% died while under neurosurgical care and 70.1% the patients had follow- up least onceConclusion: The preponderance of young patients with head injury involved in a fight injury and motor vehicle accidents has a large impact on society and on the hospital workloadKeywords: Traumatic Brain Injury, Tikur Anbessa Hospita

Outcomes of colostomy reversal procedures in two teaching hospitals in Addis Ababa, Ethiopia

Background: Colostomy creation and reversal procedures are common procedures, frequently performed by surgeons working in Ethiopia. Collected information is lacking concerning the outcome of colostomy reversal procedures in the country.Methods: A hospital based retrospective analysis was undertaken to describe the patterns of patients who underwent colostomy reversal, the timing of colostomy reversal, the frequently witnessed complications and the postoperative outcomes of patients admitted to the Tikur Anbessa and Saint Paul hospitals in Ethiopia for colostomy reversal procedure. Data was collected from 87 patients.Results: The majority of patients were males 70(82.8%). Seventy-six (87.4%) of the colostomies were situated in sigmoid colon and Hartmann’s colostomy was the most common type in 64 (60.6%). Most colostomies, 69 (79.3%), were created for non-trauma related disease conditions. The interval from the colostomy creation to colostomy closure varied from 8 weeks (2 months) to 72 weeks (18 months) with a mean interval of 28.2 weeks (6.6 months). Most, 71(81.6%) of the procedures were performed by consultant surgeons and the frequently used method was the two layered hand-sewn method in 72 (82.8%) patients. The overall incidence of complication was 17 (19.5 %). The rate of anastomotic leakage is 4(4.6 %). One patient who underwent sigmoid colostomy reversal done initially for gangrenous sigmoid volvulus died after anastomotic leak, making the overall mortality rate 1.1%. More complications occurred during Hartmann’s colostomy reversals. The morbidity rate for reversal performed within 16 weeks (4 months) of its creation was 3/28 (10.7%) for those within 16 to 24 weeks, 0/28 (0%); and for those after 24 weeks, 1/29 (3.4%).Conclusions and recommendations: Colostomy reversal is a commonly performed procedure in our setting and should be well mastered by consultant surgeons and residents under training. The associated morbidity and mortality are found to be low. It appears that delayed reversal is more advantageous and safer than early reversal procedures

Management and outcomes following emergency surgery for traumatic brain injury - A multi-centre, international, prospective cohort study (the Global Neurotrauma Outcomes Study).

Introduction:Traumatic brain injury (TBI) accounts for a significant amount of death and disability worldwide and the majority of this burden affects individuals in low-and-middle income countries. Despite this, considerable geographical differences have been reported in the care of TBI patients. On this background, we aim to provide a comprehensive international picture of the epidemiological characteristics, management and outcomes of patients undergoing emergency surgery for traumatic brain injury (TBI) worldwide. Methods and analysis:The Global Neurotrauma Outcomes Study (GNOS) is a multi-centre, international, prospective observational cohort study. Any unit performing emergency surgery for TBI worldwide will be eligible to participate. All TBI patients who receive emergency surgery in any given consecutive 30-day period beginning between 1st of November 2018 and 31st of December 2019 in a given participating unit will be included. Data will be collected via a secure online platform in anonymised form. The primary outcome measures for the study will be 14-day mortality (or survival to hospital discharge, whichever comes first). Final day of data collection for the primary outcome measure is February 13th. Secondary outcome measures include return to theatre and surgical site infection. Ethics and dissemination:This project will not affect clinical practice and has been classified as clinical audit following research ethics review. Access to source data will be made available to collaborators through national or international anonymised datasets on request and after review of the scientific validity of the proposed analysis by the central study team

Bladder Tumours at Tikur Anbessa Hospital in Ethiopia.

Background: Bladder cancer is the fourth to fifth most common cancer in men, and the eighth in women These t umors are commonest in the 50 to 70 year age group The aim of this study was to review the pattern and surgical management of bladder tumors at TAS in Ethiopia. Methods: A hospital based retrospective cross sectional analysis was conducted in TASH, department of surgery, Addis Ababa, Ethiopia. Patients’ medical records and operation theater registers of 97 patients operated upon for bladder tumors, between January2006 and December 2008 were analyzed. Results: Sixty patients were male and 37 female (M: F of 1.6:1). Their age ranged from 20 to79 years, with mean age of 49.73±1.5.Duration of symptoms ranged between 1and 48 months (mean 13.9). The most common presenting symptoms were hematuria in 89(91.8%). cystoscopy and sonographic examination of the bladder were the main modalities of investigation in the diagnosis of bladder tumors in 100% and 96.9% patients respectively. Histopathologically, 87(89.7%) and 10(10.3%) patients had malignant and benign bladder tumors respectively. Of the patients with malignant bladder tumors, 78 (80.4%) had TCC, 5(5.2% SCC, and 3 (3.1%) adenocarcinoma. Common patterns of bladder masses were papillary 77(79.7%), sessile or mixed 10(10.3%), and nodular 6(6.2%).Upon presentation, 66(74.7%) of patients had low-grade, whilst 20(23.0%) had high-grade disease, 85.5% of bladder tumors were nonmuscle invasive, while 14.9% were muscle invasive, and 2.4% metastatic. The commonest surgical technique employed for bladder tumor removal was TURBT in 80 (82.5%) patients. Forty-four (45%) of the patients had additional surgery such as repeated TURBT in 16(16.5%), cystectomy+ureterosigmoidostomy in 8(8.2%),radical cystectomy+neobladder in 5(5.2%), anti-incontinence procedure in 4(4.1%),partial cystectomy in 4(4.1% ) and redo cystectomy+sigmoid bladder in 4( 4.1%). In 83(85.6%) patients the postoperative course was uneventful, while 17(17.5%) developed immediate postoperative complications. Twelve developed late complications. There were 6(6.2%) deaths. Post operative hospital stay of 1-70 days (mean 12.1) and a follow up period ranging from 1 to 26 month (mean 3.7 months) were also the outcome of this review. Conclusion: The most common type of bladder cancer in TASH is TCC.Bladder tumor is more frequent in men than in women. The commonest procedure for bladder tumors was TURBT (p<0.001) which is the golden standared for non-muscle invasive tumors

Outcomes of Colostomy Reversal Procedures in Two Teaching Hospitals in Addis Ababa, Ethiopia

Background: Colostomy creation and reversal procedures are common procedures, frequently performed by surgeons working in Ethiopia. Collected information is lacking concerning the outcome of colostomy reversal procedures in the country. Methods: A hospital based retrospective analysis was undertaken to describe the patterns of patients who underwent colostomy reversal, the timing of colostomy reversal, the frequently witnessed complications and the postoperative outcomes of patients admitted to the Tikur Anbessa and Saint Paul hospitals in Ethiopia for colostomy reversal procedure. Data was collected from 87 patients. Results: The majority of patients were males 70(82.8%). Seventy-six (87.4%) of the colostomies were situated in sigmoid colon and Hartmann&apos;s colostomy was the most common type in 64 (60.6%). Most colostomies, 69 (79.3%), were created for non-trauma related disease conditions. The interval from the colostomy creation to colostomy closure varied from 8 weeks (2 months) to 72 weeks (18 months) with a mean interval of 28.2 weeks (6.6 months). Most, 71(81.6%) of the procedures were performed by consultant surgeons and the frequently used method was the two layered hand-sewn method in 72 (82.8%) patients. The overall incidence of complication was 17 (19.5 %). The rate of anastomotic leakage is 4(4.6 %). One patient who underwent sigmoid colostomy reversal done initially for gangrenous sigmoid volvulus died after anastomotic leak, making the overall mortality rate 1.1%. More complications occurred during Hartmann&apos;s colostomy reversals. The morbidity rate for reversal performed within 16 weeks (4 months) of its creation was 3/28 (10.7%) for those within 16 to 24 weeks, 0/28 (0%); and for those after 24 weeks, 1/29 (3.4%). Conclusions and recommendations: Colostomy reversal is a commonly performed procedure in our setting and should be well mastered by consultant surgeons and residents under training. The associated morbidity and mortality are found to be low. It appears that delayed reversal is more advantageous and safer than early reversal procedures

Experience of Pericardiectomy in Tikur Anbessa University Hospital, Ethiopia

Background: Pericardiectomy is the only accepted curative treatment for improving cardiac haemodynamics in chronic constrictive pericarditis (CCP). This study was aimed at reviewing the experience and functional outcome of patients undergoing Pericardiectomy in Tikur Anbessa Hospital between January 1996 and December 2005. Methods: This was a retrospective Analysis done at the Thoracic Surgical unit, Tikur Anbessa Hospital, Department of Surgery, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia. During the period under review, 26 patients underwent Pericardiectomy for CCP. Medical records and operation theatre registers of 19 patients were retrieved and analysed. Results: Thirteen of the patients were males and six were females (M: F=2.2:1) The ages ranged from 14 to 42 years (mean 24.3±7). The duration of illness ranged between 2 and 36 months with a mean of 15.2±10.8). Diagnosis of constrictive pericarditis was based on the clinical picture of right sided heart failure along with chest roentgenogram, electrocardiogram, echocardiography and histological examinations. The most common presenting symptoms were dyspnea in 19 (100%) patients, abdominal discomfort in 14 (73.7%) and abdominal distension in 11 (68.4%) patients. On physical examination raised JVP, peripheral edema, hepatomegaly and ascites were seen in the majority of cases. Chest x-ray revealed pleural effusion in 12 (63.2%) patients, enlarged cardiac silhouette in 9 (47.4%) and pericardial calcification in 7 (36.8%). ECG showed low QRS voltage and T wave abnormality in 10 (52.6%) and 9 (42.1%) cases respectively. Pericardial thickening/calcification (52.6%), left ventricular septa motion abnormality (42.1%) and pericardial effusion (36.8%) were seen by echocardiography. The surgical approach was mainly median sternotomy in 15 (79%) patients, and the mean operation time was 112 (range 90-135±18.9) minutes. Fifteen (79%) patients had uneventful postoperative course. Two patients developed pneumonia and one a hydropneumothorax. There was one death in the immediate postoperative period. Long term mortality of 10.5% was noted. Mean hospital stay and follow-up time were 14.3±5.3 (range 7-24) days and 12.8±6.9 (range 3-24) months respectively. Conclusion: Pericardiectomy can be performed without the use of CPB and with low mortality, and can result in an improved functional capacity in the majority of the patients