Scielo RSS <![CDATA[South African Journal of Surgery]]> http://www.scielo.org.za/rss.php?pid=0038-236120090001&lang=es vol. 47 num. 1 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>ROTEM analysis: A significant advance in the field of rotational thrombelastography</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000100001&lng=es&nrm=iso&tlng=es At the turn of the century, a significant advance in the rapidly expanding field of rotational thrombelastography (ROTEG), known at present as thrombelastometry or ROTEM analysis, was developed at the Ludwig-Maximillian University in Munich. The measuring unit is operated by a laptop computer. There are four temperature-controlled measuring channels in which the global assays not only detect coagulation factor defects but also platelet function, abnormal fibrinogen polymerisation, anticoagulant defects and hyperfibrinolysis. ROTEM has steadily increased in popularity, particularly because of its well-established application as a diagnostic aid at the point of care in the critical care situation. It also provides a useful guide in the choice of an appropriate therapeutic option in the bleeding patient, reducing costs by avoiding administration of costly component therapy such as fresh-frozen plasma, cryoprecipitate, platelet concentrates or antifibrinolytic agents. As well as being useful in monitoring anticoagulant therapy and the use of pharmacological agents, ROTEM is a valuable research tool in the field of hypercoagulability, fibrinolysis, factor XIII activity and the ultimate phases of the blood coagulation process. <![CDATA[<b>Risk of blood splashes to the eye during surgery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000100002&lng=es&nrm=iso&tlng=es BACKGROUND: With the advent of a new infectious era involving the HIV and hepatitis B and C viruses, concern has arisen about transmission of these viruses through ocular blood splashes during surgery. The purpose of the study was to determine the risk of ocular blood splashes to surgeons and their assistants during surgery. METHOD: Surgeons and assistants in several surgical disciplines were requested to wear facemasks with a transparent plastic visor. The visors were collected postoperatively and inspected for macroscopic and microscopic blood splashes. RESULTS: Fifty-nine per cent of the surgeons and assistants refused to wear facemasks with a visor. The incidence of blood splashes in those who participated was 45%. There was a trend for blood splashes to be more common during major surgery and during elective surgery. Surgeons and assistants were subject to similar risk. CONCLUSION: This study confirms the significant risk of ocular blood splashes during surgery, while also suggesting that both surgeons and assistants lack appreciation of the risk. <![CDATA[<b>Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography</b>: <b>A survey of South African endoscopists and review of the literature</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000100003&lng=es&nrm=iso&tlng=es BACKGROUND: Antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP) is controversial. We set out to assess the current antibiotic prescribing practice among South African endoscopists who perform ERCPs, and then reviewed international guidelines and relevant studies. METHODS: Our audit of South African endoscopists who perform ERCPs took the form of a questionnaire. For the literature review a Pubmed search was performed from 1978 to March 2008, and these findings were compared with the current practice in South Africa. RESULTS: No specific protocols were being implemented widely in South Africa, and there was a marked difference in the practice between surgical and medical gastroenterologists, with surgeons using antibiotics more often. There was also a wide spectrum of antibiotic types that were being used. The Pubmed search revealed only 7 randomised controlled trials, with little consensus between them as to the absolute indications for prophylactic antibiotics in ERCP. CONCLUSIONS: Guidelines on antibiotic prophylaxis for ERCP are based on poor evidence. Varied opinions on its indications in South Africa may reflect the situation in other countries as well. <![CDATA[<b>Laparoscopic repair of Morgagni diaphragmatic hernia in children</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000100004&lng=es&nrm=iso&tlng=es Minimal invasive surgery allows for excellent visualisation of the diaphragm, and is increasingly used for the repair of diaphragmatic hernias in children. This report describes laparoscopic repairs between 2001 and 2007 of four Morgagni hernias in children. All defects were treated successfully using the laparoscopic method, with no recurrences. The laparoscopic method is an ideal way to treat this type of diaphragmatic hernia. <![CDATA[<b>Preduodenal portal vein: A potential laparoscopic cholecystectomy nightmare</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000100005&lng=es&nrm=iso&tlng=es Variations of biliary anatomy are well described. Those of most relevance to the operative surgeon are the variations of the extrahepatic ducts and their relationships to the right hepatic artery and its branches. We describe another even rarer congenital anomaly of a preduodenal portal vein. Its embryological derivation and presentation are discussed to heighten awareness of its recognition and reduce the potential of a serious operative misadventure. <![CDATA[<b>36th Annual Meeting of the Surgical Research Society of Southern Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000100006&lng=es&nrm=iso&tlng=es Variations of biliary anatomy are well described. Those of most relevance to the operative surgeon are the variations of the extrahepatic ducts and their relationships to the right hepatic artery and its branches. We describe another even rarer congenital anomaly of a preduodenal portal vein. Its embryological derivation and presentation are discussed to heighten awareness of its recognition and reduce the potential of a serious operative misadventure. <![CDATA[<b>Tuberculosis resembling a malignant tumour</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000100007&lng=es&nrm=iso&tlng=es Variations of biliary anatomy are well described. Those of most relevance to the operative surgeon are the variations of the extrahepatic ducts and their relationships to the right hepatic artery and its branches. We describe another even rarer congenital anomaly of a preduodenal portal vein. Its embryological derivation and presentation are discussed to heighten awareness of its recognition and reduce the potential of a serious operative misadventure. <![CDATA[<b>Transverse colon tuberculosis presenting as colonic obstruction</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000100008&lng=es&nrm=iso&tlng=es Variations of biliary anatomy are well described. Those of most relevance to the operative surgeon are the variations of the extrahepatic ducts and their relationships to the right hepatic artery and its branches. We describe another even rarer congenital anomaly of a preduodenal portal vein. Its embryological derivation and presentation are discussed to heighten awareness of its recognition and reduce the potential of a serious operative misadventure.