Scielo RSS <![CDATA[South African Journal of Surgery]]> http://www.scielo.org.za/rss.php?pid=0038-236120110004&lang=en vol. 49 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>The handless surgeon: 29th D. J. du Plessis Lecture of the Surgical Research Society of Southern Africa, delivered in Pretoria, June 2011</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Towards a national burns disaster plan</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400002&lng=en&nrm=iso&tlng=en The International Society for Burns Injuries (ISBI) has published guidelines for the management of multiple or mass burns casualties, and recommends that 'each country has or should have a disaster planning system that addresses its own particular needs.' The need for a national burns disaster plan integrated with national and provincial disaster planning was discussed at the South African Burns Society Congress in 2009, but there was no real involvement in the disaster planning prior to the 2010 World Cup; the country would have been poorly prepared had there been a burns disaster during the event. This article identifies some of the lessons learnt and strategies derived from major burns disasters and burns disaster planning from other regions. Members of the South African Burns Society are undertaking an audit of burns care in South Africa to investigate the feasibility of a national burns disaster plan. This audit (which is still under way) also aims to identify weaknesses of burns care in South Africa and implement improvements where necessary. <![CDATA[<b>Clinical profile of assault burn victims: A 16-year review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400003&lng=en&nrm=iso&tlng=en OBJECTIVE: Assaults by burning occur infrequently and are related to the social circumstances and demographics of each population. We aimed to explore the mechanisms, complications, morbidity and mortality associated with assault burn injuries admitted to the Burns Intensive Care Unit of Merheim University Hospital in Cologne. METHODS: A retrospective data analysis of a consecutive series of 1 243 burn patients between 1989 and 2004. The cohort was divided into two groups: AG (assault group) and CG (control group). Analyses were controlled for clinical data, treatment and outcome of all patients involved. RESULTS: Forty-one patients with assault burn injuries were identified during the study period. Compared with the general burn population (CG), the AG had a significantly larger size of third-degree burns (p=0.047), a higher incidence of inhalation injury (p<0.001) and a longer intubation period (p=0.047). Patients in the AG were also more likely to undergo escharotomy (p=0.013) and to receive antibiotics on admission (p=0.016). The mortality rate was higher in the AG than in the CG (26.8% v. 19.9%), but this difference was not significant. CONCLUSIONS: Burned patients who were victims of assault tend to have more severe injuries than the general burn population. These injuries are not only physical, and their management requires a multidisciplinary approach to improve outcome. <![CDATA[<b>Rectocele and anal sphincter defect - surgical anatomy and combined repair</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400004&lng=en&nrm=iso&tlng=en This study reports on the surgical anatomy and technique of perineal repair in a selected group of parous women with faecal incontinence and/or difficulty in evacuation. Anal sphincter muscle damage is usually attributed to childbirth, although most of these women present for the first time years later. Consecutive patients with the above symptoms were examined clinically and then investigated with a perineal ultrasound scan. During the perineal operation for repair, further investigation by transillumination and measurements with calipers were done in 50 patients. All patients received routine postoperative care, and were followed up for at least 6 months. From 1995 to 2009 a total of 117 patients, all female, underwent perineal repair by a single surgeon. The age range was 24 - 82 years. In the last 50 consecutive patients, transillumination was positive prior to repair in all, and negative after. The average thickness of the rectocele wall was 2.4 mm prior to repair and 4.8 mm after. In all patients, a rectocele was found in conjunction with the anal sphincter defect. The results of combined repair were satisfactory in 109 of 117 patients (93%). <![CDATA[<b>Long-term outcomes after laparoscopic total mesorectal excision for advanced rectal cancer</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400005&lng=en&nrm=iso&tlng=en PURPOSE: The aim of this study was to evaluate the long-term outcomes of laparoscopic total mesorectal excision in the treatment of advanced rectal cancer in a randomised population. METHODS: Between 2001 and 2005, 125 patients (70 males, 55 females, mean age 55.5 (standard deviation (SD) 11) years, range 25 - 81 years) with rectal cancer were evaluated and prospectively followed up in our hospital (mean follow-up 42 (SD 23 months, range 5 - 113 months). The 5-year overall survival rate, 5-year disease-free survival rate and recurrence rate were analysed. RESULTS: There were 54 cases of cancer defined as UICC stage II and 68 cases defined as stage III. Of these cases, 22 were localised to the upper rectum, 50 to the middle rectum and 53 to the lower rectum. The 5-year overall survival rates were 71.3% and 51% among the stage II and the stage III patients, respectively. The 5-year disease-free survival rates were 59.2% and 45.4% among the stage II and the stage III cancer patients, respectively. The overall recurrence rate was 16.8% (local recurrence rate 11.25%, distant recurrence rate 8%). Multivariate analysis showed that age and size were independent predictors of overall survival (p=0.006 and p<0.001 for stage II and stage III patients, respectively). CONCLUSIONS: Our results suggest good long-term outcomes of laparoscopic surgery in the treatment of rectal cancer. However, this technique should be used with caution in older patients and patients with larger tumours. <![CDATA[<b>Intestinal inflammatory myofibroblastic tumour</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400006&lng=en&nrm=iso&tlng=en BACKGROUND: Inflammatory myofibroblastic tumours (IMFTs) are rare tumours characterised by nosologic, histogenetic and aetio-pathogenetic controversy and variable clinicopathological features. We report our experience with intestinal-IMFTs (I-IMFTs) that have been reported mainly as single case reports to date. METHODS: Five patients with I-IMFTs, identified between 2005 and 2008, formed the study cohort. The clinicopathological features were obtained from departmental and hospital records. RESULTS: The median patient age was 13 years. While 4 patients presented with symptoms and signs of intestinal obstruction, one IMFT was an incidental finding at laparotomy for trauma. Three I-IMFTs were located in the small bowel and 2 in the colon. Complete resection with end-to-end anastomoses was performed. The gross morphology included 1 polypoid myxoid tumour that served as a lead point for an intussusception, 3 multinodular whorled masses and 1 firm circumferential, infiltrative tumour. Microscopically, all tumours had typical features of IMFT with variable expression of ALK-1, a low proliferation index and tumour-free resection margins. All patients had an uneventful recovery. One patient was lost to further follow-up. Four patients were well, without local recurrence or metastases at 6 months to 3 years. CONCLUSIONS: Surgery with tumour-free resection margins is the gold standard of care of adult and paediatric I-IMFTs. Heightened recognition of I-IMFT, albeit rare, as a cause of intestinal obstruction, including intussusception, is necessary for pre-operative suspicion of I-IMFT. <![CDATA[<b>Variations in levels of care within a hospital provided to acute trauma patients</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400007&lng=en&nrm=iso&tlng=en INTRODUCTION: Caring for trauma patients is a dynamic process, and it is often necessary to move the trauma patient around the hospital to different locations. This study attempted to document the quality of observations performed on acute trauma patients as they moved through the hospital during the first 24 hours of care. METHODOLOGY: This study was a student elective and was undertaken at Grey's Hospital, Pietermaritzburg. A third-year medical student was assigned to follow acute trauma patients throughout the hospital during the first 24 hours after admission. This single independent observer recorded the frequency with which vital signs were recorded at each geographical location in the hospital for each patient. A scoring system was devised to classify the quality of the observations that each patient received in the different departments. The observer recorded all the geographical movements each patient made during the first 24 hours after admission. RESULTS: Fifteen patients were recruited into this study over a 4-week period. There were 14 adult males (average age 28 years, range 18 - 56 years) and a 7-year-old girl in the cohort. There were significant differences in the quality of the observations, depending on the geographical location in the hospital. These variations and differences were consistent in certain locations and highly variable in others. Observations in the intensive care unit (ICU) and operating theatre were uniformly excellent. In the radiology suite the level of observations was universally poor. In casualty and the wards there was great variability in the level of observation. A total of 45 distinct geographical visits were made by the study cohort. Each patient made an average of 3 (range 2 - 5) visits during their first 24 hours after admission. All patients attended casualty, and there were 11 patient visits to the ward, 10 to radiology, 4 to ICU and 5 to theatre. CONCLUSION: Significant variations exist in the level of observations of vital signs between different geographical locations within the hospital. This is problematic, as acute trauma patients need to be moved around the hospital as part of their routine care. If observations are not done and acted upon, subtle clinical deterioration may be overlooked and overt deterioration may be heralded by a catastrophic event. <![CDATA[<b>Missed injury - decreasing morbidity and mortality: A literature review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400008&lng=en&nrm=iso&tlng=en This brief literature review examines the causes of missed injury, the typical clinical pictures that are associated with missed injury and techniques and procedures to help avoid missing injury in the light of the recent literature, while highlighting the cost implications for clinicians. <![CDATA[<b>Cystic lesions of the biliary tree: Proposal for a revised classification system</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400009&lng=en&nrm=iso&tlng=en This brief literature review examines the causes of missed injury, the typical clinical pictures that are associated with missed injury and techniques and procedures to help avoid missing injury in the light of the recent literature, while highlighting the cost implications for clinicians. <![CDATA[<b>Sigmoid volvulus in pregnancy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400010&lng=en&nrm=iso&tlng=en A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality. <![CDATA[<b>Handbook of Trauma</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400011&lng=en&nrm=iso&tlng=en A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality. <![CDATA[<b>Is transdermal nitroglycerin application effective in preventing and healing flap ischaemia after modified radical mastectomy?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400012&lng=en&nrm=iso&tlng=en A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality. <![CDATA[<b>Bilharzia of the breast masquerading as a breast skin papilloma in a pregnant woman</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400013&lng=en&nrm=iso&tlng=en A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality. <![CDATA[<b>Biliary fistula in AIDS-related abdominal tuberculosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400014&lng=en&nrm=iso&tlng=en A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality. <![CDATA[<b>Is routine drainage after total thyroidectomy necessary?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400015&lng=en&nrm=iso&tlng=en A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality. <![CDATA[<b>Cyril Harold Wolpe: (1925 - 26 July 2011)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400016&lng=en&nrm=iso&tlng=en A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality. <![CDATA[<b>Nathan Cirota: (8 December 1944 - 6 June 2011)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400017&lng=en&nrm=iso&tlng=en A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality. <![CDATA[<b>South African Society of Endoscopic Surgeons Conference: 20 - 23 October 2011, Drakensberg Champagne Sports Resort, KwaZulu-Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000400018&lng=en&nrm=iso&tlng=en A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality.