An audit of the Day-of-Surgery Cancellation of Scheduled Surgical Procedures in Sagamu, Nigeria

Background: Timely performance of scheduled surgical procedures may be an indirect method of assessing the quality of surgical services in a hospital.Objective: This study aimed to determine the rate and the reasons for day-of-surgery cancellation of elective surgical procedures.Methods: A prospective study was conducted at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria to audit the type of surgery and the reasons for the cancellation of procedure among patients scheduled for elective surgical procedures.Results: A total of 1,324 patients were scheduled for elective surgeries during the period of audit and 268 (20.2%) were cancelled on the day of surgery. One hundred and seventy-four of the 268 (65.0%) cancellations were avoidable while 94 (35.0%) cancellations were unavoidable. The reasons for the cancellation of surgeries included patient-related factors (35.0%), unfavourable pre-operative clinical evaluation (31.0%), facility-based factors (28.0%) and surgeon-related factors (6.7%).Conclusion: The day-of-surgery cancellation rate was 20.2%, and the three leading causes of cancellation of elective surgeries in Sagamu included patient-related factors, unfavourable pre-operative clinical evaluation and inadequacies of hospital resources

Abdominal Masses in Children: A 10-Year Review

Background: Some childhood diseases present with abdominal masses alone or with other constitutional symptoms. The knowledge of the common causes of abdominal masses in children can assist in developing a protocol of management by clinicians.Objective: To describe the aetiology and presentation of abdominal masses in children.Methods: The hospital records of all cases of intra-abdominal masses in children managed between May 1998 and April 2008 were retrieved for analysis. Socio-demographic and clinical data were obtained and analysed using simple descriptive statistics.Results: A total of 93 children were included while those without clinical, radiological and intra-operative evidence of intra-abdominal masses were excluded from the study. There were 49 males (52.7%) and 44 (47.3%) females with male-to-female ratio of 1.1:1. The children were aged 1 day to 14 years; 15 (16.1%) were aged <3 years while 23 (24.7%), 27 (29%) and 14 (15.1%) each were aged 3-6 years, >6-9 years, >9-12 years and >12-14 years. The most common cause of abdominal masses was appendiceal mass/abscess in 29%, followed by hydronephrosis in 22.6% and nephroblastoma in 16.11%. The most common symptoms included abdominal pain (86.0%), fever (46.2%), vomiting (40.9%) and abdominal distension (32.2%). The mortality rate was 13%.Conclusion: Non-malignant conditions were mostly responsible for abdominal masses in children while abdominal pain, fever and vomiting were the leading presentations of abdominal masses in children

Experience with Lichtenstein Hernioplasty in Sagamu

Background: Newer methods have evolved to address the major drawback of the traditional methods of hernia repair. These emphasize the use of prosthetic materials to strengthen the posterior wall of the inguinal canal without tension. Although Lichtenstein hernioplasty, like other newer methods, is associated with low recurrence rates, it is not commonly used in our clinical setting.Objective: To review the outcome of Lichtenstein hernioplasty using polypropylene mesh in a resource-poor setting.Methods: The hospital records of patients who had Lichtenstein hernioplasty between the year 2004 and 2013 in a six-bed private surgical clinic and who were followed up over a two- to ten-year period, were studied. Demographic data, clinical features, operative findings and outcome measures like post-operative complications and recurrence rates, were recorded.Results: There were 62 patients (with 69 hernias) of which 2 were females with the age range of 12-84years. 50 hernias (72.5%) were of the inguinoscrotal type, 39 patients (63.0%) had right inguinal hernias, 5 (7.2%) hernias were obstructed and 8 (11.2%) hernias were recurrent. Six (9.7%) had emergency surgery, 46 (74.2%) had surgery under local infiltrations and 15 (24.2%) had spinal anaesthesia. Scrotal oedema (4.3%), haematoma (1.4%), and hydrocoele (1.4%) were the early complications recorded. One recurrence of hernia occurred in a patient who had repair of twice recurrent hernia. The mean duration of follow-up in years was 5 (S.D 2.5) years.Conclusion: Lichtenstein repair of inguinal hernia was a safe and effective procedure in the private clinical setting