Management of anorectal malformation: changing trend over two decades in Zaria, Nigeria

Background: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. Materials and Methods: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. Results: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5) and 106 (65.8) emergency operations in groups A and B; respectively. There were 61 (45.5) and 55 (34.2) elective operations in groups A and B; respectively. Regarding treatment; in group A; patients requiring colostomy had transverse loop colostomy; while in group B; sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5); anal transplant 5 (8.2); sacroabdominoperineal pullthrough (Stephen's operation) 6 (9.5) and others 21 (34.4). In group B; posterior sagittal anorectoplasty (PSARP) 46 (83.7); anal transplant 1 (1.8); posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6) and anal dilatation 6 (10.9) were done. Early colostomy-related complication rates were similar in the two groups (P 0.05). The overall late complication rate was 65.5in group A and 16.4in group B (P 0.05). The mortality was 25 (18.6) in group A compared to 17 (10.6) in group B (P 0.05). Conclusion: There have been significant changes in the management of anorectal malformations in this centre in the last two decades; resulting in improved outcomes

Computer Knowledge amongst Clinical year Medical Students in a Resource Poor Setting

Objective: To study the computer knowledge and desires of clinical year medical students at one of the oldest and largest medical schools in Nigeria. Design: A survey using validated structured questionnaires. Setting: Medical school of Ahmadu Bello University; Zaria; Nigeria.Subjects: Two hundred and thirty seven clinical year (4th; 5th and 6th years) medical students. Outcome measures: Computer knowledge; mode of acquiring computer knowledge; regular access to computer; desire for inclusion of computer training in curriculum. Results: One hundred twenty (50.6) students had knowledge of computer technology and it use. Of these; 108 (90) had no regularaccess to a computer and none owned a computer; only 32 (26.7) were sufficiently familiar with computer tools to perform advanced tasks; but 72 (60) were comfortable with word processing. Seventy two of the 120 students acquired their computer knowledge through self-learning efforts while 45 (37.5) attended short periods of formal training. Overall; 45.7of males and 64.5of females had computer knowledge. The main reason for lack of computer knowledge was lack of time and lack of access to a computer. Eighty percent of all students would like computer education to be included in medical school curriculum. Conclusion: Knowledge and use of computers amongst clinical year medical students in this setting is low. It is important that computer education be taught to the students to enhance their ability to use electronic information and communicate more effectively using computer resources

Surgical Drains: What the Resident Needs to Know

Background: Drains continue to be an important aspect of the management of surgical patients. Its use has been contentious. However; when indicated; it is important that drainage should be practiced with prudence. Methods: Publications from both local and international journals through Medline; pub med and Google search (June-August; 2007) were reviewed. Results: Drains remove content of body organs; secretion of body cavities and tissue fluids such as blood; serum; lymph and other body fluid that accumulate in wound bed after surgical procedures. Therefore; reduction of pressure to surgical site as well as adjacent organs; nerves and blood vessels; enhances wound perfusion and wound healing. Reduction of pain is also achieved. However; drains are now known not to be innocuous especially when they are poorly selected; wrongly used and left in situ for too long. Essentially; passive and active drains are the most practically useful type.Conclusion: Understanding the benefits and applications of surgical drains and tissue responses to constituent material is not only relevant to a practicing surgeon but would help to reduce the abuse of surgical drains

Surgical Drains: What the Resident Needs To Know

Background: Drains continue to be an important aspect of the management of surgical patients. Its use has been contentious. However; when indicated; it is important that drainage should be practiced with prudence. Methods: Publications from both local and international journals through Medline; pub med and Google search (June-August; 2007) were reviewed. Results: Drains remove content of body organs; secretion of body cavities and tissue fluids such as blood; serum; lymph and other body fluid that accumulate in wound bed after surgical procedures. Therefore; reduction of pressure to surgical site as well as adjacent organs; nerves and blood vessels; enhances wound perfusion and wound healing. Reduction of pain is also achieved. However; drains are now known not to be innocuous especially when they are poorly selected; wrongly used and left in situ for too long. Essentially; passive and active drains are the most practically useful type.Conclusion: Understanding the benefits and applications of surgical drains and tissue responses to constituent material is not only relevant to a practicing surgeon but would help to reduce the abuse of surgical drains

Morbidity of colostomy closure in children

The care of colostomy remains a burden to the family while complications associated with its construction and closure can be tasking to the surgeon. The aim of this study was to evaluate the outcome of colostomy closure in children in our setting. A prospective review of 31 consecutive children undergoing colostomy closure in a 6 year period. There were 18 (58.1%) boys and 13 (41.9%) girls, aged 5 months 13 years (median 3 years). The median duration of colostomy was 16 months [range, 5 days -8 years]. Indications for colostomy were anorectal malformations 16(51.6%), Hirschsprung/'s disease 10(32.3%) and others 5 (16.1%). The site of colostomy was sigmoid colon 21, transverse colon 9 and caecum one. The type of colostomy was divided 18(58.1%) and loop12 (38.7%). Intraperitoneal and extraperitoneal closure was performed in 27(87.1%) and 4(12.9%) patients, respectively. Thirteen (41.9%) patients had 16 postoperative complications; postoperative pyrexia 4 (12.9%), prolonged ileus 4 (12.9%), surgical site infection 2 (6.5%), septicaemia 2 (6.5%). Post operative complication rate was significantly associated with the status of the surgeon (p < 0.05) and duration of surgery (p < 0.05). The median duration of hospital stay was 8 days [range: 5-35 days]. There was no significant difference in hospital stay in patients with postoperative complication and thosewithout (p > 0.05). Morbidity following colostomy closure can be high, particularly when the procedure is performed by a junior trainee

Computer technology and the surgeon: what the resident needs to know

Background: Computer technology is now a well established resource in medicine and medical sciences. Surgery in developed countries has taken great advantage of this resource. This review is intended to highlight important aspects of computers in surgery and also encourages surgeons in Nigeria to acquaint themselves with its influences. Methods: Publications from local and international journals as well as standard surgical texts were reviewed. Results: The role of computers in surgery spans the areas of patient care, training, research, communication as well as surgical administration. Though a compliment to the surgeon, it has its problems including overwhelming information requiring careful scrutiny; computer fraud, hacking and viruses; copyright laws; the 'threat' of a well-informed patient population; and the risk of over dependence. Surgery in Nigeria and most of African is yet to maximize its benefits. Conclusion: The application of computers in surgery will in the near future make surgical knowledge and practice become more simplified and less time with increased productivity will be required even for highly technical procedures