Registrar perceptions on general surgical training in South Africa: a report by the South African Society of Surgeons in Training (SASSiT)

Background: Surgical training varies significantly amongst universities within the same country. This trend is reflected in South Africa and provides an opportunity for innovation to improve the quality of general surgical training. Objective: To assess the perceptions of South African general surgery registrars regarding surgical training.Method: A prospective descriptive study was performed by means of a confidential questionnaire distributed to general surgical registrars at all eight training centers in South Africa. Participants were asked to give comments regarding adequacy of formal academic teaching, level of supervision during surgical procedures, exposure to and training in minimally invasive surgery (MIS), and preparation for examinations. Descriptive statistics were generated with Microsoft Excel. Ethics clearance was obtained from the University of the Witwatersrand Human Research Ethics Committee. Results: Of 200 questionnaires distributed 105 (52.5%) were returned. 44% (105/241) of all registrars from six training institutions participated. 89.5% (94/105) of respondents reported that they attended less than six hours of formal academic teaching per week and 71.4% (75/105) indicated that their institution offered less than six hours of formal academic teaching per week. 76.2% (80/105) of respondents regarded lack of protected academic time as the greatest obstacle to their surgical training and 95.2% (99/105) reported that clinical responsibilities prevented them from attending formal academic teaching regularly. Overall, only 31.4% (33/105), 41.9% (44/105) and 37.1% (39/105) were satisfied with the amount of formal academic teaching, level of supervision during theatre procedures and exposure to minimally invasive surgery respectively. Lack of resources and lack of appropriate skills were identified as a hindrance to MIS training by 47.6% (50/105) and 28.6% (30/105) of respondents respectively. Conclusion: Surgical registrars are dissatisfied with the amount of formal academic teaching and protected academic time, level of supervision in theatre and their exposure to MIS. These challenges compromise trainees' ability to practice independently after qualification. Numerous interventions are necessary and possible to address these challenges

Demographic and histological subtypes of Hurthle cell tumours of the thyroid in a South African setting

Background: Report of Hurthle cells following fine needle aspiration cytology from a thyroid nodule raises possibility of Hurthle cell carcinoma (HCC), which is a distinct entity and accounts for 3­10% of thyroid malignancies. Aim: To determine if there are demographic and histopathological features which may be used to differentiate HCC from Hurthle cell adenoma (HCA). Methods: Histopathology records of patients who had thyroidectomy from January 2001 to October 2015 were reviewed. Data retrieved included indications for thyroidectomy, patients' demographics, histology and preoperative FNAC results. Results: At total of 2641 records were reviewed of which 25.6% (676/2641) were for neoplasms. 15.8% (107/676) of the neoplasms were Hurthle cell neoplasms (HCNs) and 25.2% (27/107) of HCNs were HCCs. 77.2% (71/92) of HCAs and 77.8% (21/27) of HCCs were from female patients. Preoperative FNAC results were available for 54.2% (58/107) and were suspicious of HCN in 12.1% (7/58). Average tumour size for HCCs and HCAs was 4.9 +/- 2.7 cm and 3.5 +/- 2.0 cm, respectively. The difference was statistically significant with a p-value of 0.016. The risk of malignancy increased from 11.1% in HCNs less than 1 cm to 53.8% for tumours which were greater than 4 cm in diameter. Conclusion: HCNs are more common in females. The likelihood of HCC rises as the size of the HCN increases. Malignancy rate exceeds 50% for HCNs which are greater than 4 cm in diameter

Changing Pattern of Incidence; Aetiology and Mortality from Acute Pancreatitis at Kalafong Hospital; Pretoria; South Africa;1988-2007: A Retrospective Evaluation

Background: Literature reports from Western countries suggest an increasing incidence of acute pancreatitis (AP) and changing pattern over the past two decades. The aim of thisstudy was to document the incidence; aetiology and mortality from AP over two decades and to examine any emerging trends.Methods: A retrospective study of all confirmed cases of AP admitted over a 20-year period to thesurgical department was performed. Patients' demographics; year of admission;number of attacks; aetiology; management and outcome were entered on a specialstudy proforma.Results: Altogether 707 attacks of AP (M: F; 5.7: 1) were recorded. The proportion of gallstone APincreased (3.1to 12.7) and that of alcohol-related AP decreased (84to 67.6). Alcohol was themain aetiological factor for AP. Drugs; hyperlipidaemia; human immunodeficiency virus (HIV) andendoscopic pancreatography-related AP increased in the second decade. The in-hospital mortality rateduring the respective periods was 6.5and 3.1.Conclusion: Gallstone AP increased during second decade from more Caucasian admissions and increased gallstones among Blacks. The reduced mortality was attributed to changing trends in the nature and aetiology of AP recorded; heightened awareness of the condition and improved management