Day case surgery in Nigerian children: influence of social circumstances of patients.

BACKGROUND: In order to achieve good results in day surgery and avoid pitfalls, selection of appropriate procedures and patients is required with attention given to the social circumstances among other considerations. The aim of this prospective study therefore was to evaluate the influence of the social circumstances of the patients on the performance of day surgery practice in our environment. METHOD: This was a prospective study carried out between April, 2004 and December, 2004, during which time 88 children aged 15 years and below with uncomplicated inguinal hernias were treated at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). The parents of the patients were interviewed about their social circumstances to determine the possibility of compliance with postoperative instructions. The data generated were then analyzed. RESULTS: More than half (54.6%) of the patients were from Ile-Ife. A few came from towns varying in distances from 65 to 80 km and spent an average time of 75 to 90 minutes to reach the hospital. Majority of the patients used public vehicles as a means of transport to and from the hospital in escort of their mothers. Despite the long distances and difficult traveling conditions, the parents still preferred day case surgery and were willing to obey postoperative instructions. CONCLUSION: From the findings in this study, day case surgery in children in our environment is feasible, despite the poor social circumstances of most of them. There is, however a compelling need to raise the standard of living of the people to enable them benefit maximally from day case surgery.

Epidemiology of external birth defects in neonates in Southwestern Nigeria.

BACKGROUND: There is paucity of information on the prevalence of birth defects in Nigeria, particularly in our setting. This study determined the epidemiology of external congenital anomalies in Southwest Nigerian children. PATIENTS AND METHODS: This was a stratified, randomized study of neonates presenting with external birth defects in Ife-Ijesha in Southwestern Nigeria, from August 2003 to July 2004. The neonates were screened for obvious congenital malformations by thorough physical examination. RESULTS: A total of 624 neonates were screened, 43 (6.9%) of whom had external birth defects (prevalence: 3.7 +/- 0.8% SD). There was a slight male preponderance (M: F= 1.4: 0.9). The overall prevalence rates of external congenital and major anomalies in Ife-Ijesa are 6.9 and 3.7% respectively. A higher prevalence for major malformations, 6.3%, was also found within the minority ethnic groups in these communities compared to the native majority. Musculoskeletal abnormalities are the most common anomaly, followed by those of abnormal external genitalia and head defects. CONCLUSION: Major malformations are more common amongst the minority settlers in this study, and musculoskeletal abnormalities were the most prevalent.

Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria.

BACKGROUND: Abdominal wounds following surgery for typhoid perforation are classified as dirty, with an infection rate of over 40%. To date, the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice, is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife, Nigeria, and advocates a multidisciplinary wound management protocol. PATIENTS AND METHODS: This is a retrospective study of children aged < 1-15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria, over a period of ten years. RESULTS: Thirty-two patients, 18 males and 14 females, in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8%) patients, while 19 (59.4%) patients had surgical site infections. Wound dehiscence, intraabdominal abscess, and faecal fistulas were the other complications documented in the study. CONCLUSION: Abdominal wounds of typhoid perforation, though classified as being dirty, can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs.

Evaluation of cosmetic appearance of herniotomy wound scars in African children: Comparison of tissue glue and subcuticular suturing.

AIM: To evaluate the cosmetic appearance of herniotomy wound scars closed using either the tissue glue or subcuticular suturing technique. MATERIALS AND METHODS: Prospective randomised control study; randomisation into tissue glue and suturing groups. Ethical clearance obtained. Cosmetic outcome were based on visual analogue scale by parents and Hollander wound evaluation scale by a Plastic Surgeon blinded to the wound closure method. RESULTS: Fifty one wounds were evaluated, 26 in the tissue glue group and 25 in the suturing group. Parents' evaluation using Visual Analogue scale (VAS) showed that in the suturing group, 17 parents (68%) gave a VAS of 8cm while six parents (24%) gave a score of 7cm. Two parents (8%) gave a score of 9cm. In the tissue glue group, 22 parents (84.6%) scored the scar of their children as 8 or 9cm on the VAS while four parents (15.4%) gave a score of 7cm. The median VAS was 8cm for both groups with a range of 7 to 9cm. The Chi- square test showed that the parents preferred tissue glue compared with subcuticular suturing (X2 = 7.90, P < 0.05). The Hollander Wound Evaluation Scale (HWES) used by Plastic Surgeon showed 21 herniotomy wounds (84%) had a score of 6 in the suturing group while four wounds (16%) had a score of 5. In the tissue glue group, 19 wounds (73%) had a score of 6, six wounds (23.1%) had a score of 5 and a patient (3.8%) had a score of 4. The median score is 6 for both groups. There was no statistically significant difference between both groups (X(2) = 1.481, P = 0.393). CONCLUSION: This study has shown that the cosmetic outcome of wound closure using the tissue glue technique and subcuticular suturing technique are similar.

Day Case Surgery in Nigerian Children: Influence of Social Circumstances of Patients

Background: In order to achieve good results in day surgery and avoid pitfalls; selection of appropriate procedures and patients is required with attention given to the social circumstances among other considerations. The aim of this prospective study therefore was to evaluate the influence of the social circumstances of the patients on the performance of day surgery practice in our environment. Method: This was a prospective study carried out between April; 2004 and December; 2004; during which time 88 children aged 15 years and below with uncomplicated inguinal hernias were treated at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). The parents of the patients were interviewed about their social circumstances to determine the possibility of compliance with postoperative instructions. The data generated were then analyzed. Results: More than half (54.6) of the patients were from Ile-Ife. A few came from towns varying in distances from 65 to 80 km and spent an average time of 75 to 90 minutes to reach the hospital. Majority of the patients used public vehicles as a means of transport to and from the hospital in escort of their mothers. Despite the long distances and difficult traveling conditions; the parents still preferred day case surgery and were willing to obey postoperative instructions. Conclusion: From the findings in this study; day case surgery in children in our environment is feasible; despite the poor social circumstances of most of them. There is; however a compelling need to raise the standard of living of the people to enable them benefit maximally from day case surgery

Epidemiology of external birth defects in neonates in South Western Nigeria

Background: There is paucity of information on the prevalence of birth defects in Nigeria, particularly in our setting. This study determined the epidemiology of external congenital anomalies in Southwest Nigerian children. Patients and Methods: This was a stratified, randomized study of neonates presenting with external birth defects in Ife-Ijesha in Southwestern Nigeria, from August 2003 to July 2004. The neonates were screened for obvious congenital malformations by thorough physical examination. Results: A total of 624 neonates were screened, 43 (6.9%) of whom had external birth defects (prevalence: 3.7 [+ or -] 0.8% SD). There was a slight male preponderance (M: F= 1.4: 0.9). The overall prevalence rates of external congenital and major anomalies in Ife-Ijesa are 6.9 and 3.7% respectively. A higher prevalence for major malformations, 6.3%, was also found within the minority ethnic groups in these communities compared to the native majority. Musculoskeletal abnormalities are the most common anomaly, followed by those of abnormal external genitalia and head defects. Conclusion: Major malformations are more common amongst the minority settlers in this study, and musculoskeletal abnormalities were the most prevalent

Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria

Background: Abdominal wounds following surgery for typhoid perforation are classified as dirty; with an infection rate of over 40. To date; the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice; is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife; Nigeria; and advocates a multidisciplinary wound management protocol. Patients and Methods: This is a retrospective study of children aged 1-15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria; over a period of ten years. Results: Thirty-two patients; 18 males and 14 females; in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8) patients; while 19 (59.4) patients had surgical site infections. Wound dehiscence; intraabdominal abscess; and faecal fistulas were the other complications documented in the study. Conclusion: Abdominal wounds of typhoid perforation; though classified as being dirty; can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs

The role of preoperative antibiotics in the prevention of wound infection after day case surgery for inguinal hernia in children in Ile Ife, Nigeria.

PURPOSE: Day case surgery for inguinal hernia had been an established practice of the Paediatric Surgery Unit, OAUTHC, Ile Ife for about two decades. In a retrospective review of the practice from the same center, a high incidence of postoperative wound infection was noted, which was attributed to the poor personal hygiene of the patients. This prospective study, therefore, was performed to evaluate the role of a single dose of preoperative antibiotic (using gentamicin) in the prevention of these wound infections after day case surgery for inguinal hernia in children. METHODS: This was a prospective study carried out over a period of 8 months from 11 April 2004 to 20 December 2004. During this period, 88 children aged from birth to 15 years were randomized into two groups of equal numbers to undergo elective inguinal herniotomy. The children in the test group received prophylactic intravenous gentamicin, 30 min before a groin crease incision was made, while those in the control group did not. All patients were subsequently followed up for 32 days for any evidence of a wound infection. RESULTS: There were 104 wounds in the ratio of 50:54 in the control and test groups, respectively. All 54 wounds of the children who received prophylactic gentamicin healed primarily and without complication. Five cases of wound infections occurred in the control group, giving an infection rate of 4.8% (P < 0.041). Staphylococcus aureus was the single pathogen isolated from the infected postherniotomy wounds and this organism was wholly sensitive to gentamicin. CONCLUSION: From the findings in this study, administration of preoperative gentamicin has a role in the prevention of wound infection after day case surgery for inguinal hernias in susceptible children. Preoperative intravenous gentamicin is therefore recommended as a prophylactic measure against wound infection after day case surgery for inguinal hernias in those children at risk of wound infection.

Malignant renal tumors in adults: a ten-year review in a Nigerian hospital.

This study was undertaken to determine the age, sex, pattern of presentation, histopathology and outcome of management of adult patients with malignant renal tumors (MRT) in Nigeria. Using hospital records, a retrospective study was performed covering the period between January 1997 and December 2006. A total of 18 adult patients had been diagnosed to have MRT during this period. Information extracted and analyzed included the age of the patient, sex, presentation, investigations, type of histopathology, management and duration of follow-up. The mean age of the study patients was 47.5 years (range 16-80 yrs). The male: female ratio was 13 : 5 and the mean duration of symptoms was 43.6 weeks (range 2-104 wks). Sixteen patients (88.9%) presented in advanced stage. Symptoms included loin pain in 17 (94.4%), abdominal swelling in 15 (83.3%), weight-loss in 13 (72.2%) and hematuria in nine (50.0%). Ultrasound and intravenous urography assisted greatly in making the diagnosis. Thirteen patients (72.2%) underwent radical nephrectomy, tumors were not resectable in two (11.1%) and three others (16.7%) were deemed unfit to undergo surgery. The average tumor mass removed at surgery was 1.884 Kg (range 0.48-3.82 Kg). Renal cell carcinoma (RCC) accounted for 13 of the tumors (72.2%). Surgical complications include primary-hemorrhage, septicemia and tumor recurrence in one patient each (7.6%). Morbidity and mortality rates were 7.6% each. The average post-operative hospital stay and follow-up duration were 9.3 days and 37.5 months respectively. Our study suggests that RCC is the major MRT in our community. Most cases still present late with loin pain and swelling, weight loss and hematuria. This late presentation and sarcomatous type of tumor have negative influence on prognosis. Radical nephrectomy is beneficial in operable, locally advanced, non-metastatic MRT.

Day case inguinal hernia surgery in Nigerian children: prospective study.

BACKGROUND: There has been an increase in day case surgery for children worldwide, but there have been few reports of the practice (most of them being retrospective) by many of the surgical sub-specialties in the sub-region. The aim of this study was to document our experience with day case inguinal hernia surgery in a developing economy. MATERIALS AND METHODS: This was a prospective study of uncomplicated inguinal hernias treated as day case at OAUTHC between April 2004 and December 2004. Data were collected and analysed. RESULTS: Eighty-eight patients were recruited into the study and none defaulted. There were 88 patients, (M:F = 16.6:1). A majority (n = 54) of the hernias occurred on the right side, while just a few (n = 18) occurred on the left. There were 5 cases of wound infections giving an infection rate of 4.8%. In all, the morbidity following day case inguinal hernia surgery was slight and no patient required readmission into the hospital. CONCLUSION: Day case inguinal hernia surgery in children is safe and well accepted by patients and parents alike. Health institutions in which children with inguinal hernias still queue for long periods for space on the operation list need to adopt day case surgery for inguinal hernia in order to forestall the risk of their obstruction.

Testicular Torsion : a Fifteen Year Review in a Nigerian Teaching Hospital

Aim and Objectives: To determine the prevalent age; presentation; duration of symptoms before intervention; and outcome of management of testicular torsion (TT) in our community. Design: A fifteen-year retrospective study. Setting: University Teaching Hospital. Materials and Method: Records of patients managed for TT; January 1992- Decem- ber 2006; were reviewed. Records of 91 out of 106 patients managed during the period were available for review. The age of patient; presentation; duration of symptoms; predisposing factors; interval between presentation and operation; and outcome of management were extracted and analyzed. Results: Ninety-one patients; mean age 20.1yrs (range 8-34) were reviewed. The average duration of symptoms at presentation was 26.7hrs (range 1.5- 168). The patients were mostly 74(81.3) students. All of them presented with scrotal pain; and 66(72.5) had scrotal swelling (Left: Right=1.8:1). Torsion was partial (180-270o) in 14(15.4); and complete (360o-1440o) in 77(84.6). Intra-scrotal anatomic abnormalities were observed in 77(84.6) patients. Testes were viable in 59(64.8) patients offered bilateral orchidopexy and gangrenous in 32(35.2) that had orchi- dectomy with contralateral orchidopexy. The average duration of hospital stay was 2.8days. Most of the patients 76(83.5) were lost to follow up within 3 weeks postoperative. Conclusion: TT occurs in patients aged 8-34yrs in our immediate community. Presentation is late and most patients 77(84.6) have predisposing congenital abnormalities. There is a need for increase awareness by the general public and the health personnel's of the danger posed by delay in treating TT. Where doubts exist; early scrotal exploration should be the investigation and intervention of choice to prevent irreversible damage to the germ cells