Building a national hernia registry in South Africa: initial ventral hernia repair results from a diverse healthcare sector.

PURPOSE: The purpose of this paper was to introduce a new registry in a developing country by describing the demographics, management and 30-day outcomes of patients undergoing ventral hernia repair in the public and private healthcare sectors of South Africa. METHODS: This study was a retrospective review of a prospectively maintained hernia registry from the 1st of February 2019 to 29th of February 2020. RESULTS: 353 ventral hernia repair cases were recorded of which 47% were incisional hernias and the remainder were primary hernias. The median age was 54 years with even distribution of males and females. Half of the patients were obese with a median BMI of 31 kg/m2. The private sector performed 190 cases (54%) and the public sector 163 cases (46%). The public sector had more current smokers undergoing elective repairs, 28% vs 15%, p = 0.01 and performed more emergency repair cases, 21% vs 8%, p < 0.01. The majority (89%) of hernias were repaired with mesh and one-third were repaired laparoscopically. 30 day follow up was obtained in 30% of cases, the private sector had better follow up rates (42% vs 14%). CONCLUSION: Participation in the HIG (SA) registry was low with poor follow up over the first year. Ongoing prospective data capture on the HIG (SA) hernia registry will continue to provide further insights into hernia repair practices in South Africa.

A prospective evaluation of the predictive value of serum amylase levels in the assessment of patients with blunt abdominal trauma.

BACKGROUND: Less than ten percent of patients who sustain blunt abdominal trauma will suffer a significant intra-abdominal injury. Identifying these patients is difficult and this study reviews the results of routine serum amylase levels in a series of patients with blunt abdominal trauma. METHOD: All patients admitted, by the primary author from November 2010 to November 2012, with a diagnosis of blunt abdominal trauma were included. All these patients had a serum amylase level measurement performed on admission. RESULTS: One hundred and three patients were selected, with an age range from 3 to 68 years. There were 33 females and 70 males. Imaging was obtained in 47 patients (38 CT scans and 9 ultrasounds). Nine (19%) of the patients who were imaged required a laparotomy due to the radiological findings, and 38 (81%) of this sub group underwent successful conservative management. Eighteen patients had a laparotomy on clinical grounds. Intra-abdominal injuries were identified in 38 patients on imaging and/or at laparotomy. In five patients laparotomy did not reveal any injuries. The remaining 38 patients were admitted for serial abdominal observation. They were all discharged home and their symptoms resolved. The serum amylase level ranged from 34 U/L to 3 156 U/L, with a mean of 227 U/L (standard deviation 456 U/L). The levels were raised in 60 patients (58%) of whom 19 (32%) had a significant intra-abdominal injury. The serum amylase level was normal in 43 patients (42%), of whom 19 (44%) had a significant intra-abdominal injury. There were eight pancreatic injuries in the group (pancreatitis (1), pancreatic contusion (3), laceration (1), and transection (3). The serum amylase level was normal in two and mildly elevated in one of the patients with contusions (91, 92 and 129 U/L respectively), mildly elevated in the patient with pancreatitis (121 U/L), and significantly raised in the others (340 U/L with the pancreatic laceration; 3 156, 472, and 1 497 U/L in those with a transected pancreas). Four patients had a serum amylase level of greater than 1 000 U/L. Two of these had pancreatic injuries (3 156 and 1 497 U/L) and had hospital stays of six and sixteen days respectively. In the other two (3 042 and 1 454 U/L) no intra-abdominal injury was found.