Inguinal hernia repair in Nigeria: a survey of surgical trainees.

PURPOSE: Africa's inguinal hernia burden is high with large numbers of untreated hernias. Mesh repair is recommended in developed countries, but the best repair in developing countries is unknown. Little is known about knowledge and practice of surgeons in Nigeria performing inguinal hernia repair. Surgical trainees can provide this information. METHODS: A questionnaire-based survey was administered to surgical trainees from all over Nigeria who had attended the West African College of Surgeons' integrated revision course in Jos, on their practice and recommendations concerning elective inguinal hernia repair. RESULTS: One hundred and nine surgical trainees (90.8%) consisting of 78 (71.6%) registrars and 30 (27.5%) senior registrars responded. Thirty-two (29.4%) used antibiotics routinely for inguinal hernia surgery. Ceftriaxone was the most widely used antibiotic (45%). Ninety-two (84.4%) respondents will perform this surgery as day case. Forty (36.7%) respondents stated modified Bassini repair as their preferred method of repair. Mesh repair was recommended by 93 (85.3%) respondents while 65 of 100 respondents (65%) recommended laparoscopic surgery. Of 103 respondents, 93 (90.3%) had performed inguinal hernia repair and 34 (33%), mesh repair. For 56 (51.4%) respondents, the most difficult part of open hernia surgery was sac dissection. CONCLUSIONS: Surgical trainees in Nigeria perform more tissue-based inguinal hernia repair than mesh but majority would recommend both mesh repair and laparoscopic surgery. Majority found sac dissection as the most difficult part of open hernia surgery.

Tension pneumoventricle: A report of two cases.

Pneumocephalus is often a complication of head trauma and cranial surgeries. Massive intraventricular pneumocephalus is an uncommon entity. We report the cases of two patients presenting same day with a clinical diagnosis of open head injury following separate road traffic accidents whose computed tomography (CT) brain images confirm skull base and vault fractures with massive pneumocephalus and tension pneumoventricles. CT scan remains invaluable in proper evaluation of head injury, and its complications for early and appropriate intervention toward reducing morbidity and mortality.

Experience in the management of the mass casualty from the January 2010 Jos Crisis.

BACKGROUND: On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident. OBJECTIVE: To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010. METHODOLOGY: We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010. RESULTS: A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point. CONCLUSION: This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.

Endoscopic resection of an esophageal leiomyoma with overlying dysplasia without specialized equipment.

Leiomyomas are rare benign esophageal tumors. Association of this subepithelial lesion with abnormal epithelium is rarer. Endoscopic mucosal resection is an alternative to surgery for removing suitable mucosal and submucosal lesions from the gastrointestinal tract. This procedure is seldom performed in developing countries due to limited equipment and expertise. We describe a case of esophageal leiomyoma with overlying dysplasia in the mid esophagus that was completely removed endoscopically in a developing country without the standard accessory equipment. Traditional thoracotomy would have been associated with higher cost and morbidity.

Laparoscopic surgery in a Nigerian teaching hospital for 1 year: challenges and effect on outcomes.

BACKGROUND: Laparoscopic surgery has developed rapidly in developed nations within a relatively short time to become a major method of treating surgical diseases, with increasing application across specialties. However this is not the situation in developing countries like Nigeria. This may be as a result of local challenges to the performance of laparoscopic procedures. It is important to identify what these challenges are. METHODOLOGY: We prospectively studied problems encountered during the performance of laparoscopic procedures, and their effects on the procedure in a Nigerian teaching hospital for a year. Demographic information, laparoscopic procedure, problems encountered and effect on procedure, and outcomes were analyzed using descriptive statistics. RESULTS: Our sample consisted of 21 patients who had laparoscopic procedures performed by the authors; 12 (57%) were therapeutic procedures. Average age was 34.1 years (range 18-50 years) and majority (61.9%) were female. Problems encountered included non functioning/malfunctioning equipment (76.2%), power outages (33.3%), and dead light source bulbs (14.3%). There were 5 (23.8%) conversions to open surgery as a result of problems encountered; another conversion (4.8%) was to tackle an ascending colon tumour discovered at laparoscopy. CONCLUSION: The performance of laparoscopic procedures in a Nigerian public hospital is affected largely by inadequate and often malfunctioning equipment, and attention to these may reduce rates of conversion to open surgery.

Laparoscopic general surgery--the journey so far.

BACKGROUND: Laparoscopic surgery has evolved in a relatively short time to become a popular and integral part of the surgical armamentarium. An overview of developments which have taken place since its inception is presented. METHODS: The PubMed database was searched for all English language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. CONCLUSION: Laparoscopic surgery has developed rapidly, initially from a basically diagnostic procedure to a therapeutic one which is currently challenging time-honoured traditional methods of surgery. Technological advancements and enthusiasm as well as the desire for scar less surgery appear to be poised to push even further the frontiers of this discipline.

Inguinal hernia: the quest for the best repair.

BACKGROUND: Inguinal hernia repair may be the most common procedure in general surgery. Many repairs have been described but none appears completely satisfactory. A brief look at the popular methods of repair from the traditional tissue approximation to the current mesh-based techniques is presented. METHODS: The PubMed database was searched for all English language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. CONCLUSION: The history of inguinal hernia is a rich one, from the traditional tissue approximation techniques to the current mesh-based repairs which are now performed as open or laparoscopic procedures. Recurrent rates have reduced but are still a problem. Perhaps the perfect repair remains elusive because the problem may also be with patients' collagen not just the surgical procedure.

Laparoscopic General Surgery - The Journey So Far

Background: Laparoscopic surgery has evolved in a relatively short time to become a popular and integral part of the surgical armamentarium. An overview of developments which have taken place since its inception is presented. Methods: The PubMed database was searched for all eng language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. Conclusion: Laparoscopic surgery has developed rapidly; initially from a basically diagnostic procedure to a therapeutic one which is currently challenging time-honoured traditional methods of surgery. Technological advancements and enthusiasm as well as the desire for scar less surgery appear to be poised to push even further the frontiers of this discipline

Inguinal Hernia:The Quest for the Best Repair

Background: Inguinal hernia repair may be the most common procedure in general surgery. Many repairs have been described but none appears completely satisfactory. A brief look at the popular methods of repair from the traditional tissue approximation to the current meshbased techniques is presented. Methods: The PubMed database was searched for all eng language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. Conclusion: The history of inguinal hernia is a rich one; from the traditional tissue approximation techniques to the current mesh-based repairs which are now performed as open or laparoscopic procedures. Recurrent rates have reduced but are still a problem. Perhaps the perfect repair remains elusive because the problem may also be with patients' collagen not just the surgical procedure