Minimally Invasive Surgery in Port Harcourt, Nigeria: Progress So Far.

Background The global practice of minimally invasive surgery (MIS) has progressed from basic to advanced procedures. Consequent to this, almost all surgical procedures can be performed through a minimally invasive technique. This study aims to audit the practice of MIS in healthcare facilities within a city in a developing country in Africa. Methods This is a multicenter, multispecialty, retrospective descriptive study of minimally invasive diagnostic and therapeutic surgeries performed in private and public health care facilities in Port Harcourt, Rivers State, Nigeria, conducted for a duration of 10 years, from January 2010 to December 2019. A proforma was distributed for completion to identified surgeons from the included study centers. Data on MIS, including types of procedures, time trends, frequency, category of surgery, and cost, were collated. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (IBM SPSS version 20.0, New York, USA). Results There were 5845 minimally invasive procedures performed during the study period, out of which only 92 (1.57%) were carried out in government-owned hospitals. Of these, 2570 were gynecologic (44.0%), 1873 were urologic (32.0%), 1300 were general surgeries (22.2%), 142 were pediatric surgeries (2.4%), and 3 (0.05%) were thoracic minimally invasive procedures performed within the 10-year period. The cost of procedures ranged from <$200 USD to >$2000 USD. The hospital stays ranged from <1 day to a maximum of 13 days. Conclusion The practice of MIS has made significant progress but has been primarily driven by the private sector. Subsidizing the cost of MIS procedures in government-owned hospitals is likely to improve patronage and improve the skills of surgeons.

Preservation of glanular cleft in the configuration of a vertical slit neomeatus in modified mathieu hypospadias repair.

BACKGROUND: The aim of this study is to review the results of modified Mathieu's repair in a single surgeon's series. The technique involved preserving the apical part of the glanular cleft including the lips, part of the un-formed glanular meatus in the reconstruction of a vertical slit neomeatus. The achievement of a vertical slit neomeatus was critically assessed. MATERIALS AND METHODS: A retrospective analysis was carried out for all cases of Mathieu's repair done by a single surgeon over the past 22 years (1995-2017). Inclusion criteria included all cases of coronal, subcoronal and distal penile hypospadias. Cases done as redo secondary Mathieu's procedure were also included irrespective of the type of primary procedure. RESULTS: A total of 97 cases fulfilled the inclusion criteria. 91 patients had a primary Mathieu's procedure. Six patients had a Mathieu's repair as a secondary operation. The complications included 4 fistulas (4.12%), 3 meatal retractions (3.09%) and 2 mild stenosis (2.06%). There were no breakdowns of the repair Ninety-four patients (96.90%) had a glanular vertical slit neomeatus. This included patients with a fistula and both patients with mild stenosis. All fistulas were successfully closed in a single attempt. Four patients (4.12%) had a slight splaying of the lower end of the meatus and three circular neomeatus (3.09%). Both cases of stenosis responded well to dilatation. CONCLUSION: Mathieu's repair is an old and time-tested technique used in surgery of distal hypospadias. With modification aiming to preserve the apical part of the glanular cleft adopted, a vertical slit neomeatus can be achieved readily as shown by our series and major complications appear rather uncommon.

Pattern, outcome and challenges of neonatal surgical cases in a tertiary teaching hospital.

BACKGROUND: Globally, the major causes of neonatal deaths are birth asphyxia, prematurity and severe infections. Little attention is paid to deaths contributed by surgically amenable conditions. This study was undertaken to determine the burden and types of surgical problems encountered in the neonatal period, their outcome and challenges encountered. PATIENTS AND METHODS: This was a retrospective study. The case notes of all neonates admitted into the newborn unit of our centre between April 2002 and March 2010 with surgical conditions were retrieved and the following information extracted: Sex, diagnosis, age at presentation, surgical intervention and outcome. RESULTS: Out of 7,401 neonates admitted within the study period, 460 (6.2%) had a surgical condition. Of the 1,657 babies that died within the same period, 196 (11.8%) of them were those with surgical conditions. Congenital abnormalities accounted for 408 (88.7%) of all the surgical cases. Intestinal obstruction 129 (31.6%), neural tube defects 101 (24.8%) and anterior abdominal wall defect 58 (14.2%) were the commonest congenital abnormalities, while fracture of the long bones following birth trauma 15 (28.8%) and perforated NEC 14 (26.9%) were the commonest acquired conditions. Surgery was performed in 166 (36.1%) and 98 (59%) had postoperative complications. Significantly, more deaths occurred in preterms than in term babies (P = 0.003) and in those delivered outside the hospital than in in-born babies (P = 0.02). The major cause of death was infection in 92 (47%). CONCLUSION: Neonatal surgical conditions contributed significantly to both neonatal admissions and overall neonatal mortality and thus highlights the need for investments in newborn surgical care in developing countries.

Pattern and survival of biliary atresia patients; experience in southern Nigeria.

BACKGROUND: Biliary atresia (BA) has been a challenge to surgeons worldwide. Beyond the revolutionary surgical technique popularised by Kasai, liver transplantation has added renewed hope in the long-term outcome. In Nigeria, where late presentation is very common, there is need to assess the long-term results of the treatment options available to us. AIM: We aimed to evaluate the presentation and management outcome of BA and the long-term survival of BA patients seen in our practice. MATERIALS AND METHODS: Cases of BA seen between January 2007 and December 2011 in three tertiary health facilities in South East Nigeria were included. Data obtained included age at presentation, clinical features, treatment offered and age at the time of death. Analysis was with the SPSS 17.0. RESULTS: Twenty four patients comprising 10 (41.7%) males and 14 (58.3%) females were included in the study. The mean age of presentation was 4.02 (±214) months; range 1.75-11.0 months. Fifteen (62.5%) patients had surgery while 9 (37.5%) received medical treatment only. The mean age at death was 14.2 (±8.1) months; range 2.5-30 months. CONCLUSION: BA poses a daunting challenge in our practice. Outcome of treatment is still discouraging. We identified late presentation, lack of facilities to make early diagnosis, lack of adequately trained manpower to manage these children and lack of post-operative care and support for patients as the major challenges in the management of BA children in our region.

Time of passage of First Stool in Newborns in a Tertiary Health Facility in Southern Nigeria.

INTRODUCTION: The first stool passed by the newborn, the meconium, is different from the ordinary stool both in its nature and its implication. Delayed or non-passage of the meconium may represent a number of clinical conditions. In this study, we sought to identify what should be considered delayed passage of meconium in our babies. AIMS AND OBJECTIVES: To investigate the timing of passage of first stool in Nigerian neonates and whether it is influenced by gender, birth weight, maternal age, and parity. MATERIALS AND METHODS: A PROFORMA WAS DESIGNED TO OBTAIN THE FOLLOWING DATA: Maternal age, parity, mode of delivery, Apgar score at 1 min, birth weight, gender, and interval between delivery and passage of first stool among normal newborn babies delivered at the obstetrics department of our center in August and September 2010. RESULTS: One hundred babies out of 393 delivered during the period of the study were included in the study. There were 63 (63%) males and 37 (37%) females. The interval between delivery and passage of meconium ranged from 0.5 to 54 h; mean, 16.2 (SD = 10.57). This was not influenced by gender, weight, maternal age, and parity. CONCLUSION: Non-passage of meconium beyond 48 h of life could be considered delayed. We therefore, recommend that clinicians should re-evaluate newborns, for hitherto unrecognized conditions, if after 48 h they have not passed first stool.

The place of spermatic fascia closure during open herniotomy in male children.

INTRODUCTION: There is currently no consensus about closing or otherwise of the spermatic fascia at herniotomy in children. This stems from lack of evidence to justify either stand, and most literatures are silent on this. This study is an effort to evaluate the place of closure of the spermatic fascia at hernia repair. AIM: To determine if there is advantage in closing the spermatic fascia over leaving it open during herniotomy in children. MATERIALS AND METHODS: Cases of inguinoscrotal hernia repaired by the same surgeon between July 2009 and June 2011 were randomly grouped into two; spermatic fascia closed (SC) and spermatic fascia open (SO) groups. They were assessed for operation duration, wound infection, scrotal hematoma, and scrotal edema post repair. The Data obtained was collated and analyzed using the SPSS 17.0. RESULTS: Seventy-six male children with unilateral complete inguinoscrotal hernia were included in this study. The overall mean duration of operation was 32.9 min (SD = 5.7); range 21-52 min. There was hematoma formation in 7 (17.9%) of the SC group and 9 (24.3%) of the SO group (P = 0.5). Scrotal edema occurred in 24 (64.8%) of the SO and 18 (46.2%) of the SC group (P = 0.3). No other complications were recorded during the period of study. CONCLUSION: There is no demonstrable advantage or disadvantage in closing the spermatic fascia at herniotomy for children. We conclude that the choice to close or not to close the spermatic fascia at herniotomy for children should be at the discretion of the individual surgeon.

Collaboration between paediatric surgery and other medical specialties in Nigeria.

BACKGROUND: The quality of service and success of patient care and research in most fields of medicine depend on effective collaboration between different specialties. Paediatric surgery is a relatively young specialty in Nigeria and such collaborations are desirable. This survey assesses the nature and extent of collaboration between paediatric surgery and other specialties in Nigeria. MATERIALS AND METHODS: This is a questionnaire survey carried out in November 2008 among paediatric surgeons and their trainees practising in Nigeria. Questionnaires were distributed and retrieved either by hand or e-mailing. The responses were then collated and analysed using the SPSS 17.0. RESULTS: Forty-seven respondents were included in the survey. Forty-five (95.7%) respondents thought that there was inadequate collaboration and that there was a need for an increased collaboration between paediatric surgery and other specialties. Anaesthesia, paediatrics and radiology are among the specialties where collaborations were most required but not adequately received. Collaboration had been required from these specialties in areas of patient care, training and research. Reasons for inadequate collaboration included the paucity of avenues for inter-specialty communication and exchange of ideas 33 (70.3%), lack of awareness of the need for collaboration 32 (68.1%), tendency to apportion blames for bad outcome 13 (27.7%), and mutual suspicion 8 (17%). CONCLUSION: There is presently inadequate collaboration between paediatric surgery and other specialties in Nigeria. There is a need for more inter-specialty support, communication, and exchange of ideas in order to achieve desirable outcomes.

Giant macroglossia with persistent nonocclusion in a neonate.

Excessive enlargement of the tongue, macroglossia, is a well-recognised clinical condition which can pose significant social and health problems. We report a case of a neonate who was born with a tongue grossly enlarged to the point of inability to feed and deformation of the jaw. Despite surgical reduction of the tongue to normal size, there was a persistent nonocclusion of the mouth, making sucking impossible. Physiotherapy did not help and our experience with neonatal jaw osteotomy is limited. We wonder if a prenatal aspiration of the tongue cyst could have forestalled this jaw deformation.

Childhood burns in south eastern Nigeria.

BACKGROUND: Burns injuries are recognized as a major health problem worldwide. In children and, particularly, in our environment where poverty, ignorance and disease are still high, they constitute significant morbidity and mortality. Previous studies on this topic in parts of Nigeria either lumped adults and children together or were retrospective. We, therefore, prospectively studied the current trends in burns in children. PATIENTS AND METHODS: This prospective study of burns spanned over a period of 18 months (June 2006-December 2007) at the Paediatric Surgery Units of the Imo State University Teaching Hospital, Orlu, and the Federal Medical Centre, Owerri, Imo State. Data were collected and analysed for age, sex, cause/type of burn, place of burn, presence or absence of adult/s, initial prehospital intervention, interval between injury and presentation, surface area and depth of burn and treatment and outcome. RESULTS: Fifty-three patients were studied, 31 (58.4%) were male and 22 (41.6%) were female (M:F = 1.4:1). Patients mostly affected were aged 2 years and below. The most common cause of burns was hot water in 31 (58.5%) patients. The vast majority of these injuries happened in a domestic environment (92.5%) and in the presence of competent adult/s (88.7%). Outcome of treatment was good: there were two (3.8%) deaths and 46 (86%) patients had complete recovery. CONCLUSION: Burns is still a major health problem among children in south eastern Nigeria. Fortunately, outcome of appropriate treatment is good. However, we think that poor safety consciousness among parents is a major predisposing factor. Public enlightenment on measures to ensure safe home environment may be necessary to avoid or limit childhood burns.

Recurrent lymphangioma: what are the treatment options?

This is a report of a rerecurrence of extensive lymphangioma involving the neck, chest and both breasts of a female. The patient has had recurrence of the lesion twice following surgical excision. Surgery alone seemed to be insufficient in this case. Could adjunct of sclerotherapy have made a difference at the first surgery? Faced with a third recurrence, what other options are left? We report this case to highlight the difficulties and dilemma in managing extensive lymphangiomas.

Childhood burns in South Eastern Nigeria

Background: Burns injuries are recognized as a major health problem worldwide. In children and; particularly; in our environment where poverty; ignorance and disease are still high; they constitute significant morbidity and mortality. Previous studies on this topic in parts of Nigeria either lumped adults and children together or were retrospective. We; therefore; prospectively studied the current trends in burns in children. Patients and Methods: This prospective study of burns spanned over a period of 18 months (June 2006-December 2007) at the Paediatric Surgery Units of the Imo State University Teaching Hospital; Orlu; and the Federal Medical Centre; Owerri; Imo State. Data were collected and analysed for age; sex; cause/type of burn; place of burn; presence or absence of adult/s; initial prehospital intervention; interval between injury and presentation; surface area and depth of burn and treatment and outcome. Results: Fifty-three patients were studied; 31 (58.4) were male and 22 (41.6) were female (M:F = 1.4:1). Patients mostly affected were aged 2 years and below. The most common cause of burns was hot water in 31 (58.5) patients. The vast majority of these injuries happened in a domestic environment (92.5) and in the presence of competent adult/s (88.7). Outcome of treatment was good: there were two (3.8) deaths and 46 (86) patients had complete recovery. Conclusion: Burns is still a major health problem among children in south eastern Nigeria. Fortunately; outcome of appropriate treatment is good. However; we think that poor safety consciousness among parents is a major predisposing factor. Public enlightenment on measures to ensure safe home environment may be necessary to avoid or limit childhood burns

Short hospital stay versus day-care Mathieu hypospadias repair.

OBJECTIVE: This study compared the outcome of Mathieu repair between patients who went home within 24 hours on catheter and dressing and patients who were managed in hospital for 48 hours and had their catheters and dressings removed before going home. PATIENTS AND METHODS: A retrospective study of Mathieu hypospadias repair performed by the same surgeon for 11 years. Outcome measures were catheter and dressing related problems/complications. RESULTS: Sixty five patients were included in the study; 43(66.2%) were managed in-hospital for the first 48 hours (Group A), while 22(33.8%) were managed as day-care cases (Group B). Complication rate was 6(14.0%) and 3(13.6%) respectively, with fistula rate of 2(4.7%) in Group A and 1(4.5%) in Group B. CONCLUSION: Day care Mathieu repair of hypospadias does not increase the occurrence of complications.