South African Journal of Surgery最新文献

Summary: Median arcuate ligament syndrome (MALS) is a rare vascular compression disorder of the celiac artery, typically presenting with postprandial abdominal pain and weight loss. We report a 44-year-old woman with chronic postprandial epigastric pain and nausea, but without weight loss. Her medical history included hypothyroidism, which may have masked this classical feature. Duplex ultrasonography revealed hemodynamically significant celiac artery compression with elevated peak systolic velocities. The patient underwent successful laparoscopic decompression of the median arcuate ligament, with sustained resolution of symptoms. This case highlights the diagnostic challenges of atypical MALS presentations and emphasises duplex ultrasonography as a valuable tool.

Background: Abdominal emergencies are common and often require emergency surgery with mortality between 14% and 20%. Strategies have been introduced to reduce complications after emergency abdominal surgery, but resources in low and middle-income countries (LMICs) countries are limited. There is a paucity of data on emergency abdominal surgery from the developing world. We aim to audit the mortality and morbidity of emergency laparotomies in the unique South African public health care system. Secondary endpoints were to identify system shortfalls to allocate quality improvement programmes to improve outcomes of acute abdominal emergencies.

Methods: A retrospective review of a prospectively maintained database was conducted on emergency surgical procedures at all the public-funded health facilities in the Cape Town Metro West, South Africa.

Results: There were 1471 patients who required emergency abdominal operations. The mean age was 36.7 (standard deviation (SD) = 15.95) with a male preponderance of 64.7%. The median duration of symptoms was 2 days (interquartile range (IQR) = 0-84). Overall 30-day mortality was 8% (n = 118) where 0.95% (n = 14) demised within 24 hours post-surgery. Factors associated with mortality were higher ASA class, higher Eastern Cooperative Oncology Group (ECOG) score, increasing age, higher Codman score, length of the procedure, presence of consultant during procedure, faecal contamination, contamination of more than one abdominal quadrant and use of inotropes intraoperatively.

Conclusion: Despite resource constraints, patients presenting with abdominal emergencies requiring emergency abdominal surgery received care with mortality outcomes comparable to reported literature. This audit can be used as guide to identify healthcare system shortfalls to improve outcomes.

Background: Duodenal injuries are infrequent occurrences in traumatic abdomen.¹ Most common cause of duodenal trauma are gunshot wounds and stab injuries.¹ The purpose of this study is to determine the surgical outcome of penetrating duodenal injuries focusing on duodenal leakage.

Methods: A retrospective chart review with a descriptive-analytical design analysed medical records of 36 patients meeting inclusion criteria from a 966-patient database with penetrating abdominal trauma, admitted to Groote Schuur Hospital trauma centre, Cape Town, South Africa, over 72 months (2014-2019). Demographic data (age, sex), preoperative assessments, operative interventions, and postoperative complications were recorded, with complications graded using the Clavien-Dindo classification.

Results: Out of 966 patients admitted during the study period with penetrating abdominal trauma, 36 (3.73%) had penetrating duodenal injuries. All 36 patients were male, with a mean age of 27.17 (SD 8.28) years. Thirty-three (91.67%) patients sustained gunshot wounds, and the remaining three (8.33%) had stab wounds. Fifteen (41.67%) patients underwent damage control surgery (DCS). Six (16.67%) patients developed a duodenal leak (DL). Ten (27.78%) patients died, including five DL patients, who died due to sepsis.

Conclusion: Simple duodenal repair appears to be the best management option for penetrating duodenal injuries, except for severe injuries graded AAST IV-V where adjunct surgical techniques may be necessary.

Summary: Cultured epidermal autografts (CEA) are seldom used in scar revision despite evidence of favourable outcomes. We report a case using a modified technique, Kleintjes Cultured Skin (KCS), for revision of childhood burn scars on the lower legs. Keratinocytes were enzymatically isolated, seeded onto the dressing, and incubated for two weeks. KCS was applied directly onto the excised scars. Scar appearance, assessed with the Vancouver Scar Scale, improved from 4 preoperatively to 2 at a follow-up of two and six years, with progressive re-pigmentation, softness, and pliability. The biopsy site also healed favourably. This case supports the potential role of KCS in cosmetic scar revision.

The South African Journal of Surgery (SAJS), established in 1962, is the official publication of the Association of Surgeons of South Africa. As a quarterly, peer-reviewed journal, the SAJS plays a vital role in disseminating surgical research, clinical insights, and commentary relevant to South Africa and the broader continent. The journal is listed and indexed internationally on MEDLINE and locally for academic subsidy purposes on the Scientific Electronic Library Online (SciELO SA). At its helm, the editor, deputy editors, and editorial board serve not merely as administrators, but as custodians of academic integrity, scientific rigor, and editorial quality.

Background: Few studies on equestrian-related injuries have specifically focused on patients in South Africa. The aim of this study was to review the spectrum of injuries and of patients treated at state-funded trauma centres in South Africa.

Methods: A retrospective study was conducted over a 12-year period from July 2012 to February 2025 on all patients treated for equestrian-related injuries.

Results: A total of 82 patients were included (83% male, median age: 17 years, median injury severity score (ISS): 9). The most common mechanism of injury was a fall (n = 41), followed by a kick (n = 38). Two were trampled, and one dragged. The most commonly injured body regions were head and neck (n = 49), face (n = 29), and chest (n = 17). Eighty-two per cent (67/82) were managed non-operatively. The overall morbidity was 21% (17/82). Respiratory complications were the most common (n = 7). The median length of hospital stay was two days (range 0-45). There were two mortalities (2%), both due to a fall from a horse resulting in severe traumatic brain injury (TBI).

Conclusion: Horse-related injuries are serious and can result in significant injuries. A significant number of patients required major operative interventions. Both riders and non-riders are at risk of injury and appropriate safety equipment and education is essential.

Background: Thyroid disease is a frequently encountered condition for the general surgeon. Limited literature on surgery for thyroid disease is available from the study area in KwaZulu-Natal which has a largely rural Black population of over three million people. The aim of the study is to audit the spectrum of surgically managed thyroid disease in a tertiary hospital.

Methods: Descriptive analysis of six-years of prospectively collected thyroid surgery data from a tertiary hospital. Demographics, surgical indications, procedures, and histologies were studied and comparative analysis performed.

Results: 346 patients with a female:male ratio of 22:1; age: 19-91 years, mean 51. The majority (77%) were Black ethnicity. 377 operations were performed. 346 patients had either a lobectomy (64.7%), subtotal thyroidectomy (13.6), or total thyroidectomy (21.7%) at the initial surgery. Re-do surgery was performed in 31 patients. The majority of surgery was for therapeutic indications, 65% for symptomatic multinodular goitre (MNG). Thyroid carcinoma (TC) was more frequently diagnosed in older female patients and 91.8% were well-differentiated TC. Two-thirds of diagnostic thyroid procedures found an adenoma.

Conclusion: Thyroid pathology is prevalent in the study region. Most thyroid surgery was for middle-aged women with MNG which harboured TC in 11.2% of cases. A larger thyroid nodule did not correlate with the increased likelihood of TC. Follicular carcinoma was higher than international studies as was follicular variant of papillary thyroid cancer which may be explained by the study population. A national database is needed to audit the spectrum of thyroid disease requiring surgery across South Africa.

Summary: Amyand's hernia is a rare condition characterised by the presence of the appendix within an inguinal hernia sac. We describe a case of a complicated right-sided Amyand's hernia, where imaging demonstrated a ruptured hernia containing a perforated appendix with an appendicolith and a rim-enhancing scrotal abscess, necessitating urgent surgical intervention. This case highlights the importance of computed tomography (CT) imaging in evaluating atypical groin sepsis, the value of multidisciplinary management, and the critical role of timely surgery. It further emphasises the need for individualised operative strategies when addressing complicated Amyand's hernia with perforation and associated soft-tissue infection.

Background: Patient- and disease-specific registries provide valuable real-world data and often demonstrate greater generalisability compared to randomised controlled trials. A national thyroid surgery registry in South Africa (SA) can promote collaboration among surgeons nationwide, guide resource allocation, inform local guidelines, improve the quality of care, and support research. Although numerous global guidelines exist on creating and implementing disease registries, there is a paucity of data from SA. This study aimed to explore the perspectives and experiences of stakeholders to establish a national thyroid registry.

Methods: A qualitative study incorporated a survey and semi-structured interviews. Study groups included clinicians who (1) were recently involved in the Thyroid Cancer Group of SA (TCGSA) audit, (2) initially expressed interest in the TCGSA audit but could not participate, and (3) individuals who were involved in existing patient registries in SA. Participant perceptions and experiences with registries were discussed, and thematic analysis was performed on the transcribed data.

Results: Twelve practical recommendations were synthesised based on the participants' perspectives. The twelve tips emphasise establishing independent, well-governed, and accessible registries that clearly communicate their goals, encourage clinician use, ensure confidentiality, provide support, and promote simplicity and incentives to drive effective participation. This study is unique as the tips provided are based on stakeholder surveys and interviews, rather than relying solely on a literature review.

Conclusion: Our findings reflect South African realities, including clinicians' attitudes and administrative gaps, as well as experience-based tips. These stakeholder-informed, SA-specific recommendations can be adapted for use in other surgical disciplines aiming to establish a registry.

Background: Damage control laparotomy (DCL) is a life-saving strategy for the management of hemodynamically unstable abdominal injuries. Although the indications are well established, factors specific to local trauma ecosystems lead to delayed implementation of DCL.

Methods: A retrospective review of prospectively collected data identified all patients who underwent DCL for trauma indications at Tygerberg Hospital between 1 January 2016 and 31 December 2020. Data were analysed using Python [version 3.10]. A hybrid costing model was used to determine the cost of DCL.

Results: One hundred and thirty-one (131) patients were included, of which 96.9% were male and the mean age was 33.4 years. Gunshots were the most common mechanism of injury (77.9%), followed by vehicle collisions (9.9%) and stabs (7.9%). The in-hospital mortality was 41.5%. The median time from incident to arrival at the trauma centre was 3 hours 7 minutes (187 minutes) and patients waited a median of 6 hours (360 minutes) for surgery once in hospital. The median duration of surgery was 120 minutes and the median time to relook laparotomy was 59 hours. The median ICU and ward stay was 9.7 days and 25.7 days, respectively. Cost was calculated using a hybrid costing model, with the cost of care for survivors estimated at R 464 951 (USD $25 200) and for non-survivors R 307 827 (USD $16 684). Total cost of care for this cohort was R 42 160 625 (USD $2 285 129).

Conclusion: Delay in surgical care for DCL patients is worse for patients treated in our unit compared to those in other units, with associated cost placing significant economic burden on the healthcare sector.