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Faisal El Mouhafid, Abderrahman Elhjouji, Mohammed Fahssi, Mbarek Yaka, Noueddine Njoumi, Mohammed Tarchouli, Hicham Iraki, Mountassir Moujahid, AbdelMounim Aitali, Aziz Zentar
Surgical Science, Volume 12, pp 95-101; doi:10.4236/ss.2021.123011

The hepatic tuberculosis is rare. The interest of this Knowledge consists in the diagnostic problems particularly in its primitive and macronodular forms. It touches all ages with a peak of frequency during 17 - 50 years old, and a female prevalence. The clinical picture is polymorphous but it is still dominated by the prolonged fever and the alteration of the general state. Case report: 30-year-old female was admitted to our hospital with painless swelling on the right side of chest and feeling of pressure in the right upper quadrant of abdomen. She has no history of fever, weight loss, and night sweating or poor appetite. On clinical examination, the patient was in good general condition. The inflammatory tumefaction of the right chest wall was marked. The palpation of the abdomen revealed a sensitive hepatomegaly. A CT scan revealed a large cystic liver. The laboratory investigations were normal. This appearance was suggestive of a hydatid cyst of the right liver and a surgical management was decided. But the histological study revealed granulomatous inflammation consisting of tuberculoid type granuloma with caseous necrosis. However, abscess of the liver due to MT was highly suspected and anti-tuberculosis therapy was started, the patient responded well. Conclusion: The analysis of this observation and the data of the literature make it possible to retain the rarity; the polymorph expression and not very suggestive of this location.
Manabu Watanabe, Hiroaki Kijima, Takayuki Yoshikawa, Kentaro Ohuchi, Yusuke Sugimura, Naohisa Miyakoshi, Yoichi Shimada
Surgical Science, Volume 12, pp 9-16; doi:10.4236/ss.2021.121002

Although the relationship between the material properties of the coracoacromial ligament and rotator cuff tears has been clarified, it is difficult to evaluate these properties in the clinical setting. The purpose of this study was to clarify the relationship between rotator cuff tears and the length and thickness of the coracoacromial ligament in living shoulders, in order to assess the potential use of these parameters as clinical indicators of the possible risk or progression of rotator cuff tears. Thirty-five volunteers (46 shoulders, mean age: 52 years) were enrolled. The presence or absence of rotator cuff tears and the length and thickness of the coracoacromial ligament were evaluated by ultrasonography. Longitudinal images of the coracoacromial ligaments with the acromion and coracoid process as landmarks were obtained, and the lengths of the ligaments were measured using acoustic shadows as the index. On the same screens, the thicknesses at the center of the ligaments were measured. Ligaments in shoulders with a rotator cuff tear were significantly shorter than ligaments in shoulders without a rotator cuff tear (25.9 ± 2.5 mm vs. 28.6 ± 1.7 mm, respectively; P < 0.0001). There was no significant difference in the thicknesses of the ligaments. The length and thickness of the coracoacromial ligament of living shoulders were easily evaluated with ultrasonography in the present study, and the coracoacromial ligament was found to be significantly shorter in shoulders with a rotator cuff tear. The risk and progression of rotator cuff tears can be evaluated clinically by measuring the length of the coracoacromial ligament.
Amadou Traoré, Madiassa Konaté, Abdoulaye Diarra, Koniba Keïta, Kadia Traoré, Zakari Saye, Youssouf Koné, Boubacar Yoro Sidibé, Amadou Maïga, Amadou Bah, et al.
Surgical Science, Volume 12, pp 67-75; doi:10.4236/ss.2021.123009

Through its impact on morbidity and mortality and the cost of medical care, Venous Thromboembolism (VTE) has a significant influence on the quality of care in a surgical environment. The objectives were to determine the risk of postoperative venous thromboembolism and to assess its prophylactic management in the general surgery department of Gabriel Toure University Hospital. This was a prospective observational study from May 01, 2018 to December 31, 2018. It included all patients of 18 years old and over, operated in regulated surgery, under general anesthesia in the department. For all of these patients, Caprini score was used to assess the risk of VTE. The ninth American College of Chest Physicians’ Consensus was used as guidelines to assess Thromboprophylaxis practices in the ward. The Caprini score was evaluated in 80 patients for 8 months. The average age was 50.2 years. The sex ratio was 0.48. The risk level of VTE was low in three patients (3.8%), moderate in 13 patients (16.3%), high in 34 patients (42.5%) and highest in 30 patients (37.5%). The main risk factors found were major surgery (87.5%), age > 40 years (72.5%), cancer (33.8%), bed rest (31.2%), obesity (27.5%) and minor surgery (12.5%). Early mobilization was performed in all patients. Pharmacologic prophylaxis was required in 80% of our patients but only 38.8% had received low molecular weight heparin. VTE complicated 5 procedures, including 3 cases of deep vein thrombosis of the limbs and 2 cases of pulmonary embolism who died. Venous thromboembolism is serious and common in surgical settings. Its prevention remains insufficient in our context.
Simon Carnot Ndrianarivony, Fenosoa Vonimbola D’Assise Rakotoarimanana, Andrandraina Iavosoa Randrianantoandro, Rantonirina Henri Andriamanantena, John Bam Razafindrabe
Surgical Science, Volume 12, pp 37-45; doi:10.4236/ss.2021.123006

Introduction: Interruptive mandibulectomy is often unavoidable despite the functional postoperative handicaps that it generates. Plate reconstruction is the only possible reconstruction in CHUDR Antananarivo. The objective of this study is to evaluate the oral-facial functional status of patients who have undergone interruptive mandibulectomy. Methods: It is a descriptive and transversal retrospective study of 18 months from January 17, 2017 to July 17, 2018. We retained 30 patients who had undergone an interruptive mandibulectomy in the ward during the study period. We studied the state of mastication, phonation, pain, swallowing, labial continence, psychological state, deformity and satisfaction. Patients were classified into 3 groups according to type of intervention A, B and C. Results: Thirty patients were included. The type C intervention was the most frequent, followed by types B and A. The postoperative follow-up period ranged from 1 to 23 months. Chewing disorder has been encountered in more than half of cases. The phonation disorder was found in groups B and C. We found 13 cases of deformity. Patients became well integrated into society after surgery. Conclusion: Mandibulectomy creates aesthetic and functional prejudices for patients. Despite these disorders, patients adapt well to their daily lives.
Derek Titus, Areta Kowal-Vern, John Porter, Marc R. Matthews, Philomene Spadafore, Sydney Vail
Surgical Science, Volume 12, pp 53-66; doi:10.4236/ss.2021.123008

Background: Alcohol and drug screens in trauma patients are endorsed by the American College of Surgeons Committee on Trauma. The objective was to determine the characteristics and frequency of alcohol and poly-drug combinations in patients triaged by Trauma Team Activation (TTA) codes. Methods: A retrospective study of a Level I hospital trauma registry was initiated with 14,972 patients of whom 7028 (47%) were Substance Users (SU). There were 10,369 TTA patients: 5396 (52%) were SU, and 4603 (31%) non-TTA patients, of whom 1632 (35.5%) were SU. Inclusion criteria were: age ≥14 years old, blood alcohol level and Urine Drug Screen (UDS) documentation, Injury Severity Score (ISS), TTA code, hospital charges and Length of Hospitalization (LOS). Statistical analyses were performed with one-way ANOVA, Maximum Likelihood chi squared, and Mann-Whitney U tests. Results: The median ISS was 5 for both groups. TTA patients were younger than non-TTA patients (median 33 years versus 41 years). Mortality was significantly higher for TTA (4.7%) than for non-TTA (0.7%) patients. From 2010-2013 to 2014-2018, all substance users had a significant decrease in alcohol only use (58.0% to 42.0%) with an increase in single drug (42.0% to 58.0%) and poly-drug use (36.9% to 63.1%), p < 0.0001. For all SU patients (TTA and non-TTA), the major single drugs used were opiates (19.9%), cannabinoids (THC) (15.2%), benzodiazepines (7.7%), amphetamines (6.6%), and cocaine (2.5%). The major poly-drugs were: opiates/THC (4.7%), opiates/benzodiazepines (4.6%), THC/amphetamines (3.1%), THC/benzodiazepines (2.2%). Conclusions: By trauma activation code designation, the TTA group had most of the positive alcohol and drug screens in this study. Since the change in mandated opioid prescription practices in 2014, this study showed increased poly-drug use (two to six-drug combinations) in urban trauma patients between 2014-2018. Opioids and cannabinoids continued to be the most frequently used drugs singly and in combinations.
Levi T. Filler, Daniel Orosco, Carl E. Mitchell, John C. Porter, Philomene Spadafore, Karen J. Richey, Bikash Bhattarai, Marc R. Matthews
Surgical Science, Volume 12, pp 107-118; doi:10.4236/ss.2021.124013

Introduction: Anterior compartment syndrome (ACS) of the lower extremity is a well-recognized surgical emergency. The anterior compartment is the most frequently missed of the four compartments during lower extremity fasciotomy. This study describes a novel approach that combines sonographic measurements and physical examination landmarks to accurately identify the anterior compartment. Materials and Methods: This study was conducted as a prospective anatomical study of 94 volunteers at a single institution. Physical exam and sonographic methods were utilized to derive measurements of the anterior compartment, followed by biometric and validation data. Results: Volunteers for the derivation and validation phases of study were similar regarding gender, height and weight, age, and BMI. The derivation set revealed the distance to the anterior compartment to be 2.77 cm (median 2.6 cm, range 1.5 - 5.4 cm) from the mid-axial line and resulted in identification of the anterior compartment 100% of the time (p < 0.001). Findings were reproducible in the internal validation set with 100% accuracy. Conclusion: The fascial planes of the anterior compartment can be identified with 100% accuracy when utilizing physical examination and sonographic methods. This can serve as a foundation for future studies evaluating ways to reduce of the number of missed anterior compartment fasciotomies in the setting of ACS.
Fatoumata Binta Balde, Abdoulaye Bobo Diallo, Abdoulaye Toure, Daouda Kante, Thierno Mamadou Oury Diallo, Alhafiz Lamadine, Diao Cisse, Olivier Kouadio
Surgical Science, Volume 12, pp 1-8; doi:10.4236/ss.2021.121001

Introduction: Urinary incontinence after closure of vesicovaginal fistula is any involuntary loss of urine that a patient complains of. We aim to study the risk factors for urinary incontinence after closure of obstetric vesicovaginal fistula in Guinea in order to develop preventive measures to reduce its incidence. Materials and Methods: This was a retrospective, multiple center cohort of women operated on for obstetric vesicovaginal fistula during a 10-year period. Results: In 1770 vesicovaginal fistulas operated, 1347 were closed. 180 women (13.36%) developed urinary incontinence. After multivariate analysis, the risk factors of urinary incontinence after closure of vesicovaginal fistula were: the patient’s age, the anatomical type III, iterative surgical intervention, the brevity of the urethra and decrease in bladder capacity. Conclusion: Urinary incontinence after closure of vesicovaginal fistula is a frequent problem in Guinea, the prevention of which should be integrated into the management of fistulas.
Moussa Sissoko, Mahamadou Coulibaly, Oumar Sacko, Sekou Koumaré, Adaman F. Traoré, Soumaîla Keïta, Sidiki Keita, Siaka Diallo, Mossa Camara, Lamine Soumaré, et al.
Surgical Science, Volume 12, pp 46-52; doi:10.4236/ss.2021.123007

Total or partial thyroidectomy has been proposed as the initial treatment for benign euthyroid oiter. The aim of this study is to determine the complications associated with surgical procedures for goiter, based on our experience. Material and method: A retrospective study over 10 years concerning 409 patients operated on for goiters in the department with 48 cases of complications. Results: 409 patients operated on for goiter in the department with 48 cases of complications (11.82%). The per- and post-operative complications were: hemorrhage (18: 4.40%), recurrent lesions (1; 0.24%), 8 cases of infection (1.96%), 5 cases of transient hypocalcemia (1.22%) and phonation disorders 9 cases (2.20%). Conclusion: Complications from goiter surgery seem to be more related to thyroid disease and the surgeon’s experience than to the surgical procedure. Better knowledge of the factors leading to complications will improve the outcome of goiter surgery.
Sidiki Keita, Koniba Keita, Moussa Sissoko, Mamadou Coulibaly, Lamine Soumare, Oumar Sacko, Oulématou Coulibaly, Sekou Koumaré, Adama K. Koita, Soumaîla Keita, et al.
Surgical Science, Volume 12, pp 127-134; doi:10.4236/ss.2021.124015

A popliteal artery aneurysm is defined as a dilation of the popliteal artery greater than 20 mm, or greater than 50% at diameter of the native artery. Popliteal artery aneurysms are rare, but are most common in the lower extremities. These aneurysms have a high risk of ischemic complications and amputations even in unoperated patients. We describe the case of a 54-year-old man, hypertensive, with a large popliteal artery aneurysm. Doppler ultrasound and CT angiography of the lower limbs showed a 100 × 80 mm aneurysm of the popliteal artery. This aneurysm is responsible for venous compression with edema of the tissues under the skin. The patient was treated and a flattening of the aneurysm associated with bypass by the inverted right internal saphenous vein taken from the ipsilateral leg was performed. The patient was discharged on the 6th day of the operation. The patient was seen again at the outpatient clinic for one month and in the 3rd month an arterial Doppler ultrasound of the lower limbs performed had shown patency of the venous graft and disappearance of the intermittent claudication.
Sidiki Keita, Koniba Keita, Moussa Sissoko, Mahamadou Coulibaly, Lamine Soumare, Oumar Sacko, Oulématou Coulibaly, Sekou Koumaré, Adama Keita, Adama K. Koita, et al.
Surgical Science, Volume 12, pp 119-126; doi:10.4236/ss.2021.124014

In Mali, few studies have concerned overall mortality in general surgery, but several specific studies have concerned the different affections. Reflection on the causes of death is an inherent part of the activity of any motivated surgical team. Objective: To analyze the rate and the main causes of mortality in the General “A” surgical department of the Point “G” CHU. Patients Method: Our study was retrospective, descriptive and covered a period of 5 years from 01/01/2014 to 12/31/2018. We collected 152 deaths for 2011 hospitalized patients. The data were collected from the files of these deaths on pre-established investigation forms. The deceased patients were classified as operative and non-operative death, death from non-cancerous and cancerous diseases, deaths occurring in emergencies and deaths in regulated surgery. Results: We recorded 152 cases of death for 2011 hospitalized patients, either an overall mortality rate of 7.55%. The average age of deaths was 44.20 years +- 17.51 years with extremes ranging from 7 years to 85 years. The sex ratio was 1.62 in favor of men. The causes of death were represented by cancerous pathologies (69 deaths or 34.67%), non-cancerous pathologies (83 deaths or 4.58%). Conclusion: The mortality rate in general surgery remains high and is mainly linked to cancerous pathologies and the delay in taking care of patients.
Danielle A. Thornburg, Areta Kowal-Vern, William H. Tettelbach, Kevin N. Foster, Marc R. Matthews
Surgical Science, Volume 12, pp 76-94; doi:10.4236/ss.2021.123010

Background: Commercially available human placental amnion/chorion tissue allografts have been successfully used as protective treatment barriers for wounds and diabetic ulcers. Burn and traumatic limb injuries with exposed bone or tendon generally require surgical flaps or amputations for healing. The purpose of this study was to determine if dehydrated human amnion/ chorion membrane allografts (dHACM) with decellularized human collagen matrix (dHCM) could be used to salvage injured human extremities. Methods and Materials: dHACM/dHCM was topically applied to the wounds after debridement. Negative Pressure Wound Therapy (NPWT) was concurrently initiated, primarily to bolster the tissue with moisture and contamination control. Approximately every seven days, wounds were re-evaluated for granulation tissue growth response. As needed, patients received dHACM/ dHCM and NPWT in the outpatient or home care settings after discharge. Results: Fifteen males and two females (26 extremities) were treated for fourteen burn and three Necrotizing Soft Tissue Infections (NSTI) injuries. Closure was observed in patients after two to five dHACM/dHCM applications. The dHACM/dHCM treatment was initiated: (median) 17-days after injury; NPWT for 17-days; autograft or primary closure after 21-days; discharge 25-days after the first application. Conclusion: Treatment with human placental-derived allografts provided a protective covering that enabled the healing cascade to generate granulation tissue formation in extremity wounds with exposed tendon and/or bone. In select limb salvage cases, dHACM/dHCM treatment may be a promising alternative to amputations, tissue rearrangements, free tissue flaps or other techniques for resolution of extremity wounds with bone and tendon exposure.
Oumar Ongoïba, Idrissa Tounkara, Thiam Souleymane, Charles Dara, Jacques Saye, Karim Dao, Djibril Kassogué
Surgical Science, Volume 12, pp 17-22; doi:10.4236/ss.2021.121003

In the literature, the management of enterocutaneous fistula of tuberculosis origin is rare. The aim of this work was to report a case of external digestive fistula of tuberculosis origin in a 10-year-old girl in northern Mali in a situation of armed conflict. She was a 10-year-old patient who was admitted to our general surgery ward for external digestive fistula evolving for more than (4) four years, at admission the general. The karnofsky index was at 40%, she could not sit or hold a cup to drink water. A 3 cm enterocutaneous fistula deafened foul-smelling liquid stools, on clinical examination, the conjunctivas were pale, the lips were dry, the eyes were sunk in the eye sockets, the ribs visible from a distance. The paraclinical aspects (Itra-Dermo-Reaction (IDR) to tubercria, anatomopathology) were positive, specifying the place of medical treatment and evolution under medical treatment. Digestive fistula of tuberculosis origin is a rare condition in surgical settings.
Souleymane Sanogo, Drissa Traoré, Mamadou Coulibaly, Birama Togola, Bréhima Bengaly, Ousmane Ibréhima Touré, Drissa Ouattara, Bréhima Coulibaly, Babou Ba, Siaka Diallo, et al.
Surgical Science, Volume 12, pp 23-30; doi:10.4236/ss.2021.122004

CHU (University Hospital Center) Point G: The department of surgery B is a surgical department of CHU Point G. The department is par excellence a reference department for cases of visceral surgery, cancer surgery, cardiovascular surgery, plastic and endocrinology surgery. As a reminder, the CHU Point G is the largest 3rd level referral hospital in Mali. Aim: To study the environmental risk factors of stomach cancer in the B surgery department of the Point G University Hospital in Bamako. Patients and Methods: We performed a cross-sectional study with retrospective collection from January 2008 to June 2018 (126 months). Results: We have identified 380 cases of digestive cancer, including 193 cases of stomach cancer or 50.79% of digestive cancers. The mean age of the patients was 57.21 ± 13 years. Male sex represented 55% (n = 106). Eating habits were dominated by the consumption of tô with potash (cereal paste) with 64.76% (n = 185). The main methods of preserving meat and fish were curing and smoking with 57.51% (n = 111). Chronic smoking was found in 24.35% (n = 47), alcohol + tobacco consumption in 2.59% (n = 5). The low socio-economic class represented 126 cases or 65.38%. Housewives and cultivators were respectively 37.82% (n = 73) and 227.97% (n = 54). 20.20% (n = 39) had a history of epigastric pain. Epigastralgia was the most common functional sign with 84.5% of cases (n = 169). An epigastric mass was found in 72 patients or 37.3%. Adenocarcinoma represented 97.4% (n = 188). Palliative surgery concerned the majority of our patients with 64.8% of patients (n = 79). The postoperative consequences were simple in 28.57% of cases (n = 28), the postoperative morbidity and mortality were respectively 33.61% (n = 41), and 23.77% (n = 29). The overall survival rate after surgery was 10.81% at 2 years and 2.94% at 5 years. This rate was 58.83% at 2 years and 28.50% at 5 years after curative surgery. Conclusion: The risk factors for stomach cancer are many and varied. Some are particularly present in Africa. Delay in diagnosis due to a belief in traditional healers is common in our community.
Olakunle F. Babalola, Adedayo I. Salawu, Abiodun I. Okunlola, Oladipo Omoseebi
Surgical Science, Volume 12, pp 31-36; doi:10.4236/ss.2021.123005

Background: Foreign body granuloma is a rare late complication of fascia lata graft donor site with few reported cases in the literature. It can mimic soft tissue sarcoma. Clinical and radiological findings may not be enough to solve the puzzle and histology remains the mainstay of diagnosis. Aim: Our aim is to highlight the unusual long interval between initial surgery and presentation of foreign body granuloma. Case Presentation: A 65-year-old man who presented 48 years after initial surgery with progressive painless fascia lata donor site soft tissue swelling. The management and histology findings were highlighted. Conclusion: The occurrence of foreign body granuloma remains an important differential following a history of past surgical procedure regardless of the time interval between the surgical procedure and the clinical presentation.
Moussa Sissoko, Mahamadou Coulibaly, Sékou Koumaré, Oumar Sacko, Sidiki Keïta, Soumaila Keita, Siaka Diallo, Lamine Soumaré, Adama F. Traoré, Adama Koïta, et al.
Surgical Science, Volume 12, pp 103-106; doi:10.4236/ss.2021.124012

Splenic infarction is a rare condition (1/500,000 and 1/100,000) but potentially fatal. The prognosis depends on the diagnostic delay and above all on the speed of treatment. It usually occurs in a particular area such as myeloproliferative syndrome, sickle cell anemia, thalassemia etc. The objective of this work was to report a clinical case of necrosis of the spleen.
Fengjuan Zhu, Hua Wang, Jianyun Zhao, Yan Wang, Panpan Cui, Jiansheng Li
Surgical Science, Volume 12, pp 135-142; doi:10.4236/ss.2021.124016

Objective: To explore the methods and effects of pectoralis major myocutaneous flap in pharyngolaryngeal cancer surgery. Methods: Among 23 cases of pharyngolaryngeal cancer patients, the surgical procedure was based on pathologic conditions, and the surgical defects were repaired by pectoralis major myocutaneous flap. Results: Among 23 patients, there were 1 case of skin flap necrosis, 4 cases of pharyngeal fistula, 1 case of hypopharyngeal esophageal stenosis; except 1 case of pharyngeal fistula died of carotid artery rupture caused by infection, 1 case of hypopharyngeal esophageal stenosis required a gastric tube, and the rest patient’s swallowing function is normal. Conclusion: The blood supply of pectoralis major myocutaneous flap is reliable with the tissue volume enough for reconstruction. It turns out to improve patient survival and postoperative quality of life with the application of pharyngolaryngeal cancer surgery.
Liu Minqiang, Li Xiaoshan, Chunxiao Hu, Xu Bo, Wang Yanjuan, Wei Dong, Gu Zhengfeng, Hu Chunxiao, Chen Jingyu, Wu Qiang, et al.
Surgical Science, Volume 11, pp 222-235; doi:10.4236/ss.2020.118025

Background: Extracorporeal membrane oxygenation (ECMO) is an effective adjuvant therapy for cardiopulmonary support during the period of lung transplantation (LTx). However, factors associated with the application of ECMO after LTx remain controversial. The purpose of this study is to clarify the risk factors of post-operative ECMO support and to evaluate the outcomes. Methods: It was a hospital, single-center, retrospective study. 266 patients underwent LTx supported by ECMO were included. According to whether or not the patients received continourly ECMO support after the surgery, the enrolled patients were further divided into intra-operative ECMO group (group I, 105 cases) and post-operative ECMO group (group P, 161 cases). The peri-operative data of the donors and recipients were collected. The independent risk factors associated with post-operative ECMO support during LTx were identified. The relationship between primary graft dysfunction (PGD)/post-operative survival and duration of ECMO support was also analyzed. Results: Prolonged donor ventilation ≥ 5 days, pre-operative recipient mechanical ventilation, bilateral lung transplantation (BLT), veno-venous (V-V) ECMO and PGD in recipient were independent risk factors for post-operative ECMO support. The risk of PGD and post-operative death increased along with the increase of ECMO bypass time, and the mortality risk in group P was 2.33 (95% confidence interval: 1.16 - 4.67) times as that in group I. Conclusions: Mechanical ventilation for donor ≥ 5 days, pre-operative mechanical ventilation, BLT, V-V-ECMO and PGD in recipient were independent risk factors for post-operative ECMO support after LTx, and post-operative ECMO could not reduce recipients’ hospital mortality.
Juliano Mendes De Souza, Nicholas Galat Ahumada, Hipolito Carraro Junior
Surgical Science, Volume 11, pp 237-241; doi:10.4236/ss.2020.119026

Since the beginning of the pandemic caused by the new Coronavirus (SARS- CoV-2), critically ill patients care has been challenging. It is necessary to perform the best available practice and protect the health team, preserving human resources and rationalizing costs. Changes in tracheostomies institutional protocols are necessary according to each health care services reality. This is particular important in developing countries. The aim of this study is to establish a practical and sucint guideline to minimize controversies regarding the proper timing to perform elective tracheostomies in critically ill coronavirus infected patients.
Jessica Liebaert, Harald Rudolf Bliem, Christine Unterrainer, Johann F. Kinzl
Surgical Science, Volume 11, pp 194-207; doi:10.4236/ss.2020.117022

Mahamadou Coulibaly, Drissa Traoré, Bréhima Bengaly, Birama Togola, Drissa Ouattara, Nouhoum Ongoiba
Surgical Science, Volume 11, pp 216-221; doi:10.4236/ss.2020.118024

Purpose: To assess the epidemiological, clinical and therapeutic aspects of acute appendicitis at the Koutiala Reference Health Centre. Methods: This was a prospective study conducted in the general surgery department of the Koutiala Reference Health Centre. Patient records admitted for simple and complicated appendicitis during the period from August 1, 2017 to August 31, 2018 have been collected. Patients operated on for simple and complicated acute appendicitis were included in the study. Patients who did not have surgery were excluded. Results: We collected records of 62 patients who had surgery for simple and complicated acute appendicitis. They accounted for 11.9% of surgical procedures (n-520) and 27.3% (n-227) of surgical emergencies. The average age was 33.1 years-15.7. Men were in the majority with 72.5%. Simple acute appendicitis accounted for 56.4% of cases (n-35) and complicated appendicitis 43.6% of cases (these were 16 cases of appendicular peritonitis, 09 cases of appendicular abscess and 02 cases of appendicular plastron). Therapeutically, appendectomy was performed in 58 patients. In 4 patients the appendix was completely necrotized. The average length of hospitalization was 3.3 days-0.8 for single acute appendicites and 6 days-2.7 for complicated appendicites. Postoperative morbidity of complicated appendicitis was 6.4% (no. 4) and mortality was zero. Conclusion: Simple acute appendicitis is more common. Laparotomy remains the only way at present. Postoperative morbidity is high in complicated appendicitis and mortality is zero.
Ronald Awoonor-Williams, Raphael Kofi Vowotor, Frank Nketiah-Boakye, George Asafo Adjaye Frimpong, Angelina Ampong, Joseph Adjei Kwarteng, Pierre Kusi Aidoo Amankwah, Michael Leat
Surgical Science, Volume 11, pp 354-364; doi:10.4236/ss.2020.1111037

Cheickna Sylla, Soumano Oumar Traoré, Alassane Traoré, Alou Samaké, Saleck Doumbia, Saoudatou Tall, Belco Tamboura, Sitapha Dembélé, Seydou Z. Dao, Ibrahima Teguété, et al.
Surgical Science, Volume 11, pp 329-341; doi:10.4236/ss.2020.1110034

Objectives: The goal was to assess the risk factors for emergency cesarean section versus prophylactic caesarean section. Materials and Methods: This was a descriptive analytical cross-sectional study of the Type Cas/Witnesses at the Reference Health Centre of Commune V of the District of Bamako in Mali. The sample consisted of 100 cases for 200 controls (1 case for 2 controls) with retrospective collection of data for the period from January 1 to July 11, 2011 (6 months and 11 days). Results: During the study period, out of a total of 3559 deliveries, we recorded 2,794 vaginal deliveries, 78.50% and 765 caesarean sections or 21.50%. Of the 765ceras, we performed 353 emergency caesarean sections or 46.15% and 412 prophylactic caesarean sections 53.85%. We have selected 100 prophylactic caesarean section files and 200 emergency caesarean section files. The average age of the patients was 27.41 years-5.84 with extreme ages of 14 to 40 years. 100% of our patients (Cas) had performed at least one antenatal consultation compared to 83.5% of the parturients evacuated (Witnesses). The most frequently cited reasons for evacuation were: acute fetal suffering, non-cephalic presentation and excessive uterine height with 30%, 17.5% and 12% respectively. The bulk of the caesarean section indications were dominated by dystocies with 90% in cases compared to 65% in Witnesses, followed by acute fetal suffering with 30% in Witnesses. We recorded 30% perinatal deaths among Witnesses compared to 1% in Cases. We recorded 16 uterine ruptures in the Witnesses among which 2 hysterectomies and 14 hystererraphia. Conclusion: Prophylactic caesarean section improves maternal and perinatal prognosis more than emergency caesarean section.
Francois Adrien Morel Bokalli, Chi Fru McWright, Jerry Brown Njoh Aseneh, Takere Maseoli Mbachan, Ngomba Divine Mokake, Jules Clément Assob Nguedia, Marcelin Ngowe Ngowe
Surgical Science, Volume 11, pp 298-311; doi:10.4236/ss.2020.1110032

Background: Perforations are major complications of peptic ulcer disease and surgical emergencies with important mortality and morbidity. Helicobacter pylori (H. pylori) has been identified as one of the commonest factors associated with peptic ulcer disease. However, little is known about its implication in cases of perforations in Cameroon. We aimed to determine the frequency of Helicobacter pylori infections in cases of perforated peptic ulcers, describe clinical features and outcomes of these cases in Cameroon. Method: A hospital-based retrospective cross-sectional study was conducted through the review of patients’ records admitted for peptic ulcer perforations in Laquintinie and Douala General Hospitals over a period of 5 years (January 2014 - December 2018). We defined H. pylori infection as; positive result on tissue biopsy at time of surgery. We used SPSS version 23.0 to analyse data and set an alpha value at P = 0.05. Results: We reviewed 115 cases of peptic ulcer perforation, with a mean age of 40 years and sex ratio (M:F) of 5:1. All patients underwent emergency laparotomy, 48 (41%) cases had a biopsy report and the prevalence of H. pylori infection in these cases was 47.9 %. Smoking, alcohol consumption and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) use, were not associated with peptic ulcer perforation. The morbidity was at 43.7% and mortality at 14%. Mortality was increasing with a higher Mannheim Peritonitis Index score (OR: 23.51, 95% CI: 4.197 - 143.003, P-value: 0.000). Conclusion: We observed a high prevalence of H. pylori infection in patients with peptic ulcer perforations. We recommend systematic H. pylori screening in cases of perforations and that larger studies should be carried out to evaluate the association of H. pylori infection with peptic ulcer perforation in Sub-Saharan Africa.
Louis Traore, Laye Toure, Moussa Sidibe, Mamadou Diallo, Aboul Kadri Moussa, Mamadou Bassirou Traore, Tiéman Coulibaly
Surgical Science, Volume 11, pp 289-297; doi:10.4236/ss.2020.1110031

Introduction: Since the times of our ancestors, traditional medicine has existed to cure all diseases [1]. The objective of this study was to assess the complications of traditional fracture treatment. Patients and Methods: This was a prospective study extending from January 01, 2018 to June 30, 2018, duration of six months. It concerned patients who had traditionally been treated beforehand for traumas with bone lesion in a traditional therapist and who had developed a complication, the definitive management of which was made in the department. Results: This study involved 102 patients, including 71 men (69.6%), with a sex ratio of 2.2. 33 patients or 32.4% were under 15 years old. The average of our patients’ age was 29.61 years with extremes of 2 and 89 years. Pupils/students (44 pupils and 5 students) were the most represented with 49 cases or 48.1% of the cases. The majority of patients (59.8% of cases) were educated or had a basic level. The majority of patients (36.3%) came as motif for a painful swelling. Gangrene was the most common complication with 37 cases or 36.3% of cases. Conclusion: At the end of our study, we have noticed that the traditional preliminary treatment of fractures was based mainly on trial and error. Practicing with inadequate means and measures without respecting the anatomical structures, is a real source of disabling handicaps. We have recorded 38, among the 102 patients who came for a complication of traditional treatment: that is 45.2% amputation, which is deplorable.
Sidiki Keita, Koniba Keita, Mahamadou Coulibaly, Lamine Soumare, Moussa Sissoko, Oumar Sacko, Sekou Koumaré, Adama K. Koita, Soumaîla Keita, Zimogo Zié Sanogo
Surgical Science, Volume 11, pp 435-445; doi:10.4236/ss.2020.1112045

Introduction: Hemorrhoidal disease is the most common condition in proctology: it is defined by signs or symptoms attributed to hemorrhoids. There is no parallel between the extent of hemorrhoidal anatomical disease and the symptoms described by patients. Our objective was to assess the incidence of hemorrhoidal disease, to diagnose it and to propose therapeutics. Patients and Method: This was a prospective and descriptive study based on a pre-established protocol that had taken place over a 12-month period. All patients (92 cases) underwent a general examination and a proctological examination. Anoscopy has often been associated with rectoscope with or without biopsy of the rectal mucosa. The inclusion criteria were the finding of hemorrhoidal disease, associated or not with other proctological diseases and the criteria for non-inclusion was any other anorectal pathology. Results: Among our patients there were 69 men or 75% of cases and 23 women or 25% of cases. The sex ratio was 3 in favor of men, the average age was 35.42. The duration of progression of the disease was between 0 - 2 years in 59.78%. Constipation (60 cases or 66.3%) and diarrhea (60 cases or 22.8%) were the factors that triggered the disease. Hemorrhoids with 3 packets were the most common (49 cases or 53.26%). 56 patients were treated medically and 36 patients were operated on. The surgical technique was simple hemorrhoidectomy according to MILLIGAN and MORGAN. It was associated with a fissurectomy in 8.33% of cases, a fistulectomy in 13.90% of cases or a thrombectomy in 33.33%. Early surgical sequels were dominated by pain in all patients, rectorragie, and urine retention. We did not deplore any deaths. Conclusion: Hemorrhoidal disease is an anatomoclinical entity that is still poorly elucidated and no direct link between the nature of the lesions and symptomatology can be established.
Takanori Ayabe, Masaki Tomita, Ryo Maeda, Manabu Okumura, Kunihide Nakamura
Surgical Science, Volume 11, pp 405-427; doi:10.4236/ss.2020.1112043

Background: Since bleedings in surgery are infrequent and inexperienced, we always try to proceed with surgery assuming a crisis situation, adhere to routine procedures and its standardization. We focus on the bleeding accidents and reveal how to implement a resilient healthcare theory. By clarifying the Safety-I and Safety-II, we developed a system to support surgical safety based on the surgeon’s individual, team, and organization. Material and Methods: We searched 25 cases of bleeding incidents in thoracic surgery, which were obtained from the database of the Project to Collect Medical Near-Miss/Adverse Event Information of the Japan Council of Quality Health Care in April 2018. Retrospectively, we analyzed 13 hemorrhage cases in our department between July 2002 and March 2020. We studied their surgical factors such as procedures, sites and causes of bleeding, response, treatment, and outcomes. Results: The causes of bleeding included damage of the adhesion detachment, insertions of automatic sutures and forceps, detachment of ultrasonic scalpel, vascular taping, removal of resected lung, lymph node dissection, exfoliation of the infiltrated adventitia of vessels, pull-out of vessel, gauze attachment with staple cut-line of vessel, thoracoscopic collision, infectious vascular rupture, detachment of vascular ligature, and suction tube hit. We summarized the variation in the usual controllable and unexpected uncontrollable bleeding and learned how to respond and treat them. We built up the balanced combination of Safety-I and Safety-II in the daily routine work in normal surgery, the patient’s individual factors, the massive bleeding, and its life-threatening crisis. Conclusions: We can learn how to prevent and respond to bleeding accidents by developing a system to support surgical safety (Safety-I and Safety-II). We can flexibly respond to unexpected bleeding disturbances under constraints by adjusting the surgeon’s individuals, team, and organization.
O. Sacko, M. Sissoko, L. Soumare, S. Keita, S. Koumare, B. Konare, M. Camara, M. Coulibali, S. Diallo, B. Traore, et al.
Surgical Science, Volume 11, pp 343-346; doi:10.4236/ss.2020.1111035

Colonic intussusception on carcinoma is rare. We report the case of an ileo-coeco-colic invagination on carcinoma of the right colon that occurred in a 40-year-old patient. The clinical symptomatology had a tendency to tumoral pathology of the colon. The ultrasound performed revealed acute intussusception. During the operation, we found an ileoceco-colic intussusception. A right hemicolectomy was performed. Anatomopathological examination of the operative specimen confirmed the diagnosis of adenocarcinoma. Conclusion: Intussusception is uncommon in adults, and is often indicative of an organic barrier to colon. His symptomatology is not very specific. Ultrasound and abdominal computed tomography help in the diagnosis. Surgical excision followed by anatomopathological examination of the operative specimen allows the diagnosis to be made histologically.
A. Mawla Walid, N. Elgohary Marwan, Atef Elekiabi Omar, Walid A. Mawla, Marwan N. Elgohary, Omar Atef ElEkiabi
Surgical Science, Volume 11, pp 61-68; doi:10.4236/ss.2020.114008

There are several surgical techniques for management of obesity, the most commonly used management strategies were; laparoscopic gastric bypass and laparoscopic sleeve gastrecomy, both techniques have advantages and drawbacks. But there are few published studies which clarified such issue and compare between both management strategies. We aimed in the present study to compare laparoscopic sleeve gastrecomy and laparoscopic gastric bypass as management surgical strategies of morbid obesity regarding technical success, degree of weight loss, degree of weight loss maintenance, postoperative and long term morbidities and degree of presence or absence of nutritional deficiencies. Patients and Methods: This is a prospective study which included a cohort of 100 patients with morbid obesity 50 of them underwent Laparoscopic gastric bypass and performed 50 underwent Laparoscopic sleeve gastrecomy with a five-year follow-up. Results: We showed that weight loss was higher in the laparoscopic sleeve gastrecomy group initially (p = 0.002), then after 2 years total weight loss was higher in the laparoscopic assisted gastric bypass group (p = 0.004). Diabetes, dyslipidemia and hypertension resolution was more common after laparoscopic assisted gastric bypass than after laparoscopic assisted sleeve gastrecomy. Occurrence of nutritional deficiencies was less commonly happened after laparoscopic assisted gastric bypass than after laparoscopic assisted sleeve gastrecomy. Conclusions: We showed a similar rate of weight reduction and resolution of nutritional deficits initially in both between laparoscopic assisted sleeve gastrecomy and laparoscopic gastric bypass maintenance of weight reduction was found more in laparoscopic assisted sleeve gastrecomy but rates of nutritional deficits were higher in such procedure.
Ibtsam Shehta Harera, Taha A. Baiomy, Ahmed A. Obaya, Shady E. Shaker, Amr Samir, Ahmed M. Elsayed, Enas Mahmoud Hamed, Loay M. Gertallah
Surgical Science, Volume 11, pp 39-49; doi:10.4236/ss.2020.113006

Background: Colorectal cancer (CRC) who is initially diagnosed with single or multiple synchronous distant metastases has an incidence of about 20% of all CRC patients. There is a controversy regarding the role of resection of the primary tumors in those patients. The aim of this study was to explore the prognostic roles and survival advantages of surgical excision of the primary colonic tumor in patients with CRC who are primarily diagnosed with distant metastases. Patients and Methods: We included forty patients who were diagnosed initially with stage IV CRC. We have divided the included patients into two categories the first one included 20 patients that underwent surgical excision of the primary cancer followed by administration of chemotherapy and the remaining 20 patients were initially given chemotherapy without excision of the cancer. We followed patients for 24 months to detect progression, response to chemotherapy, recurrence free survival and overall survival rates. Results: There is statistically significant difference between patients underwent different initial management techniques regarding N stage of the tumor (p = 0.039), response to chemotherapy (p = 0.048), occurrence of relapse (p = 0.022), disease free survival (DFS) (p = 0.027) or overall survival (OS) rates (p = 0.001) (DFS and OS were significantly higher among patients who received initial surgical management. Primary surgical removal of the tumor improved OS rate by 8 months (p = 0.001). Conclusion: Surgical removal of the primary malignancy in mCRC patients before chemotherapy administration improves patients’ survival rates and response to chemotherapy that lead to a better prognosis.
Natacha Boumas, Beelke D’Hondt, Catherine De Magnee, Raymond Reding, Francis Veyckemans
Surgical Science, Volume 11, pp 9-14; doi:10.4236/ss.2020.111002

Introduction: Congenital septal anomalies between the trachea and the esophagus are rare conditions. It seemed to us interesting to recall the contribution of tracheoscopy in the diagnostic and therapeutic strategy of esophageal atresia and congenital esoaerian fistulas. Patients and methods: This is a retrospective study between June 1994 and June 2014 of children who underwent a tracheoscopy, at the Saint-Luc University Clinics in Brussels, the diagnostic set of esophageal atresia (EA) or a congenital esoaerian fistula was suspected. Results: A total of 43 children with esophageal atresia or congenital esoaerian fistula underwent tracheoscopy. Before the tracheoscopy, the diagnosis of the anatomical type of atresia of the esophagus and esoaerian fistula was as follows: type C, 34 (79.1%); type A, 4 (9.3%); type E, 5 (11.6%). After performing the tracheoscopy, the diagnosis was changed as follows: type C, 34 (79.1%); type A, 3 (7%); type E, 4 (9.3%); type B, 1 (2.3%), a patient with a tracheoesophageal laryngo cleft (2.3%). Tracheoscopy also made it possible to find 2 cases of tracheomalacia, 2 cases with 3 bronchial tubes and one case associating a diverticulum of the trachea. No complications were correlated with the performance of the tracheoscopy. Conclusion: Our study confirms the benefits of tracheoscopy in the laden price of esophageal atresia or congenital esoaerian fistula.
Mahbuba Begum, Mohammad A. Majid, Din Mohammad, Wahida Begum, Abdullah Yusuf, Shamima Sultana
Surgical Science, Volume 11, pp 25-31; doi:10.4236/ss.2020.112004

Background: Ileal perforation is a very critical condition. Objectives: The purpose of the present study was to see the post-operative mortality after ileal perforation. Methodology: This prospective cohort study was conducted in the Department of Surgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2000 to December 2002 for period of 2 years and 3 months. All the patients presented with ileal perforation at any age with both sexes were included in this study. Patients were selected consecutively and the patients who showed ileal perforation at laparotomy were included in this study. Preoperative diagnosis was based on detailed history, complete physical examinations supported by plain x-ray abdomen in erect posture including both domes of diaphragm. After immediate resuscitation surgical treatment was undertaken as soon as possible following admission in all cases. The patients were followed up and the mortality profiles were recorded after surgical intervention. Result: Out of 53 patients having postoperative complications 38 patients were survived and 15 patients were expired. So total survivors were 85% and non-survivors 15%. In this study most of the mortality (12%) was attributed to septicemia and mode of death was multiple organ failure. Respiratory complications caused 2% mortality one patient died of ARDS and another elderly patient with preexisting bronchial asthma developed respiratory failure and was unresponsive to treatment. One death was related to faecal fistula followed by severe fluid, electrolyte and acid-base imbalance with peritonitis and gross sepsis. Conclusion: In conclusion, the mortality is significantly high due to septicemia, ARDS and faecal fistula.
Ali Mahmood, Charisma Gajula, Prianka Gajula
Surgical Science, Volume 11, pp 82-88; doi:10.4236/ss.2020.114011

COVID 19 has caused capitulation from healthcare entities all over the world. First described in Hubei, China, the virus has spread to 185 countries, showing little signs of eradication or eradication. There does not exist a medical treatment regimen or a vaccine to address COVID 19 definitively. The best response, to date, has been early diagnosis and immediate isolation or quarantine of the patient, with supportive care. As medical institutions all around the world struggle to keep up with this pandemic, there is not a consensus amongst medical professionals in the rapid diagnosis of this disease entity. Purpose: The purpose of our study was to review the literature and establish a test, or tests, that would aid the clinician in attaining a swift, yet accurate diagnosis. Methods: We searched PubMed and Google scholar and reviewed 32 articles. Keyword searches consisted of COVID 19, pandemic, diagnoses, diagnostic testing, pandemic amongst others. We compared the data obtained from these studies in an effort to find the best diagnostic test. Results: There were a total of 12,270 patients that were in our study [1]-[32]. This is the largest study to date in the literature addressing diagnosis of COVID 19. Fever, cough and fatigue, in that respective order were the most common clinical symptoms. Laboratory findings consisted of leukopenia, elevated erythrocyte sedimentation (ESR) and elevated C-reactive protein, CRP. The gold standard test described in multiple studies was the RT-PCR. Serum assays of IgM and IgG were also drawn and found to be accurate in 93% of the time. CT Chest was both sensitive and specific, 90% and 86%. This diagnostic imaging was even more successful when coupled with clinical symptoms and approaching days 7 - 12 since the onset of clinical symptoms. Discussion: This is the largest study compiled to address diagnostic testing in COVID 19 patients. The patient population is spread vastly around the world, with access to many reported tests limited in certain countries. Given the significant sensitivity and specificity of diagnostic imaging, in the setting of clinical symptoms, we recommend patient undergo CT Chest in the face of COVID 19 exposure and clinical symptoms. While RT-PCR, IgM-IgG assays are beneficial, isolation, treatment, and possible quarantine of presumptive positive COVID 19 patients (based upon clinical symptoms and imaging) should not be delayed, for fear of increased infectivity and further risk to society at large.
Mahamadou Coulibaly, Bréhima Bengaly, Drissa Ouattara, Traoré Drissa, Diallo Siaka, Souleymane Sanogo, Birama Togola, Nouhoum Ongoiba
Surgical Science, Volume 11, pp 187-193; doi:10.4236/ss.2020.117021

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D. M. Seto, S. G. R. Attolou, M. G. Yassegoungbe, K. M. Savi De Tove, S. A. Allode
Surgical Science, Volume 11, pp 122-126; doi:10.4236/ss.2020.116016

Mamadou Traore, Kouakou Ibrahim Anzoua, Kouamé Bernadin Kouakou, Ismael Kalou Leh Bi, Ahou Bernadette N’Dri, Aka Gerald Kakou, Serge Amos Ekra, Blaise Amos Kouakou, Inza Bamba, Roger Lebeau, et al.
Surgical Science, Volume 11, pp 89-98; doi:10.4236/ss.2020.115012

Background: Peritonitis is one of the most common surgical emergency in tropical countries. It is still a significant cause of mortality and morbidity. This study aimed to describe the aetiology of acute non traumatic diffuse secondary peritonitis (ANDSP) and to report the outcome after treatment. Material and Methods: A retrospective survey of patients with ANDSP was carried out from January 2007 to December 2016 in the Digestive and General Surgery Service of Bouaké Teaching Hospital in the central part of Côte d’Ivoire. The hospital is a tertiary referral centre and serves urban and rural population from Bouaké’s agglomeration but also from the whole central and northern parts of the country. During the study period, all patients found to have at laparotomy ANDSP were included. The analysed variables include epidemiologic charts, clinical presentation, cause of peritonitis, surgical treatment, postoperative outcome and prognostic factors. Results: Over the studied period 626 cases of ANDSP were operated on. The main aetiologies were gastroduodenal peptic ulcer perforation (n = 252, 41.1%), typhoid ileal perforation (n = 207, 33%) and appendicular peritonitis (n = 123, 19.6%). The mean duration of hospital stay was 13.8 ± 9.6 days (range 8 - 87 days). The length of hospital stay was significantly influenced by postoperative complications (23.5 ± 5.4 days versus 10.8 ± 2.7 days P = 0.000000). Two hundred and sixty one postoperative complications were recorded in 242 patients (38.6%) with wound infection being the commonest postoperative complication. A repeat laparotomy was indicated in 73 patients. Eigthy (n = 80) patients died (mortality 11.2%). Risk factors for death were hemodynamic shock, ASA > II, Age ≥ 60 years, M PI > 29 and digestive sutures performed in septic environment below the transverse mesocolon. Conclusion: The spectrum of aetiology of ANDSP in this tropical area is different from the one observed in the Western countries. Proper treatment of typhoid fever and amoebiasis can reduce the incidence of peritonitis. Early consultation together with adequate resuscitation and surgical management can improve the prognostic which still remains poor.
Okyere Isaac, Singh Sanjeev, Okyere Perditer, Kusi Antwi, Gyasi Brenu Samuel, Isaac Okyere, Sanjeev Singh, Perditer Okyere, Antwi Kusi, Samuel Gyasi Brenu
Surgical Science, Volume 11, pp 177-186; doi:10.4236/ss.2020.117020

We present the case of a 46-year old man with a two-year history of losing his denture presenting with cachexia and a two-month history of dysphagia to both liquids and solids associated with odynophagia. Review at the ENT department where a diagnostic rigid oesophagoscopy was done under general anaesthesia showed a denture impacted to the wall of the oesophagus at 17 cm from the incisor. Attempts at retrieval were unsuccessful as the denture was deeply embedded in the oesophageal wall and bled easily on attempted removal. He subsequently underwent a 2-stage surgical management approach by the cardiothoracic surgical team. Patient first underwent nutritional rehabilitation for a month through a created feeding gastrostomy tube via a limited midline laparotomy. He then had a open cervical oesophagotomy and removal of the denture. Currently doing well six months after surgery and tolerating normal oral diet.
Mahamadou Diallo, Abdoul Kadri Moussa, Layes Toure, Louis Traoré, Cheick Oumar Sanogo, Terna Traore, Seydina Alioune Beye, Abdrahamane Toure, Making Mounkoro, Mahamadou Kane, et al.
Surgical Science, Volume 11, pp 51-60; doi:10.4236/ss.2020.114007

Introduction: Subtalar or peritalian dislocation is rare; it represents 15% of peritalian injuries. The aim of this study was to describe the radioclinical and therapeutic characteristics and to assess the functional result. Patients and Methods: This study is about a continuous descriptive and prospective study over a period of 5 years. It has been conducted from March 2013 to February 2018 at the Ségou Hospital, a second referral hospital in Mali. The functional results were evaluated by the score of the American Orthopedic Foot and Ankle Society (AOFAS). Results: Seven cases of subtalar dislocation fractures were diagnosed in six male patients with an average age of 38 years (36 to 47 years old). In five cases the etiology of the trauma was a motorcycle accident and a fall from height. The lesion was bilateral in one case. The average time to care was 3 hours (1 to 9 hours). There was one case of open dislocation fracture with talus enucleation. The dislocation was medial in 6 cases and lateral in one case. It was pure in three cases. The treatment was orthopedic in 2 cases and surgical in 5 cases. The post-operative complications were complicated by an infection of the operative site in one case. The average length of hospital stay was 4 days. The functional result was excellent in 2 cases; good in 2 cases, fair in 2 cases and poor for 1 case. Conclusion: Subtalar dislocation is a rare and serious lesion of the posterior tarsus. The long-term prognosis depends on the earliness of treatment and the severity of the associated injuries.
Amadou Bah, Ibrahima Diakite, Amadou Maiga, Boubacar Yoro Sidibe, Madiassa Konaté, Zakari Saye, Boureima Kelly, Tany Koné, Siaka Konate, Arouna A. Doumbia, et al.
Surgical Science, Volume 11, pp 69-73; doi:10.4236/ss.2020.114009

We report a case of torsion of an ovarian tumor in a 68-year-old woman with no medical and surgical history. The diagnosis was made in front of an intermittently painful pelvic mass. The treatment consisted of a left annexectomy; the anatomopathological examination revealed a fibro-inflammatory and hemorrhagic cyst. Postoperative results were simple with a 12-month follow-up.
Baiyshbek Osumbekov, Murat Chokotaev, Ruslan Osumbekov, Nurdin Mamanov, Zamirbek Arynov, Zhypargul Abdullaeva
Surgical Science, Volume 11, pp 281-288; doi:10.4236/ss.2020.1110030

Aim: This article aimed to investigate the analysis of various methods for eliminating the residual liver cavity after laparoscopic echinococcectomy in patients. Methods: The authors used the following methods of eliminating the residual cavity: omentoplasty (36.8%), abdominalization (30%), drainage of the residual cavity (26.2%), and a combination of omentoplasty with drainage of the residual cavity (7%). Results: In the postoperative period, complications occurred in 2 (3.5%) cases in the form of bile leakage from the residual liver cavity. Conclusions: It is recommended to use abdominalization and omentoplasty when choosing a method for eliminating the residual liver cavity.
Corona Figueroa Alejandro Angel, García Rodríguez Francisco Mario, Lorenzo Silva José Manuel, Corona Padilla Alejandro Arnulfo, Mancera Steiner Carlos, González Chávez Alberto Manuel
Surgical Science, Volume 11, pp 209-215; doi:10.4236/ss.2020.118023

Squamous cell carcinoma is a type of skin cancer with abnormal proliferation of keratinocytes. Its incidence reaches approximately 20% of cases of non-melanoma skin cancer, which has increased in recent decades due to growth in life expectancy, increased sun exposure, the use of tanning beds and improved detection of this type of tumors. We present a patient who was diagnosed with a squamous cell skin carcinoma in the chest wall, treated initially with surgical resection. A few years recurred in the same place, so the patient received radiotherapy with poor response. Ultimately a new surgical approach was performed with a wide margin resection by a multidisciplinary surgical team. Multidisciplinary management in this type of procedure is important so that the long-term result is optimal for the patient.
Tadeja Pintar, Bojana Beović
Surgical Science, Volume 11, pp 99-110; doi:10.4236/ss.2020.115013

Background: Aminoglycosides are used as empirical antibiotic treatment of intraabdominal infections which are caused by Gram negative bacteria and for which the treatment of choice is surgery. Aminoglycosides maintain good efficacy against these bacteria and reduce the need for prescribing fluoroquinolone, cephalosporin and carbapenem antibiotics which contribute to the development of resistant bacterial strains. In recent years, several clinical trials and international guidelines have advised against the use of aminoglycosides owing largely to doubts about their effectiveness and to the concern for their known nephrotoxicity and ototoxicity. Aim: In our study, we aimed to prove whether aminoglycosides are appropriate agents in the treatment of acute appendicitis. Methods: Retrospectively, patients with acute appendicitis we included in the trial. Demographic characteristics, comorbidities, clinical signs and symptoms, the type of antibiotic and surgical treatment were analyzed. The effect of independent variables on the occurrence of complications was calculated using Student’s T-test and Fisher’s precise test. The effect of aminoglycosides on the loss of kidney function was determined by means of a linear regression method. Results: 300 patients proved acute appendicitis were included in the study. Univariate statistical analysis showed that the risk factors for postoperative complications in treating acute appendicitis were: age over 76 years (p < 0.001), acute perforated appendicitis (p = 0.03573) and appendicitis with periappendiceal infection (p = 0.01253), the presence of cardiovascular (p < 0.001), pulmonary (p = 0.00339), and kidney (p < 0.001) diseases, and no an achieved ASA group of IV (p < 0.001). Treatment with aminoglycosides did not influence the occurrence of postoperative complications (p = 0.3135). Multivariate statistical analysis showed that aminoglycosides did not have a statistically significant effect on the decrease of glomerular filtration rate. Conclusion: Aminoglycoside antibiotics are a safe and effective treatment of acute appendicitis; our not published data are positive of AGs use in acute cholecystitis and left colon diverticulitis which requires surgery. If used for a limited time period, they do not increase the risk for kidney injury and remain a stable low level of all over complications.
Augusto C. A. Tinoco, Matheus P. S. Netto, Renam C. Tinoco, Thammy L. Bastos, Bárbara S. F. Paula, Leonardo El-Kadre Tinoco, Luciana J. El-Kadre
Surgical Science, Volume 11, pp 166-176; doi:10.4236/ss.2020.116019

Background: Although laparoscopic gastrectomy is becoming more popular as a curative therapy for gastric cancer, there are concerns about its oncological adequacy. We have compared the outcomes of laparoscopic total gastrectomy (LTG) and laparoscopic subtotal gastrectomy (LSG), both with modified D2 lymphadenectomies for the treatment of advanced gastric cancers. Aim: To compare the outcomes of laparoscopic (total and subtotal) gastrectomy with modified D2 lymphadenectomy for the treatment of gastric cancer, contributing to the literature regarding the overall survival of these patients and postoperative complications. Methods: From 1993 to 2014, 239 patients were operated on laparoscopic gastrectomy at our department. The routinely laparoscopic gastrectomy was performed in all patients with gastric cancer including those presenting with obstruction and bleeding. Data could be collected, on a retrospective way, from 2006 to 2014, from the medical records of 103 patients who underwent LSG (n = 72) or LTG (n = 31). We excluded patients with metastatic disease and those who could not have a complete tumor resection. Results: Most patients were in advanced stages of cancer. Adenocarcinoma was the most common find, with 43% of cases in stage IIA and 31% in stage IIIB. Intracorporeal Roux-en-Y or Billroth II anastomoses were employed. Postoperative complications, for LSG and LTG, were 18% and 35.4%; mortality rate, during hospital stay, was 4.9% and 7.7%; three-year survival rate, 53.1% and 59.3%; and five-year survival rate, 46.9% and 40.7%. Mean hospital stay was 7.08 days, being significantly lower in LSG group (p < 0.05). Hospital acquired pneumonia was the most prevalent clinical complication, while deaths arising from surgical complications were caused mainly by gastro-jejunal or esophago-jejunal anastomosis leaks. Conclusions: Both LSG and LTG with modified D2 lymphadenectomy are feasible alternatives to open surgery and survival rates were comparable. The increased risk of complications observed in LTG did not influence the overall mortality rate. We hope that these findings should contribute to improve the acceptance of laparoscopic gastrectomy as a safe procedure for gastric cancer treatment.
Mahamadou Coulibaly, Drissa Traoré, Birama Togola, Souleymane Sanogo, Bréhima Bengaly, Drissa Ouattara
Surgical Science, Volume 11, pp 379-384; doi:10.4236/ss.2020.1111039

Purpose: Describe the indications and techniques of digestive anastomoses at the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study conducted in the general surgery department of the Koutiala District Hospital. Patients who benefited from digestive anastomosis between the hollow organs of the digestive tract during the period from August 1, 2017 to September 30, 2020 were included. The anastomoses with solid organs were not selected in this study. Results: One hundred and thirty-two patients were registered. Digestive anastomosis accounted for 11.5% of all surgical procedures. The average age was 38.6 years. Men were in the majority with 70.5%. The Karnofsky index was estimated to be less than 50% in 12 patients. Digestive anastomoses were indicated after resection of ileal necrosis in 43 patients (32.6%) followed by tumor resection in 32 patients (24.2%) and typhic perforations in 20 patients (15.1%). There were also 12 cases of digestive stoma (9.1%), 15 cases of volvulus of the sigmoid colon (11.4%), 7 cases of rectal prolapse (5.3%) and 3 cases of Hirschprung’s disease (2.3). Digestive anastomosis was performed in 89 patients in an emergency and was manual in all patients. Post-operative morbidity was 18.9%. These recorded complications, classified grade I (10 cases), grade II (3 cases), grade IIIa (2), grade IIIb (6 cases) and grade IV (4 cases) according to Clavien-Dindo, consisted of 8 cases of postoperative peritonitis (6.1%), 3 cases of external digestive fistula (2.3%), 2 cases of evisceration (1.5%), 12 cases of parietal suppuration (9.1%) and 4 cases of death (3.0%). Conclusion: Young male subjects are the most affected. Anastomoses are performed more often after the removal of the island necroses. Morbi-mortality is high. Success depends on several factors, including the general condition of the patient and the mastery of the anastomosis technique.
Waylon M. Zeng, Anamaria Parus, Connor W. Barnes, Matthew E. Hiro, Martin C. Robson, Wyatt G. Payne
Surgical Science, Volume 11, pp 312-328; doi:10.4236/ss.2020.1110033

Aloe vera has been used for centuries for medicinal purposes. Clinical and experimental evidence indicates usefulness for skin moisturization, promoting wound healing, thermal skin injury, frostbite, and ischemic skin insults. Aloe vera has anti-inflammatory, vasodilatory, antimicrobial, and proliferative actions, which have been investigated in various experimental models and in various in vitro studies. This extensive literature review of the properties and actions of Aloe vera finds substantial evidence for the reported and also likely clinical usefulness for Aloe vera in Plastic Surgery and in wound care and wound healing. Though further clinical investigation is warranted, Aloe vera use may likely be indicated in situations where its effects could positively influence outcomes, such as wound healing, flap vascularity, and inflammatory skin pathologies.
Sidiki Keita, Koniba Keita, Mahamadou Coulibaly, Moussa Sissoko, Lamine Soumare, Oumar Sacko, Sekou Koumaré, Adama K. Koita, Soumaîla Keita, M. Doumbia Dramane, et al.
Surgical Science, Volume 11, pp 446-452; doi:10.4236/ss.2020.1112046

Introduction: Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or localized purulent peritonitis; it’s a medico-surgical emergency. Our objectives are to determine the frequency, describe the clinical, therapeutic and prognostic aspects of peritonitis by appendicular perforations. Patients-Method: This was a 24-month retro, prospective, descriptive study from January 1, 2018 to December 31, 2019; conducted in the Bougouni Reference Health Center Surgery Unit. All patients of appendicular peritonitis at the Bougouni Reference Health Centre were included. Results: During the study period, 68 cases of generalized acute peritonitis including 30 appendicular peritonitis cases were collected. Appendicular peritonitis accounted for 44.1% of surgical procedures. Males accounted for 71.0% with a sex ratio of 1.2 at risk of men, the average age was 26.07 years. Abdominal pain and vomiting were the reasons for consultation in 86.7% and 76.7% of cases. Physical examination was used in most cases to make the diagnosis. X-ray of the abdomen without preparation, and abdominal ultrasound were performed systematically. Surgical treatment consisted of an appendectomy with peritoneal toilet followed by drainage. The average length of hospitalization was 8.8 days with extremes of 1 - 44 days. Hospital mortality was 3.3%; morbidity and high mortality were related to delayed consultation. Conclusion: Appendicular generalized acute peritonitis is a medical-surgical emergency with a high mortality rate associated with delayed management.
Sidiki Keita, Koniba Keita, Moussa Sissoko, Mahamadou Coulibaly, Lamine Soumare, Oumar Sacko, Sekou Koumare, Adama K. Koita, Soumaîla Keita, Zimogo Zié Sanogo
Surgical Science, Volume 11, pp 469-478; doi:10.4236/ss.2020.1112049

Introduction: The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. Methodology: The study was conducted in the surgery “A” department of the Teaching Hospital of Point G in Bamako. The study is retrospective and descriptive, over 5 years, ranging from January 2014 to December 2018. We conducted a comprehensive recruitment of all patients operated on for sigmoid volvulus during the study period. The only criterion for inclusion was patients operated on for volvulus of the sigmoid colon in the surgery “A” department of the Point G Hospital and the non-inclusion criteria were all patients operated on for other sigmoid pathologies without volvulation and patients operated on for other types of occlusions. Result: We conducted an exhaustive recruitment of 55 patients operated on for sigmoid volvulus during the study period. Sigmoid volvulus accounted for 13.75% of intestinal obstructions. The average age of patients was 48.013 ± 18.042 years with extremes of 24 years and 82 years. The age group 40 - 49 was the most represented at 21.8%. The sex ratio (M/F) was 8 in favour of male sex. The duration of the disease was less than 1-day in 50.94% of patients. There were two cases of ileo-sigmoid nodes. Immediate anastomosis resection was performed in 27 patients or 49.2% of cases. The time to restore continuity when specified was between 60 - 90 days and the median incision was the most common route of recovery at 80.8% of cases. The average length of hospitalization was 9 days with extremes of 2 days and 42 days. The morbidity rate was 7.3%. In our study we had 3 deaths or 5.5% of the cases. Conclusion: The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. The volvulus of sigmoid is a serious surgical emergency that requires early diagnosis and management. In Mali, there is no validated consensus for the choice between immediate anastomosis resection if possible and multi-stage surgery. The purpose of this study is to evaluate the different surgical approaches carried out in the surgery “A” department of the Point G Hospital.
Sidiki Keita, Koniba Keita, Moussa Sissoko, Mahamadou Coulibaly, Lamine Soumare, Oumar Sacko, Sekou Koumaré, Adama K. Koita, Soumaîla Keita, Zimogo Zié Sanogo
Surgical Science, Volume 11, pp 458-468; doi:10.4236/ss.2020.1112048

Introduction: Although its incidence has tended to decrease for several years, stomach cancer remains one of the most frequently diagnosed cancers worldwide. Globally, gastric cancer is the 4th most common cancer in men, the 5th in women, and the third leading cause of cancer death in men, the 5th in women. Patients and Methods: This was an analytical, prospective and descriptive study. Study Framework: Our study took place in the “A” surgery department of the Point “G” Hospital in Bamako. Study Period: August 1, 2003 to August 31, 2005. The design and preparation phase of the fact sheet lasted 1 month. The data collection phase lasted 18 months. All the patients who consulted for gastric tumor had a record. The follow-up phase of the patients lasted 6 months during which the patients were followed by appointment, by contact person or seen at home. Data entry and analysis were conducted with Epi-Info software (version 6.0). Inclusion Criteria: All patients hospitalized for gastric cancer in the “A” surgery department of the Point “G” Hospital. Result: The distribution of patients according to the evolutionary stage TNM was: Stage IV (50 cases, or 64.94%); Stage III (21 cases, or 27.27%); Stage II (6 cases, or 7.79%). In our series the average age was 59 with extremes of 20 to 85 years. The most represented age group was 46 - 65 years. Men were 60 cases (77.90%) 17 cases for women (22.10%). The sex ratio was 3.53 in favor of men. All 77 patients were recruited during the outpatient clinic, including 55 patients referred by a physician and 20 patients who came by themselves. Esogastroduodenal fibroscopy was performed in all of our patients. The tumor was localized: to the cardia in 10 cases; cardiac fundus in 2 cases; antrum in 24 cases; antro-pyloric in 28 cases; Pylorus in 1 case; great curvature in 5 cases; small curvature in 2 cases. Postoperative complications were: parietal infection in 12 cases or 17.40%; digestive fistula in 3 cases and evisceration is 1.40%. The overall three-month survival rate was 51.90% and at 6 months was 48.10%. Conclusion: Stomach cancer is the most common digestive cancer in Mali. In Africa the diagnosis is usually late and the R1 lymph node dissections remain the basic technique, despite the results obtained in the Japanese series. The results of several major series argue for their effectiveness in improving patient survival.
Sidiki Keita, Koniba Keita, Lamine Soumaré, Moussa Sissoko, Mahamadou Coulibaly, Oumar Sacko, Sekou Koumaré, Adama K. Koita, Soumaîla Keita, Zimogo Zié Sanogo
Surgical Science, Volume 11, pp 428-434; doi:10.4236/ss.2020.1112044

Introduction: Post-operative acute evisceration is defined as a total dehiscence of the abdominal wall of all the constituents of the abdominal wall. The objective is to determine hospital frequency, identify favorable factors and key etiologies, and assess the rate of morbi-mortality. Patients and Method: This is a retrospective and descriptive study carried out in the general surgery departments of the Teaching Hospitals of Point “G”, Gabriel TOURE and the pediatric surgery department of the Gabriel TOURE University Hospital in Bamako, involving 53 patients. The study ran from January 1, 2005 to December 31, 2007. Inclusion Criteria: All cases of postoperative acute evisceration operated. Non-Inclusion Criteria: All cases of evisceration of other etiologies. Results: The average age was 34.2 years with extremes of 6 and 75 years, the sex ratio was 1.12 in favor of women. The initial clinical picture was peritonitis in 26 cases or 49.1%, occlusion in 16 cases or 30.2% and tumors in 6 cases or 11.3%. The post-operative complications responsible for evisceration were: parietal suppuration 28 cases or 52.8%; digestive fistulas 15 cases or 28.3%; post-operative ascites 4 cases or 7.5%. Conclusion: Post-operative acute evisceration is a rare but serious condition due to morbidity and mortality.
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