ISSN / EISSN : 2157-9407 / 2157-9415
Current Publisher: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 812
Latest articles in this journal
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.