ISSN / EISSN : 2157-9407 / 2157-9415
Published by: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 836
Latest articles in this journal
Surgical Science, Volume 12, pp 332-337; https://doi.org/10.4236/ss.2021.129034
It is estimated that between 0.3% - 0.5% of patients with cholelithiasis have biliary ileus, of this small proportion, only between 1% - 3% is complicated by the syndrome described in 1896 by Leon Bouveret. Bouveret syndrome refers to the obstruction of the gastric outlet tract secondary to the passage and impactation of a gallstone in the duodenum, through a cholecystoduodenal fistula. It is most common in women, between the ages of 74 - 77 and is clinically characterized by pain, bloating, incoercible vomiting and anorexia.
Surgical Science, Volume 12, pp 313-318; https://doi.org/10.4236/ss.2021.129032
Synchronous transverse and sigmoid colon volvulus are very rare. We report the case of a 23-year-old man who underwent emergency surgery for sigmoid colon volvulus. An intraoperative finding of transverse colon volvulus associated with sigmoid colon volvulus was made. Left and transverse colectomy was performed followed by colorectal anastomosis. The postoperative period was uneventful. Synchronous volvulus of the transverse and sigmoid colon is a surgical emergency. The clinical signs are not specific and the discovery is often intraoperative. It is necessary to know how to evoke the diagnosis in a case of sigmoid colon volvulus, to avoid inadequate management with dramatic consequences.
Surgical Science, Volume 12, pp 261-273; https://doi.org/10.4236/ss.2021.128027
Background: Survival of patients after rectal cancer surgery as well as their quality of life (QoL) has been little studied in Africa and never in our country in particular. Methods: We conducted a cross-sectional multicentre study in Yaoundé (Cameroon). We reviewed operating reports of the selected departments to identify patients operated from January 2010 to December 2019 for a rectal cancer. The outcome of patients enrolled had to be known until December 2020. Patients who were alive were contacted to evaluate their QoL using the EORTC QLQ C30 (European Organization for Research and Treatment of Cancer QoL questionnaire). Results: During the study period, rectal cancer was ranked 4th within the digestive cancers. We included 68 patients; their mean age was 49.74 years and 41.18% were under 45. The sex ratio was 1.19 in favour of males. The tumour was mainly located in the lower rectum (45.6%). The main surgical procedure implemented was abdomino-perineal resection (42.6%). Forty-one patients died, giving a mortality rate of 60.29%. The mean survival time was 13 months. The 5-year survival rate for the 32 patients operated from January 2010 to December 2015 was 21.87%. The overall QoL of the 27 living patients was good with a mean of 62.346 ± 15.907. Sexual complications and urinary disorders were found in 40.74% and 14.81% of patients, respectively. Conclusion: There is a low hospital incidence of rectal cancer in our context. The 5-year survival after rectal cancer surgery is poor while the QoL of living patients is good.
Surgical Science, Volume 12, pp 339-349; https://doi.org/10.4236/ss.2021.1210035
Introduction: Abdominal trauma is a major public health concern. Their management is controversial and difficult. Operative indications are not codified in all situations. Patients and Methods: This was a descriptive cross- sectional study over a period of 5 years, carried out in the surgical emergency department of the Central Hospital of Yaoundé and the Emergency Centre of Yaoundé. We reviewed retrospectively medical records of patients who had laparotomy after abdominal trauma. Results: We collected 115 files. There was a male predominance (83.47%) and the average age was 33.8 years. The average time to admission was 12.3 hours and the aetiologies were dominated by road traffic accidents (53%). Abdominal contusions represented 69.56% of cases and abdominal wounds 30.44% of cases. Indications for surgery were hemodynamic instability, evidence of a lesion of a hollow viscus, the presence of evisceration or a gunshot wound, and initial non-operative treatment failure. Postoperative morbidity was 9.56% and overall mortality was 3.47%. Conclusion: Surgical management of abdominal trauma is frequent in our setting, mainly indicated for hemodynamic instability. Results are good with a low morbi-mortality.
Surgical Science, Volume 12, pp 127-134; https://doi.org/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.
Surgical Science, Volume 12, pp 143-159; https://doi.org/10.4236/ss.2021.125017
Background: Clinical pathways are effective in reducing healthcare cost and standardizing management protocol for diseases and conditions. However, there are no standardized pathways for appendicitis. This study aims to determine whether implementation of a standardized clinical pathway for managing appendicitis may lead to improved patient care. Materials and Methods: We searched for articles published in PubMed, MEDLINE, and Cochrane library between 1974 and 2015. Thirty-seven papers published in English that met inclusion criteria were included and analyzed in this review. A total of 37 studies met inclusion criteria and were analyzed for the purpose of this study. Results: A clear definition for appendicitis pathway was observed in 30 articles. Appendicitis was diagnosed based on clinical and laboratory findings; however, 34% of the studies included radiological investigations. Sixteen studies provided clear definitions for discharge criteria. Time of follow-up (5 - 28 days) was reported in 10 studies. Operative time was the most commonly used outcome measure. The mean length of stay for non-complicated appendicitis was 1.3 days, and 6.26 days for complicated appendicitis. Most of the studies concluded that the accuracy of a clinical pathway for appendicitis diagnosis can be achieved by assessing the incidence of a normal appendix. The mean cost for patient care was $4874.14 (SAR 18,278.03). Conclusion: There was no standardized definition for appendicitis clinical pathway components. Studies suggested that establishing a clinical pathway for appendicitis improves the outcome and minimizes the cost.
Surgical Science, Volume 12, pp 1-8; https://doi.org/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; https://doi.org/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 107-118; https://doi.org/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.
Surgical Science, Volume 12, pp 381-389; https://doi.org/10.4236/ss.2021.1211040
Introduction: The installation of a digestive stoma involves changes affecting all aspects of the patients’ lives. The objective of this study was to determine the impact of a digestive stoma on the quality of life of patients operated on at the Yaounde Central Hospital (YCH). Patients and Methodology: We conducted a prospective descriptive study over a period of 12 months from June 2018 to May 2019 in all patients with a digestive stoma for at least 3 months operated on at the YCH. The follow-up was done within 12 months. Quality of life was assessed using the stoma QOL (quality of life) and self-image using the BIS (Body Image Scale). Results: We collected a total of 34 patients, of whom 22 were male, giving an M/F sex ratio of 1.8. The average age of the patients was 42.8 years. The indications were tumoral in 44.11% of cases (n = 15) and non-tumoral in 55.88% of cases (n = 19). The colon was the most frequently ablated organ (n = 26) with 76.5% of colostomies. The complication rate was 67.6%. Stomal oedema was the most common early complication with 38.2% of cases. All patients used colostomy bags. The average time to return to sexual activity was 8 months for men and 9 months for women. 85.3% of the patients had an average impairment of quality of life according to the Stoma Quality of Life Scale. According to the Body Image Scale, 73.5% of the patients had a moderate dissatisfaction with their self-image. Conclusion: The realization of a digestive stoma imposes a long-term follow-up especially on the psychological level in order to allow the empowerment of the patients who all have a modification of their quality of life and their self-image.