|Year : 2018 | Volume
| Issue : 1 | Page : 63-68
71st NSRS Conference Abstract
|Date of Web Publication||16-Mar-2018|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. 71st NSRS Conference Abstract. Niger J Surg 2018;24:63-8
| Realization of Target Clinical Endpoint for Initiation of Neoadjuvant Chemotherapy among Locally Advanced Breast Cancer Patients in Nigeria|| |
Olayide Agodirin, Samuel Olatoke, Ganiyu Rahman, Halimat Akande1, Olufemi Habeeb, John Agboola2, Ademola Adeyeye
Department of Surgery, College of Health Science, 1Department of Radiology, University of Ilorin/University of Ilorin Teaching Hospital, 2General Hospital, Ilorin, Kwara State, Nigeria
Background: Downsizing tumor in readiness for surgical extirpation is the tradition aim of neoadjuvant chemotherapy (NAC) for locally advanced breast cancer (LABC). This is still the prevalent target clinical endpoint (TCE) for NAC in Nigeria because of florid grave signs. Numerous criteria such as response evaluation criteria in solid tumors (RECIST) and progression-free survival measure NAC effect while realization of readiness for surgical extirpation are under-reported. Aim: This study aims to describe rate of realization of readiness of LABC for surgical extirpation after NAC and to compare same with rate of response according to RECIST criteria. Methods: Forty-eight women (32–85 years [mean = 49.3 ± 13.4]) with LABC were observed for maximum of 6 NAC cycles. Primary outcome was binary “yes” or “no” response to the question did we realize TCE? Response according to RECIST criteria was secondary outcome. Test of significance was by one-sample binomial test and Chi-square test at P = 0.05. Results: Epirubicin-based NAC was the most frequent regimen. Widest tumor diameter was 18 cm (mean 10 ± 3.9 cm.). Most frequent indication for NAC was tumor-breast ratio. TCE was realized in 35% (P = 0.06). Stability, partial, or complete response according to RECIST criteria was achieved in 80% (P = 0.001). Comparison of proportions of successes in TCE and RECIST criteria yielded P = 0.0001. Conclusion: Majority achieved clinical benefit (s) according to RECIST criteria; TCE was not realized in the majority. No association between RECIST response and realization of readiness for surgical extirpation. Therefore, telling the tumor reduction rates without stating achievement of specific endpoints may not tell the whole story about the effectiveness of NAC.
| Hematoma Localization under Ultrasound-Guidance for Excision of Impalpable Breast Lesions – a Modification to Make Screening Effective in Nigeria: Pilot Study|| |
Agodirin SO1,2, Olatoke SA2, Rahman GA2, Akande HJ3, Habeeb OG2
1School of Clinical Research, Texila American University, Guyana, South America, Departments of 2Surgery and 3Radiology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
Background: Diagnosing and treating impalpable breast lesions is one of the greatest gains of screening, and it is a game changer in winning against breast cancer. Screening must be complemented with the availability of methods to handle impalpable lesions. At the least, the impact of screening is considerably diminished and at worst, screening will be counter-productive or downright unethical if detected lesions cannot be diagnosed and treated, yet standard methods of handling impalpable lesions are not available or not sustainable in low-income centers. Objective: The objective of this study is to make screening effective by finding cheap and sustainable method of localizing, diagnosing, and treating impalpable breast lesions. Methods: Intraoperative ultrasound (USS) directed biopsy of impalpable breast lesions was modified so that the localization and operative procedure can be dissociated and performed with limited facility; under USS-guidance at the radiology department, hematoma was formed around impalpable lesions by injecting 3–4 mls of patient's own blood into them and incision placement was planned at the same time. Two to three days later, during the open surgical procedure without intraoperative USS-facility, the iatrogenic hematomas were found and excised. Primary measures of outcome were achievement of successful excision and histologic diagnosis. Results: Following walk-in screening, 5 impalpable breast lesions visible to mammography and ultrasound were included. All 5 were successfully localized and excised. Histologic diagnosis was reached in all 5 lesions. Conclusion: This small volume pilot experience demonstrated how impalpable lesions can be handled in poor resource centers. The hematoma localization under ultrasound-guidance for excision method allows flexibility of scheduling and lowers dependence on high technology.
| Necrotizing Fasciitis of the Breast in Ahmadu Bello University Teaching Hospital (Abuth) Zaria North-Western Nigeria|| |
Abur PP, Yusufu LMD, Odigie VI
Department of Surgery, ABUTH, Zaria, Nigeria
Introduction: Necrotizing fasciitis of the breast is rare globally. However, there is an observed increase in the number of cases seen in the premier tertiary hospital in Northern Nigeria. Moreover, there is no previous documentation on the disease from this center. The aim of this study was to highlight the clinical features, predisposing factors, complications, treatment, and outcome of Necrotizing fasciitis of the breast in ABUTH, Zaria. Patients and Methods: It was a 5-year prospective study from January 2012 to December 2016. The biodata, clinical features, predisposing factors, complications, treatment, and outcome of necrotizing fasciitis of the breast were documented. The results were analyzed using SPSS version 21 (IBM, Chicago) and presented as percentages and charts. Results: Thirty-nine out of 163 women with infective breast disease had necrotizing fasciitis of the breast in the study, aged 16–50 years. Majority of the patients 28 (71.8%) were <31 years. Most of the patients were of low educational status (89.6%) with only Quranic or primary education. The most common clinical features were foul smelling discharging ulcers/sinuses and necrosis of the skin of the breast in all patients. The left breast was most commonly involved 19 (48.7%) patients. Four (10.3%) patients had bilateral mammary involvement. Majority of the patients 29 (74.4%) were lactating mothers. Poorly treated mastitis/breast abscess was the predominant predisposing factor in 34 (87.2%) patients. Culture reveals polymicrobial organisms in 20 (51.3%), monomicrobial 13 (33.3%), and nonisolate in 6 (15.4%). Thirty-six (92.3%) patients had serial wound debridement, 25 (64.1%) had split-thickness skin grafting, and 3 (7.7%) had toileting mastectomy. Mortality rate was 10.3%. Conclusion: With an average of seven cases in a year, necrotizing fasciitis of the breast is not uncommon in our center. Majority of the patients were illiterate with low socioeconomic status. Poorly treated mastitis/breast abscess in lactating women was the major predisposing factor. There is a need to teach mothers how to take adequate care of lactating breasts, good hygiene, and present early to the hospital.
| Managing Obstructive Jaundice in a Resource-Limited Setting: Challenges and Limitations|| |
Moses L Adeoti, Adetunji S Oguntola, Anthony O Ajiboye1, Ademola A Adeyeye2, Olufemi G Habeeb2, Olusola O Akanbi, Tayewo O Akinloye
Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, 1Department of Surgery, Bowen University Teaching Hospital, Ogbomoso, Oyo State, 2Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
Background: Obstructive jaundice is a common clinical condition in our setting. Various factors influence its management and outcome. Objectives: The objective of this study is to highlight challenges and limitations in the management of obstructive jaundice in a resource-limited setting. Methods: All patients with a diagnosis of obstructive jaundice between April 2012 and March 2017 in Ladoke Akintola University of Technology Teaching Hospital Ogbomoso and Bowen University Teaching Hospital Ogbomoso were included. Relevant data were obtained through a paper pro forma Results: Sixty-nine patients were studied. The patients' mean age was 48.7 years (±3.41) with male to female ratio of 1:1.16. Malignant cases were responsible for 85.5% of cases. The mean duration of disease was 121 days (±14.3). All patients had abdominal ultrasound scan done and was helpful mainly in patients with cholelithiasis (88.9%). Only 45% of patients could afford preoperative computed tomography, other minimally invasive investigations were not available. The mean bilirubin level was 388.27 μmol/l (±15.55) while mean serum albumin level was 29.1 g/dl (±1.56). Serum bilirubin level >420 μmol/l was significantly associated with hepatorenal syndrome (P = 0.0231) while serum albumin level shows a negative correlation with duration of symptom (r = 0.811). Fifty-six (78.3%) patients had deranged international normalized ratio at presentation. Dialysis was done in 6 (21.42%) out of 28 patients that required it. Fifty-four (78.3%) patients were operated upon while 15 (21.7%) patients were not operable. Financial hardship was the main reason for delayed surgery 53 (76.81%). None of the patients operated on had intraoperative cholangiography due to the lack of facility. Conclusion: Obstructive jaundice is a common surgical condition in our environment. The diagnosis and treatment are met with challenges and limitations. Majority of cases were malignant in origin and presented lately when only treatment option was palliative procedure.
| Intestinal Obstruction from Internal Hernias: A Report of Two Cases|| |
Adeyeye AA1,2, Onjefu SA1, Shittu AA1
1Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, 2Department of Surgery, Bowen University, Iwo, Osun State, Nigeria
Background: Intestinal obstruction is one of the most common surgical emergencies requiring the attention of an abdominal surgeon. Cases of bowel obstruction due to internal hernias are uncommon and are rarely reported in our environment. Case Reports: A 70-year-old male presented with acute small bowel obstruction. Exploratory laparotomy revealed a gangrenous loop of ileum herniating through the epiploic foramen. The involved bowel was reduced and resected. Intestinal continuity restored with a primary anastomosis. A 45-year-old male presented with acute intestinal obstruction. Celiotomy revealed a viable loop of proximal ileum herniating into the paracecal recess. The involved bowel was manually reduced and the paracecal recess closed. Conclusion: Internal hernias are rare. The diagnosis should be considered in patients with small bowel obstruction with a history suggestive of adhesions.
| Challenges of Parents With Snoring Child: How Satisfactory Are Parents With Management Outcome?|| |
Ogunkeyede SA, Adebola SO1, Ogundoyin OA
Department of Otorhinolaryngology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, 1Department of Otorhinolaryngology, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria
Background: Parents experience psychosocial and economic ordeals in caring for children with obstructive symptoms of adenotonsillar enlargement. Their level of satisfaction varies with management outcome. Aim: Evaluating the challenges of parents with snoring children and their satisfaction postsurgical care. Methods: A prospective study among children following adenotonsillar surgeries for obstructive symptoms at the Department of Otorhinolaryngology, LAUTECH Teaching Hospital, Ogbomoso, Nigeria. A validated interviewer-assisted questionnaire was used to obtain sociodemographic factors, clinic-pathological features, treatment prior hospital presentation, indications for surgery, and duration of hospital stay postsurgery. The questionnaire was completed by the mothers. The data extracted from hospital records were type of surgery and complications. Through a telephone conversation, the caregivers answered a validated semi-structured questionnaire on the distressing symptoms before surgery and their satisfaction postsurgery. The data analysis was done using IBM-SPSS 20. Results: A total of 52 patients were recruited, 23 (44.2%) males and 29 (55.8%) females (male: female = 1:1.3). Age range 5 months–13 years (mean age, 4.2 years ± 2.3). Symptom duration before hospital presentation ranged from 1 month to 5 years. About 98% of the parents had commenced antibiotics as self-medication at onset of the symptoms. Symptoms included snoring, difficulty in breathing, restlessness, and persistent nasal discharge. The patients had adenoidectomy and/or tonsillectomy and were discharged within 24–72 h postsurgery. The distressing symptoms resolved within 1 week in 46 (88.5%) of the patients, while 6 (11.5%) had a delay in symptom resolution. Parents were satisfied with management outcome. Conclusion: Adenoid/tonsil surgical outcomes were favorable with symptom resolution, and all parents were satisfied.
| Random Blood Sugar in Trauma Patients in Bowen University Teaching Hospital, Ogbomosho: A 6-Month Prospective Study|| |
Ajiboye OA, Agbakwuru EA, Ajao EA, DrAkanbi OO, Akande JO, Arnold Edward, Olutogun T, Joseph AA, Olufemi-Aworinde KJ, Akinwumi AI
Department of Surgery, Obafemi Awolowo University Teaching Hospital, Ile Ife
Background: Blood sugar level estimation could give information regarding glucose derangement and type of fluid to administer to prevent further disaster. Aim: The aim was to determine the pattern of blood sugar level of trauma patients at a presentation in BUTH's casualty unit between December 2016 and May 2017 and to relate findings to what fluid(s) would be appropriate to administer posttrauma. Methodology: A 6-month prospective study was carried out. Capillary blood collection for random blood glucose estimation was done using needle pick on patient's finger pulp. A calibrated glucometer was used in reading the result. Results: Seventy patients had their random blood sugar estimated. Of this, 56 (80%) were males, 14 (20%) were females. The age ranged from 15 to 80 years with mean age at 36.01 ± 12.8 years with most frequent age group between 20 and 39 years (41; 58.6%). Majority of the patients were illiterate (23; 32.9%) and presented within 1–6 h posttrauma (29; 41.4%). At presentation, the majority of patients were normoglycemic (50; 71.43%) while twenty patients (28.57%) presented with hyperglycemias (mild 15.71%; moderate 1.43%; and severe 11.43%). Majority were involved in road traffic accident (69; 98.6%); one in domestic accident (1; 1.4%). The most common organ involved was bone (43; 61.4%) followed by head (head injury 14; 20%). Conclusion: Majority of patients in our study had normal blood glucose level; few with hyperglycemia mainly due to the head and skeletal injury.
| Passive Leg Raising: a Simple and Effective Predictor of Fluid Responsiveness in Critically Ill Patients|| |
Olusola O Akanbi, Olawale O Olakulehin, Olufemi G Habeeb1, Oluwasegun O Olanipekun, Tayewo O Akinloye, Yusuf A Yunusa2
Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, 1Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, 2Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
Background: Intravenous fluid administration forms the primary therapeutic intervention for hemodynamically unstable patients. However, studies have shown that about 50% of septic shock patients would not respond to fluid challenge. The passive leg raising (PLR) mimics exogenous fluid replacement by redistributing the fluid in the lower limbs to central circulation. Objectives: This study was conducted to determine the predictive value of PLR in predicting fluid responsiveness in septic shock patients. Methods: Patients with a suspected clinical diagnosis of septic shock seen in Ladoke Akintola University of Technology Teaching Hospital Ogbomoso over 6-month period were included. All the patients underwent PLR and were then divided into responders (systolic blood pressure (SBP) >90 mmHg) and nonresponders (SBP <90 mmHg). Both two groups were then managed with fluid therapy and oxygen support. This was followed by further recategorization into two groups; those who responded to fluid therapy to maintain blood pressure (FTG) and those who required cardiotonic drugs. The pre- and post-intervention vital signs were then retrospectively analyzed between the groups. Results: Twenty-five patients were included; 11 (44%) responded to PLR. The mean age of the responders and nonresponders were similar (51.67 ± 3.54) and (49.53 ± 5.28), (P = 0.2378). Pre-PLR pulse rate (PR), SBP and mean arterial pressure (MAP) were comparable in responders and nonresponders; PR (P = 0.3793), SBP (P = 0.8865) and mean arterial blood pressure (P = 0.3081) whereas post-PLR PR, SBP, and MAP showed statistically significant difference between responders and nonresponders; PR (102.90 ± 13.79) versus (121 ± 16.85), (P = 0.0076), SBP (102.63 ± 3.06) versus (85.14 ± 1.40), (P< 0.001), and MAP (82.14 ± 10.92) versus (68.99 ± 5.40), (P = 0.001). Nine (81.81%) out of 11 patients that responded to PLR belong to FTG. Giving PLR a 81.81% and 71.42% positive predictive value and negative predictive value, respectively, in predicting pre-load-dependent circulation. There was no statistically significant difference in mortality rate between responders and nonresponders (27.27% vs. 35.71, P = 0.7750). Conclusion: PLR is a simple and effective predictor of responsiveness to fluid therapy in critically ill patients in septic shock. Other interventions should be considered early in patients who failed to respond to PLR.
| Surgical Residency Training in Nigeria: Closing the Mentoring Gap|| |
Olusola O Akanbi, Olawale A Olakulehin, Moses L Adeoti, Olufemi G Habeeb1, Julius O Olaogun2, Oyintonbra A Koroye3
Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, 1Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, 2Department of Surgery, Ekiti State University, Ado-Ekiti, Ekiti State, 3Department of Surgery, Niger Delta University Teaching Hospital, Okokibiri, Bayelsa State, Nigeria
Background: Mentoring is an important and valuable aspect of professional development in medicine and forms a sound basis for professional advancement and career satisfaction. Objective/Aim: This study was thus carried out to determine the view and perception of surgical resident trainees about mentoring programs in surgical residency training in Nigeria. Methods: This was a cross-sectional prospective study of surgical residents in tertiary health-care centers in Nigeria. Surgical residents were interviewed over telephone to obtain relevant information about mentor, mentee, and mentoring. Results: One hundred residents were interviewed for the study. The mean age of the residents was 31.64 (±1.786). Seventy-two (72%) of the residents were junior residents. Twenty-nine (29%) of the residents claimed to have mentors and 20 (68.96%) of them claimed that they chose their mentors without their mentors awareness. All the respondents claimed that there is no structured mentoring program in their various faculties. Fifty-seven (80.3%) of the residents who claimed not to have mentors would wish to have one, while nine and five residents would not like to have an indifferent, respectively. Eighty-nine (89%) residents believed that mentoring is beneficial. The mentored residents would like to be mentors in future compared to nonmentored resident (P< 0.001). Only 2 (18.3%) out of eleven residents who claimed to have chosen their mentor by themselves claimed that such relationships are beneficial as compared to 16 (88.9%) out of eighteen of those who claimed that their mentor chose them. Conclusion: Despite inclination toward mentoring system in postgraduate surgical faculties our study found significant mentorship gap in our surgical residency training. We thus suggest the introduction of a structured mentoring program in our faculties.
| Pattern of Analgesic Prescriptions Following Abdominal Surgery in a Tertiary Health Care Centre|| |
Olufemi G Habeeb, Olusola O Akanbi1, Olawale L Idris2, Musibau O Adejumobi2, Julius O Olaogun3
Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, 1Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, 2Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, 3Department of Surgery, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
Background: Pain is an inevitable occurrence following surgery, and its control is an important component of postoperative care. Significant percentage of patients still suffers from poor postoperative pain control. Poor postabdominal operative pain control is associated with a lot of secondary undesirable consequences. Objective/Aim: We conducted this study to determine the pattern of analgesic prescriptions among patients that underwent abdominal surgery in out centre. Methods: The study included 120 patients that underwent abdominal surgery over a 3-year period in Ladoke Akintola University of Technology Teaching Hospital Ogbomoso. The patients' case notes were reviewed after discharge to obtain relevant data. Results: The mean age of the patients was 47.36 (±8.933). Twenty-four (20%) were older than 65 years. The most common abdominal surgical procedure performed was appendectomy. Nonsteroidal anti-inflammatory drugs (NSAID) only, opiod analgesic only, opiod-NSAID combination, and NSAID-NSAID combination were prescribed for 42.5%, 30.83%, 14.16%, and 7.85% of cases, respectively, and no prescription in four cases. Eighty-two (56.94%) out of 144 prescriptions were in generic names. Pentazocine was the most commonly prescribed opiod. Females tend to have more opiod prescription (odds ratio [OR] = 3.4, P = 0.0052). Other factors that favored opiod prescription include; age <65 years (OR = 4.8571, P = 0.0019), patient in high social class (OR = 3.6364, P = 0.4182), and Yoruba ethnicity (OR = 3.2406, P = 0.0149). Diclofenac was the most commonly prescribed NSAID to patients that underwent abdominal surgery. Eighty-seven of the patients were discharged home without analgesic prescription and in none of the case notes were documented evidence of patients' pain assessment before discharge. Conclusion: Nonsteroidal analgesic is the most commonly prescribed analgesic to patients undergoing major abdominal surgery. Ethnicity, age and sex were found to significantly affect opioid prescriptions. We recommend the use of analgesic combinations and dose adjustment based on patients' severity of pain, in postoperative abdominal pain control.
| The Burden of Chronic Low Back Pain in an Oil and Gas Company, Southern Nigeria|| |
Medical Center, Nigerian National Petroleum Corporation Warri Nigeria
Background: Chronic low back pain (LBP) results in significant disability leading to restrictions on activity and absenteeism at work. The economic and public health effect of LBP are enormous and appears to be increasing. Aim: The aim of the study is to determine the epidemiology of chronic LBP, its impact on productivity and the financial cost in the workplace. Methods: The study is a 2-year prospective review of consecutive LBP presenting in the OPD. All patients with an LBP of at least 12 weeks in duration were included in the study. Patients were assessed with Oswestry LBP disability questionnaire. All patients were treated initially with rest, analgesic and physiotherapy. Those who failed to respond to the initial treatment were further treated with epidural steroid injection and/or Surgery. Results: A total of 165 patients were seen in the OPD with LBP, 44 patients met the inclusion criteria. Twenty-two patients had magnetic resonance imaging, revealing 9 cases of spinal stenosis and 13 lumbar spondylosis with disc protrusion. Seven patients had surgery while 28 were treated nonoperatively. The average man-hour loss was 124.2 h, and the estimated cost of surgical intervention was 21.2 million naira. Conclusion: The burden of managing chronic LBP is enormous both in terms of impact on productivity and financial cost. Therefore, provision of a dedicated spinal health services in our tertiary hospitals is imperative.
| Multiple Abdominal Wall Hernias in Uyo|| |
Udo Isaac A, Etuk Emmanuel B, Umeh Kingsley U
Department of Surgery, General Surgery Unit, University of Uyo/Teaching Hospital, Uyo, Nigeria
Background: Primary abdominal wall hernias commonly present at multiple sites and may be unknown to many patients. Such may occur in family clusters which may presuppose a genetic anomaly. The diagnosis of these hernias may be at the first or subsequent presentation to the surgeon. Identification and simultaneous repair of these hernias should be a principal management objective of the hernia surgeon based on cost and morbidity. Aim: The aim is to clinically examine patients presenting with abdominal wall hernias for concurrent existence of other hernias. Methods: An observational study to be done over 6 months and involving consecutive adults presenting with abdominal wall hernia at the surgical outpatient were examined in two positions for the presence of other hernias or evidence of previous hernia surgery. Incisional hernia was excluded. The age, sex, primary presenting hernia, and other hernias found were recorded into a template. The analysis was done with SPSS 17 (SPSS Inc., Chicago, IL, USA) and presented as tables and charts. Results: Twenty-four patients were enrolled; 14 (58.3%) males 10 (41.7%) females presenting with 28 hernias. The 38–47 years and 58–67 years of age groups had 8 (33.3%) patients each, and the 28–37 years of age group had 4 (16.7%) patients. Eleven other hernias unreported by the patient were diagnosed; inguinal hernia 5 (45.4%), umblical hernia 4 (36.4%), and paraumblical hernia 2 (18.2%). Conclusion: Multiple abdominal wall hernias are a common presentation to the general surgeon and simultaneous repair will save cost and improve the quality of life of patients.
| Awareness of the Lichtenstein Inguinal Hernia Repair among Secondary Health Providers in Akwa Ibom State|| |
Udo IA, Umeh KU, Etuk EB
Department of Surgery, University of Uyo/University of Uyo Teaching Hospital, Uyo, Nigeria
Background: The Lichtenstein technique of inguinal hernia repair is simple, tension-free, and easy to learn. It is often done on an ambulatory basis under ilioinguinal and iliohypogastric nerve block with or without sedation. It is currently considered the minimum standard of care for inguinal hernias in Europe and North America. It has the advantages of reduced postoperative pain on account of the absence of tension. In a bid to advocate the wide adoption of this technique in Akwa Ibom State, a workshop was mounted for selected physicians engaged in surgical care who practice at secondary care. Resource persons were drawn from the Department of Surgery, University of Uyo Teaching Hospital and Ethicon. Activities included lectures, video sessions and hands-on session in the theatre. Aim: To assess the awareness of the Lichtenstein procedure among secondary care hernia surgeons. Methods: Questionnaires were given to participants at a workshop for the Lichtenstein technique of inguinal hernia repair before the commencement of didactic lectures, video demonstrations, and hands-on sessions. Participants previously received lectures on this technique at continuing medical education forum and hands-on sessions at their institution of practice in the last 1 year. The questionnaire tested 8 domains of the repair. The data were analyzed manually and presents as pie-charts. Results: Fifteen physicians completed the questionnaire, one response was invalidated. The best outcomes were in the domains of the type of anesthetic technique (97%), tension-free (60%), and point of recurrence (53%). The scores for mesh dimension (33%), mesh overlap (6%), mesh fixation (13%), and patient return to activity (27%) were too low. Conclusion: The awareness of the Lichtenstein technique was very low among secondary care surgical care providers in Akwa Ibom state; there is a need for more training.
| Surgical Check List: Time to Emphasize Its Importance|| |
Olawale A Olakulehin, Olusola O Akanbi1, David A Onilede, Moses L Adeoti, Olufemi G Habeeb2, Oluseyi F Oke3
Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, 3Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, 2Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria, 1Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso
Background: Surgery puts patients at appreciable risk of adverse outcomes including death. Operative surgical checklist serves as an aide memoire to ensure patients' and health-care personnel's safety during the perioperative period. Objective: This study was conducted to find out awareness and compliance of medical practitioners on use of the WHO Surgical Checklist. Methods: This was a cross-sectional survey of one hundred and nineteen private medical practitioners attending their 39th annual general and scientific meeting. Relevant data were obtained through a pretested paper-based questionnaire. The questionnaires were distributed by two of the researchers and some other research assistants randomly to the respondents at the meeting. Results: A total of 119 questionnaires were analyzed. The mean age of the respondents was 58.20 (±4.761). The mean duration of time from postqualification was 31.083 (±4.387) while the mean duration of being in private practice was 21.437 (±3.44) years. Twenty-four (20.16%) of the respondents have additional qualifications in various clinical and nonclinical specialties. Forty-seven (39.49%) of the respondents had heard about surgical checklist mainly from the internet. Only 5 (10.63%) of them use it and it is <25% of the occasions. Use of checklists shows no significant statistical difference between those with additional qualifications and those without (P = 0.6970). About 96% of the respondents believed that surgical checklist is beneficial. Most (85.7%) respondents would like to use surgical checklists if made available, while the most common reason identified as a barrier to use of surgical checklist was its unavailability. Conclusion: Awareness and compliance to use of surgical checklist among medical practitioners were low. We, therefore, suggest the need to further emphasize surgical checklists at various levels of our practice.