Annals of African Surgery

Myomectomy During the First and Second Trimesters of Pregnancy. A Therapeutic Dilemma: Report of Two Cases

2024-07-23T13:08:18+00:00

Myomectomy during pregnancy is a rare situation, reserved for exceptional cases. We report two cases of myomectomy during pregnancy. Case 1 was a 31-yearold primigravida with a large transmural myoma complicated by intense pelvic pain not responding to medical treatment due to red degeneration in a 6-week pregnancy. Case 2 was a 30-year-old primigravida with multiple myomas complicated by necrosis and hydronephrosis. We performed multiple myomectomy at 17 weeks’ pregnancy after failure of medical treatment. Concerning the operative technique, we performed myomectomy during pregnancy followed by prophylactic cerclage of the cervix. The operation is carried out as quickly as possible by the most experienced surgeon of the team, in order to shorten the operating time and limit blood loss. Myomas that are in contact with the uterine cavity are not removed. In all, 500mg of hydroxyprogesterone was administered intramusculary 24h before the procedure, intraoperatively, and after operation to limit the risk of abortion. In Case 1, myomectomy was performed successfully without maternal or fetal complications. However, the patient developed placental abruption at 33 weeks of pregnancy. The newborn died 3h after birth. In Case 2, myomectomy was complicated by a spontaneous abortion at the end of the operation. The patient developed necrosis of the remaining myomas and endometritis leading to hysterectomy. Thus myomectomy during pregnancy should be performed as a last resort in only well-selected patients.

A Clinical Audit of Post-Operative Outcomes of Laparoscopic Nissen’s Fundoplication in a Single Center in Sub-Saharan Africa

2024-07-23T13:15:29+00:00

Introduction: Gastroesophageal reflux disease (GERD) is a common benign condition with a population prevalence of 18–28%. Laparoscopic antireflux surgery is increasingly being offered to patients with GERD in our setting; however, the outcomes remain unknown.

Methodology: A retrospective clinical audit of patients who underwent laparoscopic Nissen’s fundoplication in a single center. Data were summarized as mean (±SD) and median (interquartile range [IQR]); associations were analyzed with Chi square or Fischer’s exact test. A Modified Visick scoring system was used to assess the severity of symptoms after surgery. Regression models were used to analyze the factors associated with recurrence. Kaplan–Meier plots were plotted, and cox regression models, hazard ratio, and their confidence intervals were calculated.

Results: A total of 127 patients were identified, with 6 having had previous laparoscopic Nissen’s fundoplication. Post-operative modified Visick scores at 2 weeks and 3 months were 1.04 (±0.05) and 1.03 (±0.04), respectively, for both typical and atypical symptoms. The recurrence rate was 12.6%, with 87.4% 5-year recurrence-free survival.

Conclusion: Laparoscopic Nissen’s fundoplication provides good control of both typical and atypical GERD symptoms with a low recurrence rate and a 5- year recurrence-free survival that is comparable to universal rates.

Adjunctive Uterine Incision Compression Versus Tourniquet Alone for Reduction of Blood Loss During Abdominal Myomectomy: A Randomized Controlled Trial

2024-07-23T13:27:57+00:00

Introduction: The effectiveness of the uterine tourniquet alone for securing hemostasis during abdominal myomectomy remains debatable; however, its combination with uterine compression though popular has very scanty documented evidence of hemostatic efficacy.

Aim: To determine the effect of uterine incision compression (UIC) combined with tourniquet on operative blood loss associated with abdominal myomectomy.

Materials and Methods: A multicenter randomized double blind, controlled trial involving 184 participants randomized into two groups: 92 in the UIC and 92 in the control arm. UIC was administered in the interval from release of the uterine tourniquet to palpation of contraction. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 21.

Results: The mean intraoperative blood loss was lower in the UIC group (951.41 ± 362.32 mL) than in the control group (1051.30 ± 427.77 mL), but did not reach statistical significance (p = 0.125). The observed mean duration of myomectomy was, however, longer among the controls (152.95 ± 32.67 min, compared with 119.70 ± 23.96 min, p = 0.001). The control group also had significantly higher rates of deployment of additional hemostatic measures (OR = 4.68, 95% CI = 2.304–12.784, p = 0.001), occurrence of postoperative pyrexia (OR = 1.65, 95% CI = 1.256–2.154, p = 0.002), and greater mean postoperative blood loss (p = 0.003).

Conclusion: Although no statistically significant difference occurred in intraoperative blood loss, adjunctive UIC was useful in reducing operating time and postoperative blood loss

Status of Surgical Research and Publication in Africa

2024-07-23T12:58:42+00:00

Introduction: The research output in surgical branches such as orthopedics and sports medicine (OSM) is meager from Africa, considering the population and the high burden of health-related problems. We conducted this study to analyze the trend of publications in OSM from African countries and compared it with other surgical specialities.

Methods: We used the SCOPUS data from the Scimago Journal & Country Rank website, as it allows us to draw substantial journal metrics for research.

Results: During the past three decades (between 1996 and 2022), Africa’s global contribution to all surgical specialities has increased. In OSM, this was only 0.65% in 1996 and had risen to 1.79% in 2022. The total publications in OSM were 8297 from 49 countries during this period. The number of publications has risen from 61 (in 1996) to 931 (in 2022), with the maximum surge seen during the past decade. South Africa, Egypt, and Tunisia are the leading African nations in OSM publications and have contributed 77% of the total publications from Africa in 2022. There were only three orthopedic and four other surgical specialities indexed journals listed in the SCImago, arising from Africa.

Conclusions: There was an increased research output from Africa in OSM during 1996–2022, especially in the past decade. However, only three nations have contributed more than three-fourth of these publications. There is a scarcity of indexed journals in the surgical disciplines arising from Africa.