Annals of African Surgery <p>The goal of the <em>Annals of African Surgery</em> is to provide a medium for the exchange of current information between surgeons in the African region. The journal embraces surgery in all its aspects; basic science, clinical research, experimental research, surgical education. It will assist surgeons in the region to keep abreast of developing surgical innovations.</p> Surgical Society of Kenya – en-US Annals of African Surgery 1999-9674 <p>Authors submitting articles to The Annals of African Surgery do so on the understanding that if accepted, they will retain the copyright and allow the journal to publish and archive the article under the CC BY (Creative Commons Attribution License) 4.0 International. See details on the <a title="" href="" target="_blank">Creative commons website</a>. All authors will be required to sign an Author Agreement form detailing the agreement with the journal prior to the article being published. Download the form <a title="" href="" target="_blank">here</a></p><p><span lang="EN-GB">© 2019 <em>Annals of African Surgery</em>. This work is licensed under the Creative Commons Attribution 4.0 International License.</span></p> Editorial: Opportunities for Surgical Research in the COVID-19 Era <p>No Abstract.</p> Patrick Kyamanywa Copyright (c) 2021-02-09 2021-02-09 18 1 1 3 10.4314/aas.v18i1.1 Comparing Banana Leaf Dressing and Vaseline Gauze Dressing for Split-Thickness Skin Graft Donor Sites in a Ugandan Hospital <p><strong>Introduction</strong>: This study compared the effectiveness of banana leaf dressing (BLD) with the commonly used Vaseline gauze dressing (VGD) on split-thickness skin graft (SSG) donor sites. VGD is not completely nonadherent and is associated with pain on removal. BLD is smooth, non-adherent, pain-free and available.</p> <p><br><strong>Methods</strong>: In this prospective study, consecutive patients were dressed with either BLD or VGD. Ease of applying and removing the dressings was scored. Pain scores were taken on postoperative days 3, 5, 7, 9 and 10. On day 10, the dressing was changed, epithelialization recorded and a swab taken for microbial culture. Average cost of each dressing was calculated.</p> <p><strong>Results</strong>: There was no significant difference between postoperative pain scores with either dressing (p=0.992). BLD patients had less pain on&nbsp; dressing change (p=0.006). Both dressings were easy to apply; BLD was easier to remove (p=0.000). Wounds with BLD re-epithelialized faster (p=0.0158). 40% of wounds grew no organism on microbial culture, 25% grew <em>Staphylococcus aureus</em> and 35% grew unusual organisms (p=0.482). VGD was 4 times more expensive than BLD (p=0.000).</p> <p><strong>Conclusion</strong>: Banana leaf dressing is effective and highly recommended for dressing SSG donor sites.<br><br><strong>Keywords</strong>: Split-thickness skin graft, Donor sites, Banana leaf dressing, Vaseline gauze dressing </p> Naomi Leah Kekisa George Galiwango Andrew Hodges Copyright (c) 2021-02-09 2021-02-09 18 1 4 9 10.4314/aas.v18i1.2 Prevalence of Traumatic Brain Injury Among Trauma Patients in Ethiopia: Systematic Review and Meta-Analysis <p><strong>Background</strong>: Traumatic brain injury (TBI) is a common cause of mortality and disability in young age populations, particularly in children and adolescents. The objective of this systematic review and metaanalysis was to assess the prevalence of TBI among trauma patients in Ethiopia.</p> <p><strong>Methods</strong>: A three-stage search strategy was conducted on PubMed/Medline, Science Direct and African Journals Online, and a grey literature search was conducted on Google Scholar. Data were analyzed with R version 3.6.1.</p> <p><strong>Results</strong>: The pooled prevalence of TBI in Ethiopia was 20% (95% confidence interval (CI), 11–32). Subgroup analysis revealed that road traffic accident was the commonest mechanism of injury in Ethiopia at 21% (95% IC, 15– 30), next was assault at 18% (95% CI, 5–48).</p> <p><strong>Conclusion</strong>: This review shows a high prevalence of TBI among trauma patients in Ethiopia when compared with continental and global reports. Policymakers and stakeholders should work on regulatory laws on transportation; pre-hospital emergency medical care system is also in high demand.<br><br><strong>Keywords</strong>: Head injury, Road traffic accident, Assault, Ethiopia</p> Semagn Mekonnen Abate Bedru Jemal Abafita Tesfanew Bekele Copyright (c) 2021-02-09 2021-02-09 18 1 10 17 10.4314/aas.v18i1.3 Evaluation of Double Mesh Modification of Chevrel’s Technique in Management of Midline Incisional Hernia <p><strong>Background</strong>: Chevrel’s technique provides tensionfree repair of midline incisional hernia, but wide skin and subcutaneous dissection increases rate of complications. Here, we evaluate the double mesh modification of Chevrel’s technique in midline incisional hernia repair.</p> <p><strong>Methods</strong>: 22 patients with midline incisional hernia underwent double mesh modification of Chevrel’s technique. After excision of hernial sac with minimal dissection of the skin and subcutaneous tissue, the anterior rectus sheath is incised on both sides to create medial flaps that are sutured to<br>each other. Both recti abdominis muscles were dissected off the posterior rectus sheath, opening the retrorectus space. Prolene mesh was fixed in the retrorectus space with prolene sutures, and tailored to cover the bare area of anterior surface of both recti muscles and fixed to the lateral flaps of the anterior rectus sheath with interrupted prolene sutures.</p> <p><strong>Results</strong>: We observed no recurrences, no skin necrosis, two cases of seroma, one case of superficial wound infection and one case of temporary<br>chronic pain.</p> <p><strong>Conclusion</strong>: Double mesh modification of Chevrel technique is an efficient method for treatment of midline incisional hernia, with minimal surgical site occurrences.</p> <p><strong>Keywords</strong>: Chevrel technique, Double mesh technique, Midline incisional hernia </p> Hazem Nour Hany Mohamed Mohamed Farid Copyright (c) 2021-02-09 2021-02-09 18 1 18 22 10.4314/aas.v18i1.4 Predicting Response to Neoadjuvant Chemotherapy in Women with Locally Advanced Breast Cancer in Kenya: Utility of Ki67 <p><strong>Background</strong>: Ki67 levels have been shown to have good predictive value in breast cancer treatment. There is paucity of data on Ki67 levels in predicting response to neoadjuvant chemotherapy (NACT) in Kenya. This study evaluated the utility of Ki67 in predicting response to NACT.</p> <p><strong>Methods</strong>: This was a prospective observational study carried out at Kenyatta National Hospital between December 2017 and January 2019 on<br>patients with locally advanced breast cancer. We recruited 61 women through consecutive sampling technique. Data collected included patient demographics, pre-treatment tumor size, Ki67 levels and tumor biology. After 3 cycles of first-line chemotherapy, ultrasonography was used to determine response. Data were analyzed by SPSS for proportion of change in tumor size. The response was correlated with tumor biology and pretreatment levels of Ki67 using chisquare at a 95% confidence interval. A p-value &lt;0.05 was considered statistically significant.</p> <p><strong>Results:</strong> The response rate after 3 cycles of NACT was 39.4%, sensitivity and specificity of Ki67 levels were 70.8% and 43.2% respectively with a cut-off value of 32.5%.</p> <p><strong>Conclusions</strong>: Ki67 was found to predict response in our context at a rate of 39.4% at 20% cutoff after 3 cycles. </p> <p><strong>Keywords</strong>: Ki67, Breast cancer, Neoadjuvant chemotherapy</p> Edwin Mogere Joseph Githaiga Francis Owilla Mary Mungania Daniel Ojuka Copyright (c) 2021-02-09 2021-02-09 18 1 23 28 10.4314/aas.v18i1.5 Comparison of Outcomes of Open Tension-free Mesh Repair and Totally Extraperitoneal Laparoscopic Repair of Inguinoscrotal Hernias <p><strong>Background</strong>: This study aimed to determine the differences in postoperative complications experienced by patients with inguinoscrotal hernia after laparoscopic versus open repair, and the association of risk factors to development of postoperative complications.</p> <p><strong>Methods: </strong>We retrospectively reviewed the charts of all patients with inguinoscrotal hernias who had either Lichtenstein repair or totally&nbsp; extraperitoneal laparoscopic (TEP) repair from January 2014 to December 2017.</p> <p><strong>Results</strong>: The study was performed on evaluable data that could be extracted for 49 patients: 14 were offered TEP repair and 35 Lichtenstein repairs.&nbsp; There was no statistical difference in the mean operative time and mean time taken to return to normal activities between the two groups. The length of hospital stay was one day for both groups. Two patients from the TEP repair group and one patient from the Lichtenstein repair group developed recurrence. Three patients from the TEP group and one patient from the Lichtenstein repair group developed chronic groin pain. One patient from the totally extraperitoneal laparoscopic repair group developed a seroma.</p> <p><strong>Conclusion</strong>: Our study demonstrated a trend towards better postoperative outcomes in the Lichtenstein repair group than in the TEP group.</p> <p><strong>Keywords</strong>: Open tension-free mesh repair, Totally extraperitoneal laparoscopic repair, Inguinoscrotal hernias </p> Bhekithemba Shazi Modise Koto Chukwuemeka Osuagwu Hermanus Schoeman Copyright (c) 2021-02-09 2021-02-09 18 1 29 33 10.4314/aas.v18i1.6 Laparoscopic-assisted Appendectomy in Children with Uncomplicated Appendicitis <p><strong>Background</strong>: Acute appendicitis is one of the common surgical emergencies in the pediatric population. In 1990, laparoscopic-assisted&nbsp; appendectomy was used in children for the first time. In this study, we present our initial experience with laparoscopic-assisted appendectomy in children, using two trocar sites, and assess it for safety and outcome.</p> <p><strong>Methods</strong>: 76 cases with acute appendicitis underwent laparoscopic-assisted appendectomy at Salmaniya Medical Complex (SMC), Kingdom of Bahrain, between January 2012 and December 2015. These cases were reviewed prospectively.</p> <p><strong>Results</strong>: 76 patients between 5 and 12 years underwent laparoscopic-assisted appendectomy at SMC. Operative time ranged from 25 to 45 min&nbsp; (mean 33.93 min). Postoperative hospitalization ranged from 2 to 5 days (mean 2.88 days). One patient developed wound infection which&nbsp; subsequently subsided with conservative treatment. One case was converted to open appendectomy, but without any intraoperative complications. All patients were followed up for 2 weeks, 1 month, and 3 months postoperatively.</p> <p><strong>Conclusion</strong>: Laparoscopic-assisted appendectomy in children is a safe alternative to the open technique. The operative time in this technique and the length of hospitalization are both less and shorter than the open counterpart. No major intra-operative or postoperative complications were documented. Recovery was excellent.</p> <p><strong>Keywords</strong>: Appendicitis, Laparoscopic-assisted appendectomy, Open appendectomy </p> Saeed Al Hindi Husain Al Aradi Mohamed Mubarak Noor AlHashimi Copyright (c) 2021-02-09 2021-02-09 18 1 34 38 10.4314/aas.v18i1.7 Potential of the Pentacam in Screening for Narrow Angles in Patients with Chronic Angle-Closure Glaucoma <p><strong>Background</strong>: Chronic angle-closure glaucoma (CACG) is a visually destructive disease. Effective management of CACG requires identifying eyes with narrow angle.</p> <p><strong>Objective</strong>: To compare pentacam with gonioscopy in detecting narrow angles in eyes with CACG.</p> <p><strong>Method</strong>: We enrolled 101 eyes with glaucoma. Gonioscopy was performed on all eyes. Using Shaffer’s grading, subjects were classified into angle closure and open angle. Anterior chamber volume (ACV) and anterior chamber depth (ACD) were measured with the pentacam. Receiver operating curve was constructed for each parameter and the area under the curve (AUC) was calculated.</p> <p><strong>Results</strong>: Ten eyes (9.9%) were classified as angle closure on gonioscopy. To detect narrow angles, ACV (AUC 0.956; 95% confidence interval (CI) 0.894–0.987) performed similar to ACD (AUC=0.930, p=0.33). Using a cutoff of 102 mm<sup>3</sup> , ACV had 100% sensitivity and 88.5% specificity for detecting narrow angles in CACG patients. With an ACV cutoff of 102 mm<sup>3 </sup>, the PPV for detecting angle closure was 48.9% (95% CI, 34.8–68.2), while the NPV was 100% (94.1– 100%), using 9.9% prevalence of angle closure from this study.</p> <p><strong>Conclusion</strong>: ACV and ACD measured by the pentacam have the potential to determine narrow angles in eyes with CACG.</p> <p><strong>Keywords</strong>: Chronic angle-closure glaucoma, Pentacam HR, Anterior chamber volume, Gonioscopy </p> Seth Lartey Abdul-Kabir Mohammed Emmanuel Appiagyei Kojo Akuffo Copyright (c) 2021-02-09 2021-02-09 18 1 39 44 10.4314/aas.v18i1.8 Orofacial Infections in Kenya: A Retrospective Study <p><strong>Background</strong>: Orofacial infections are either odontogenic or non-odontogenic in nature. The clinical spectrum of these infections is diverse. This study aimed to describe the presentation and management of patients presenting with orofacial infections at Kenyatta National Hospital (KNH).</p> <p><strong>Materials and Methods</strong>: This was a retrospective study based on clinical records of patients treated for orofacial bacterial infections at KNH from<br>January 2016 to December 2018. Data on the following study variables were obtained and analyzed: demographic data, clinical presentation,&nbsp; diagnosis, management, and treatment outcome.</p> <p><strong>Results</strong>: 214 clinical records were studied. Male to female ratio was 1.4:1 with age range of 3 months to 78 years (mean=27.0 years). Swelling (96.30%, n=206) was the most common symptom, next was pain (58.90%, n=123). The most common source of infection was odontogenic (60.30%,<br>n=129) in nature. Permanent teeth (57.00%, n=122) were more commonly involved than deciduous teeth (2.80%, n=6). In both dentitions, the mandibular posterior teeth were the most commonly involved, Ludwig’s angina (30.84%, n=66) and submandibular abscess (25.23%, n=54) were the most common clinical diagnoses of orofacial bacterial infection. The commonly used treatment modality was a triad of extraction of the associated tooth, incision and drainage, and antibiotic therapy. These management modalities resulted in favorable treatment outcomes (92.50%, n=198) in most cases.</p> <p><strong>Conclusion</strong>: Orofacial infections can occur among all sociodemographic groups. These infections are potentially life-threatening if not diagnosed early and managed promptly. Multidisciplinary teams are required to manage the severe morbidity and mortality of advanced orofacial infections.</p> <p><strong>Keywords</strong>: Orofacial infections, Odontogenic, Abscess, Ludwig’s angina</p> Kimathi Denis Mutwiri Elizabeth Dimba Bernard Mua Nzioka Copyright (c) 2021-02-09 2021-02-09 18 1 45 51 10.4314/aas.v18i1.9 Orthopedic Day-case Surgery in Nigeria: A Single-center Experience <p><strong>Background</strong>: The concept of day-case surgeries is relevant in orthopedic specialty in developing countries, where orthopedic elective procedures have relatively longer duration of surgical waiting time, mainly due to lack of inpatient bed space. We aimed to determine the scope, safety and outcome of orthopedic day-case surgeries in a Nigerian setting, and identify potential areas for intervention to improve the practice.</p> <p><strong>Methods</strong>: This was a 12-month prospective study of 71 eligible, consenting and consecutive patients who presented at the National Orthopedic Hospital Enugu and were carefully selected and prepared for orthopedic day-case surgeries.</p> <p><strong>Results</strong>: Within the period of study, 53 of 540 elective orthopedic procedures were carried out as daycase, giving a day-case surgery rate of 9.8%. Of the patients enrolled, male to female ratio was 1.2:1 and age range was 8 months to 76 years. Eighteen (25.4%) patients had their day-case&nbsp; procedure cancelled on the day of surgery. The commonest procedure was removal of implant. Conversion rate was 32% mainly due to operation occurring late. Complication (mainly pain) rate was 30%, and correlated with duration of procedure (p&lt;0.006). The satisfaction rate among patients was 98%; no re-admission or mortality was observed.</p> <p><strong>Conclusion</strong>: In this study, orthopedic day-case procedures were safe, though there was low use of daycase surgery in scope, complexity and&nbsp; number of procedures. This and the high conversion rate observed call for a dedicated day-case unit and measures to facilitate timelines of the procedures.</p> <p><strong>Keywords</strong>: Orthopedics, Day-case surgery </p> Echezona Valentine Malizu Omolade Ayoola Lasebikan Njoku Isaac Omoke Copyright (c) 2021-02-09 2021-02-09 18 1 52–58 52–58 10.4314/aas.v18i1.10 Diagnostic Challenges in Right Iliac Fossa Mass Caused by a Fish Bone <p>Right iliac fossa (RIF) mass is a common condition seen by surgeons. Despite advances in diagnostic modalities, it remains a diagnostic and therapeutic challenge, hence many authors describe RIF mass as temple of surprises. We report a challenging case of a 35-year-old man who<br>presented with a tender RIF mass. Abdominal ultrasonography (USG) and computed tomography (CT) scan abdomen were done and he was treated nonsurgically. His symptoms recurred after one month and a CT scan abdomen was repeated which revealed a suspicious foreign body within the appendicular mass. Laparotomy was performed which showed a macerated appendix with a 4-cm long fish bone within. The role of diagnostic tools in managing RIF mass and the treatment modality of appendicular mass are discussed. In managing RIF mass, a surgeon must be aware of the<br>various differential diagnoses, but common diagnosis should always be entertained. Multi-modal diagnostic tools must be considered, including serial imaging in different planes.</p> <p><strong>Keywords</strong>: Appendicitis, Right iliac fossa mass, Fish bone </p> Ahmad Ibrahim Yahaya Ismail Burud Jasiah Zakariaa Copyright (c) 2021-02-09 2021-02-09 18 1 59 62 10.4314/aas.v18i1.11 Spontaneous Temporal Lobe Encephalocele Within the Sphenoid Sinus <p>Encephaloceles are herniation of cranial content arising from a skull defect. Encephaloceles of the lateral wall of the sphenoid sinus (ELWSS) are&nbsp; uncommon events. In most cases, these cranial hernias are secondary to trauma and craniofacial surgery. Spontaneous forms are even<br>rarer and not well understood. The most adopted hypothesis is a persisting Sternberg’s canal, an embryonic remnant connecting the middle cranial fossa and the nasopharynx. ELWSS are usually revealed by cerebrospinal fluid (CSF) leak. Diagnosis of this disease necessitates quick management due to the potential of lethal complications such as meningitis. We report the case of a spontaneous ELWSS in a 53-year-old woman revealed by CSF leak which was successfully managed with a conventional transcranial approach. We focus on the clinical aspect and pathogenesis of the disease, and discuss the main possible surgical approaches.</p> <p><strong>Keywords</strong>: Spontaneous encephalocele, Sphenoid sinus, CSF leak, Transcranial approach </p> Mohammed Dhaha Abdelhafidh Sliman Nadhir Karmeni Sawsen Dhambri Jalel Kallel Copyright (c) 2021-02-09 2021-02-09 18 1 63 66 10.4314/aas.v18i1.12