Annals of African Surgery https://www.ajol.info/index.php/aas <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 – sskenya2000@gmail.com 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="https://creativecommons.org/licenses/by/4.0/" href="https://creativecommons.org/licenses/by/4.0/" 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="https://www.annalsofafricansurgery.com/File+download/302/AAS+Author+Agreement+2.0.pdf" href="https://www.annalsofafricansurgery.com/File+download/302/AAS+Author+Agreement+2.0.pdf" 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> Eye Surgery in Africa https://www.ajol.info/index.php/aas/article/view/210970 <p>No Abstract.</p> Abba Hydara Copyright (c) 2021-07-20 2021-07-20 18 3 126 129 10.4314/aas.v18i3.1 Barriers and Facilitators to Uptake of Prostate Cancer Screening in a Kenyan Rural Community https://www.ajol.info/index.php/aas/article/view/210971 <p><strong>Background</strong>: Prostate cancer (PC) is curable with early detection, yet it remains a major public health problem globally and a leading&nbsp; cause of mortality among men. The objective of the study was to explore the barriers and facilitators to the uptake of prostate cancer screening among men aged 40–69 years in a rural community in Kenya.</p> <p><strong>Methods:</strong> We utilized an explorative qualitative design and purposive sampling to select participants. Six focus group discussions (FGDs)&nbsp; and seven in-depth interviews were conducted among 59 men aged 40–69 years and key informants in Kiambu County, Kenya. Data was collected using a semi-structured guide and content analysis was done.</p> <p><strong>Results:</strong> The facilitators of screening included experience of symptoms, proximity and prominence of cancer, accessibility, and advocacy. The barriers to screening included lack of knowledge, fatalistic beliefs, low risk perception, stigma, and male dominance factors.</p> <p><strong>Conclusion</strong>: This study provides vital information for the development of interventions to enhance shared decision-making in regard to PC screening. Capacity building of clinicians, task shifting and provision of well-coordinated affordable culturally sensitive screening services should be explored. The concerted effort among policy makers and all health care workers to overcome the stated barriers to&nbsp; screening is highly recommended.</p> <p>&nbsp;</p> Ruth Gathoni Mbugua Simon Karanja Sherry Oluchina Copyright (c) 2021-07-20 2021-07-20 18 3 130 136 10.4314/aas.v18i3.2 Indications and Outcomes of Corneal Transplant Surgery in Ghana https://www.ajol.info/index.php/aas/article/view/210976 <p><strong>Background:</strong> Corneal blindness contributes to 25% of all blindness. We review corneal transplant, a common surgical remedy, in Ghana to determine indications and visual outcomes in resource-poor environments.</p> <p><strong>Methods:</strong> A retrospective cross-sectional study of keratoplasty evaluating indications, pre- and postoperative outcomes complications and&nbsp; their associations, between January 2014 and December 2018 at a teaching&nbsp; hospital in Ghana. Descriptive statistics and McNemar’s test were used for the analyses.</p> <p><strong>Results</strong>: Seventy-five eyes were studied. The mean ± standard deviation (SD) age of patients was 45.08 ± 17.85 years, the majority being 20–39 years (58.7% were male). Pseudophakia bullous keratopathy (PBK) was the commonest indication for keratoplasty (26.7%) followed by keratoconus (21.3%). Preoperatively 96% of eyes were blind with vision &lt;3/60 with 64% out of the total eyes with vision &lt;1/60. Postoperatively, 60% of all grafts had uncorrected vision of 3/60 or better after the last follow-up. McNemar’s test revealed a statistically&nbsp; significant difference between postsurgical and pre-surgical visual acuity (VA) (p &lt; 0. 001). The median follow-up period was 12 months. The commonest postsurgical complication was raised intraocular pressure (IOP) (22.7%) with a total of 14.7% of grafts failures.</p> <p><strong>Conclusion</strong>: In this setting, PBK is the leading indication for corneal transplant. Visual outcomes for corneal transplant in this&nbsp; resource poor area are not worse than in other settings. We need to pay attention to corneal transplant services to cater for the expected increase&nbsp; in PBK from the increasing cataract surgical rate.</p> Seth Lartey Ellen Konadu Antwi-Adjei Abdul Kabir Mohammed Emmanuel Owusu Poku Copyright (c) 2021-07-20 2021-07-20 18 3 137 142 10.4314/aas.v18i3.3 Comparison of the Outcomes of Manual Small Incision Cataract Surgery (MSICS) and Phacoemulsification (PHACO) in Ghana https://www.ajol.info/index.php/aas/article/view/210980 <p><strong>Background</strong>: The growing middle-class population of Ghana has seen more people being employed in visually demanding occupations&nbsp; and hence there is an increased desire for quality post-cataract surgical visual outcomes. This study aimed at comparing the outcomes of manual small incision cataract surgery (MSICS) and phacoemulsification (PHACO) among Ghanaians.</p> <p><strong>Methods</strong>: This was a retrospective cross-sectional study in which records of patients who underwent MSCIS or phacoemulsification by the same surgeon were reviewed.</p> <p><strong>Results:</strong> Medical records of 248 eyes were reviewed, out of which 132 underwent PHACO and 116 had MSICS. A significant number of the&nbsp; PHACO group had good (6/6–6/18) uncorrected visual acuity (UCVA) compared to the MSICS group at 1–2 weeks follow-up (p = 0.003) and 4–6 weeks follow-up (p = 0.002). MSICS resulted in a higher total astigmatic change compared to PHACO (p &lt; 0.001). The PHACO group<br>had a higher number of postoperative complications compared with the MSICS group (p &lt;0.001). Postoperative borderline and poor&nbsp; uncorrected visual acuity were associated with age, total astigmatic change, and postoperative complications.</p> <p><strong>Conclusion:</strong> The postoperative UCVA outcomes at 4–6 weeks’ follow-up indicates that PHACO resulted in noticeably less spectacle dependency when compared to MSICS. </p> Samuel Kyei Ebenezer Zaabaar Frank Assiamah Michael Agyemang Kwarteng Kofi Asiedu Copyright (c) 2021-07-20 2021-07-20 18 3 143 149 10.4314/aas.v18i3.4 Pattern and Outcome of Splenic Injury in Children https://www.ajol.info/index.php/aas/article/view/210982 <p><strong>Background</strong>: The spleen is the most frequently injured organ in abdominal trauma. The aim of this study was to evaluate the pattern and management outcome of splenic injury in children in a tertiary hospital.</p> <p><strong>Methods</strong>: This was a retrospective study of children treated for splenic trauma at the Pediatric Surgery Unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. The medical records of the patients over a 10-year period were evaluated.</p> <p><strong>Results</strong>: There were 61 cases of splenic trauma of which 72.1% were male. Their ages ranged from 4 to 14 years with a median of 10 years. Road traffic accident and fracture were the most common mechanism of injury and associated injury respectively. The majority had grade III splenic injury and nonoperative management was the predominant modality of treatment. Operative procedures included splenectomy and splenorrhaphy. Mortality occurred in two (3.3%) patients.</p> <p><strong>Conclusions</strong>: Splenic injury can be associated with significant morbidity and mortality. Road traffic accidents are a common cause of&nbsp; splenic injury and nonoperative management is an effective modality of treatment.</p> Kevin Emeka Chukwubuike Copyright (c) 2021-07-20 2021-07-20 18 3 150 154 10.4314/aas.v18i3.5 Association Between Serum Sodium Abnormalities and Clinicoradiologic Parameters in Severe Traumatic Brain Injury https://www.ajol.info/index.php/aas/article/view/210984 <p><strong>Background</strong>: Secondary brain insults after traumatic brain injury such as electrolyte dysfunctions are associated with poor outcomes. This study aimed at determining the incidence of serum sodium ion abnormalities and their association with clinicoradiological parameters.</p> <p><strong>Methods:</strong> A prospective crosssectional study of one hundred and seventeen patients with severe head injury. Data collected included patient demographics, prehospital interventions, clinical examination findings, computed tomography (CT) scan head findings, serum sodium ion levels (at admission and 48 h later), and outcome (30 days).</p> <p><strong>Results:</strong> At admission, 93(79.5%) patients had normal serum sodium ion levels. However, 48 h post-admission, hypernatremia was&nbsp; prevalent in 56(63.6%) patients (p &lt; 0.001). Hypernatremia was significantly associated with the use of mannitol (p = 0.036), lower Glasgow&nbsp; Coma Score (p = 0.047), higher Injury Severity Score (p = 0.015), presence of subdural hematoma (p = 0.044), midline shift &gt;5 mm (p = 0.048), compressed/absent basal cistern (p = 0.010), and higher Rotterdam CT Score (p = 0.003). Hypernatremia reported 48 h&nbsp; postadmission was associated with a high 30-day mortality rate [odds ratio (OR) 3.55, p = 0.0095]. Risk of mortality associated with hyponatremia and hypernatremia at admission was not statistically significant.</p> <p><strong> Conclusion</strong>: While both hyponatremia and hypernatremia can occur in serious TBI patients, hypernatremia predominates 48 hours post- admission and is associated with statistically significant increased risk of death. </p> Philip Mwachaka Angela Amayo Nimrod Mwang’ombe Peter Kitunguu Copyright (c) 2021-07-20 2021-07-20 18 3 155 162 10.4314/aas.v18i3.6 Review of Histology Results of Hand Masses: A South African Audit https://www.ajol.info/index.php/aas/article/view/210987 <p><strong>Background</strong>: Patients with hand masses present for consultation either for pain, loss of function, or cosmetic embarrassment caused by the mass. The majority of hand masses are benign soft tissue tumors. The aim was to review the histology results of hand masses operated on at the Chris Hani Baragwanath Academic Hospital Hand Unit in Johannesburg, South Africa, to explore the relationship of the types of masses according to age, sex, side, and compare the findings with what is in the current literature.</p> <p><strong>Methods</strong>: Patients operated on in the hand unit, for hand masses between April 2016 and April 2019 with histology results were included in the study for statistical&nbsp; analysis.</p> <p><strong>Results</strong>: There were 64 males and 105 females with a mean age of 41.03 ± 18.81 years. The most frequent masses were ganglion cysts.&nbsp; Females appeared to be more affected than males by the different hand masses, but there were no statistically significant differences. Of the 21 giant cell tumors, 15 occurred on the right hand (p-value = 0.021).</p> <p><strong>Conclusion:</strong> The profile of hand masses at a high-volume hand unit in Johannesburg, were comparable to the reported literature. There&nbsp; were no significant differences between sex and diagnosis, however, there was a relationship between diagnosis and side for giant cell tumors of tendon sheaths, requiring further exploration. </p> Christian Vyamungu Pascaline Fru Tatolo Sefeane Cynthia Sathekga Elias Ndobe Copyright (c) 2021-07-20 2021-07-20 18 3 163 169 10.4314/aas.v18i3.7 Objective Measurement of Impact of Bench Laparoscopic Training in Novices https://www.ajol.info/index.php/aas/article/view/210989 <p><strong>Background:</strong> We are currently in the era of laparoscopic surgery. It has gained popularity in the last few decades because of its well- known advantages. Laparoscopy requires different skills from those of open surgery. In a paradigm shift, learning basic surgical skills is now performed more in the skills laboratory than in the operation theater. However, there is a lack of reliable training and assessment tools for laparoscopic surgical skills. This study aimed to objectively assess the effect of bench laparoscopic training in novices.</p> <p><strong>Methods</strong>: This prospective study was conducted at the Clinical Skills Centre of Bangalore Medical College and Research Institute (BMCRI) in Bangalore, India. Sixty interns with no previous experience in laparoscopy were included. They underwent supervised training on the box trainer for 3 days, 2 hours a day, in basic surgical&nbsp; tasks, including pointing dots, joining straight lines, joining curved lines, picking objects, peg transfer, and circle cut. All participants were assessed objectively in a virtual reality (VR) simulator before and after training. The objective outcomes measured were time taken, distance traveled, and error scores given by the VR simulator metrics.</p> <p><strong>Results</strong>: The novices showed statistically significant improvement in all the tasks after the training compared with their skill levels before&nbsp; the training.</p> <p><strong>Conclusion</strong>: Structured short-term training significantly improves basic laparoscopic surgery skills.</p> Prashanth Annayyanapalya Thimmegowda Krish Lakshman Rajashekara Reddy Sachin Nale Ravishanka Ravishanka Copyright (c) 2021-07-20 2021-07-20 18 3 170 175 10.4314/aas.v18i3.8 Operative Management and Outcomes of Patients with Sigmoid Volvulus at a Tertiary Public Hospital in Malawi https://www.ajol.info/index.php/aas/article/view/210992 <p><strong>Background:</strong> <em>Sigmoid Volvulus</em> (SV) is a common cause of acute bowel obstruction in Malawi. We aimed to&nbsp; describe the surgical&nbsp; management of SV and its outcomes at Kamuzu Central Hospital, Lilongwe, Malawi.</p> <p><strong>Methods:</strong> We retrospectively reviewed records from January 2019 to December 2019 of all SV patients, aged 18 years and above. Data&nbsp; extracted included age, sex, admission date, surgery date, bowel viability at time of surgery, procedure done, suspected anastomotic leakage, length of hospital stay and mortality. The data was analyzed using STATA 14.0.</p> <p><strong> Results:</strong> There were more males (n= 59, 81.9 %) than females. The median (IQR) age was 50.5 (38-60) years. A viable sigmoid colon was present in 61 (84.7%) patients. The commonest procedures done were sigmoid&nbsp; resection and primary anastomosis (RPA) (59.7%, n=43) and Hartmann’s procedure (HP) (36.1%, n=26). The median length of hospital stay was 5 days in HP, 7 days in RPA and longest in&nbsp; mesosigmoidopexy (10 days). Suspected anastomotic leakage occurred in 2(4.7%) patients. The overall mortality was 6.9% with all deaths occurring in RPA patients.</p> <p><strong>Conclusion</strong>: Mortality is high in SV patients who undergo RPA. We recommend Hartmann’s procedure in cases where the bowel has&nbsp; significant oedema or is gangrenous.</p> Ephraim Bitilinyu-Bangoh Fatsani Mwale Loveness Ulunji Chawinga Gift Mulima Copyright (c) 2021-07-20 2021-07-20 18 3 176 179 10.4314/aas.v18i3.9 Lymphocytic Colitis in Nigeria: A Case Series https://www.ajol.info/index.php/aas/article/view/210994 <p>The term “microscopic colitis” (MC) is used to describe a chronic inflammatory bowel disease that includes two main subtypes based on&nbsp; histopathologic features: collagenous and lymphocytic. Scientific literature is replete with documentation of the disease from various regions of the world. However, the condition is rarely described in black African patients. We herein present the details of the clinical&nbsp; aspects and endoscopic findings of 3 Nigerian patients with the lymphocytic variant of MC. A short literature review of the clinical, endoscopic, and pathologic features of this rare condition as well as other relevant aspects of MC is also presented.<br><br></p> Aderemi Oluyemi Martins Momoh Emuobor Odeghe Samuel Keshinro Copyright (c) 2021-07-20 2021-07-20 18 3 180 184 10.4314/aas.v18i3.10 Unusual Abdominal Wall Abscess Post-Laparoscopic Cholecystectomy https://www.ajol.info/index.php/aas/article/view/210995 <p>Cholecystectomy is the most commonly performed operation worldwide nowadays. Laparoscopic cholecystectomy (LC) is the gold&nbsp; standard treatment of gallstones. We present a case of an 81-year-old male with a 3-months’ history of loss of appetite and weight with no associated symptoms. The patient had undergone an LC for symptomatic cholelithiasis 1 year previously, with an uneventful recovery. The clinical examination was essentially normal. A computed tomography (CT) of the abdomen and pelvis showed thickening of the right&nbsp; perihepatic peritoneum measuring 15 × 15 × 3.5 cm, suggestive of chronic granulomatous lesion or atypical mesothelioma. We performed a diagnostic laparoscopy and found the lesion to be an abdominal wall abscess. The abscess cavity was deroofed, the pus was drained and a thorough wash out given. Surprisingly no stones or any foreign body were found in the cavity. Histology of the abscess wall showed non-specific inflammation. We report this case as a post-LC abdominal wall abscess with two peculiar features – (a) no systemic or local&nbsp; symptoms, and (b) no association with spilt gallstones or other foreign bodies like sutures.</p> <p>&nbsp;</p> Prashanth Annayyanapalya Thimmegowda Krish Lakshman Copyright (c) 2021-07-20 2021-07-20 18 3 185 188 10.4314/aas.v18i3.11 Small Bowel Intussusception due to Multiple Intestinal Metastases from Lung Adenocarcinoma https://www.ajol.info/index.php/aas/article/view/210996 <p>Metastatic small bowel tumors are rare. They often present with small bowel occlusion, bleeding, perforation, or intestinal intussusception. Pulmonary adenocarcinoma with metastasis to the small intestine causing intussusception is exceedingly rare. A 72-yearold male patient with a past medical history of left lung adenocarcinoma, presented to the emergency department with abdominal pain and vomiting. On admission, an X-ray of the abdomen without preparation showed some hydroaeric levels on the small intestine. The abdominopelvic&nbsp; computed tomography (CT) scan revealed an ileo-ileal invagination, with an image of the invagination rod. The patient underwent a&nbsp; surgical resection of the small bowel with the removal of the ischemic areas and immediate anastomosis. Macroscopic examination of the surgical specimen revealed five tumor masses varying in size between 1 and 4 cm. The histological examination of the samples taken from these tumors, coupled with an immunohistochemical study confirmed the diagnosis of intestinal metastases of pulmonary origin&nbsp; expressing cytokeratin 7 (CK7) and thyroid transcription factor 1 (TTF1) but negative for CK20, chromogranin, and synaptophysin. The&nbsp; postoperative course was uneventful, and the symptoms transiently recovered. However, the patient died 3 months later. We should consider multiple metastatic lesions in adult intussusception, especially in patients with a past medical history of lung cancer.</p> <p>&nbsp;</p> Faten Limaiem Saadia Bouraoui Copyright (c) 2021-07-20 2021-07-20 18 3 189 193 10.4314/aas.v18i3.12