RESUMEN
OBJECTIVE: To evaluate the challenges and outcome of management of large abdominal wall hernias in a resource limited environment and highlight the options available to surgeons in similar conditions. DESIGN: A review of prospectively collected data on large abdominal wall hernias managed between 2003 and 2009. SETTING: University of Nigeria Teaching Hospital, Enugu, Nigeria and surrounding hospitals. SUBJECTS: Patients with hernias more than 4 cm in their largest diameter, patients with closely sited multiple hernias or failed previous repairs and in whom the surgeon considers direct repair inappropriate. OUTCOME MEASURES: Demographics of patients with large hernias, methods of hernia repair, recurrences, early and late complications following the repair. RESULTS: There were 41 patients, comprising 28 females and 13 males with ages 14 - 73 years. Most (53.7%) were incisional hernias. Gynecological surgeries (66.7%) were the most common initiating surgeries. Fifteen of the patients (36.6%) have had failed previous repairs, 41.5% were obese, five patients presented with intestinal obstruction. Thirty nine of the hernias were repaired with prolene mesh, one with composite mesh and one by danning technique. Most of the patients had extra peritoneal mesh placement. Three patients needed ventilator support. After a mean follow up of 18.6 months, there was a single failed repair. Two post op deaths were related to respiratory distress. There were 12 wound infection and 8 superficial wound dehiscence, all of which except one resolved with dressing. One reoperation was done following mesh infection and extrusion. CONCLUSION: Large abdominal wall hernia repair in resource limited environments present several challenges with wound infection and respiratory distress being the most notable. Surgeons who embark on it in these environments must be prepared t o secure the proper tissue replacement materials and have adequate ventilation support.
Asunto(s)
Hernia Abdominal/cirugía , Complicaciones Posoperatorias/cirugía , Mallas Quirúrgicas , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Recurrencia , Reoperación , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/cirugía , Técnicas de Sutura , Resultado del Tratamiento , Adulto JovenRESUMEN
Increasingly, many institutions and surgical groups are resorting to laboratory simulations when teaching surgical skills. The Association of Surgeons of Great Britain and Ireland partnered with the West African College of Surgeons and Johnson and Johnson Corporation to introduce basic surgical skills (BSS) training into West Africa. The local faculty at the University of Nigeria Teaching Hospital, Enugu, was able to use the opportunity of this partnership to establish a regular basic surgical skills training programme. The achievement in Enugu shows that, with a dedicated team of local faculties, giving the local medical trainers a short introduction to the practicalities of organizing and conducting BSS is enough to jump start the programme in resource-poor countries. The Enugu example is a model that should be emulated by centres in other resource-poor countries to make the course a regular feature of their surgical training.
Asunto(s)
Curriculum , Cirugía General/educación , Internado y Residencia/organización & administración , Competencia Clínica , Educación de Postgrado en Medicina , Evaluación Educacional , Humanos , Intercambio Educacional Internacional , Nigeria , Evaluación de Programas y Proyectos de SaludRESUMEN
Cystosarcoma Phyllodes is an uncommon disease of the breast with variable clinical behaviour. Its incidence is reported as 1% of all breast tumours. The occurrence of bilateral disease is very rare. In this communication, we present a case of metachronous bilateral benign cystosarcoma phyllodes presenting in a 24year old nulliparous lady. She had right breast mastectomy after two recurrences following local excision. The left breast lesion developed one year after the treatment of the right lesion, again she had to be treated with mastectomy after 2 recurrences. This case unlike most reported cases of bilateral Phyllodes tumour occurred in a nulliparous lady. The problems of diagnosis, clinical behaviour and management are discussed.