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Abstracts of Papers Presented at the Annual Scientific Conference of the Association of Surgeons of East Africa Held in Lusaka, Zambia on 5&To Pbecember 2001

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Abstracts of Papers Presented at the Annual Scientific Conference of the Association of Surgeons of East Africa Held in Lusaka, Zambia on 5&To Pbecember 2001 Abstracts of papers presented at the annual scientific conference of the Association of Surgeons of East Africa held in Lusaka, Zambia on 5&to Pbecember 2001. GENERAL SURGERY Should all hernias undergo elective surgery? Stefan Post, Professor and Chairman of Surgery, University Hospital Mannheim, University of Heidelberg, Germany. It is generally accepted in the international Short-stay thyroidectomy: surgical community that all inguinal hernias Trends in length of post-operative should be operated electively unless the patient hospitalisation over a period of ten is extremely old or frail. However, the main years in a developing country central argument rests on the risk of strangulation despite the fact that little is known about the actual risk Hospital. in a particular patient. K L Erzingatsian This study presents a risk calculation based on a few Professor of Surgery, UTH. historical reports dealing with the risk of incarceration P 0 Box 50110, Lusaka, Zambia. and on contemporary epidemiological data from Germany. Three strategies are presented: prophylactic Short-stay surgery is an established form of patient indication on principle (A), elective operation in every management in the developed countries. There is little second case (B) and operation in case of strangulation published on the subject from the developing world. only (C). It is calculated that for the male German This paper describes the personal experience of short- population aged 65 years and above 69954 (A), 36292 stay thyroidectomy over a period of 10 years. It is a (B) and 2630 (C) inguinal hernia repairs would be retrospective study on the work carried out in the necessary annually; 167 (A), 145 (B) and 123 (C) Department of Surgery, University Teaching Hospital, perioperative death would occur associated with 1702 Lusaka. Seventy-nine consecutive thyroidectomy (A), 1373 (B) and 1048 (C)years of life lost respectively. patients were included in the study. There were 65 Thus operation of every inguinal hernia would even female and 14 male patients with an average of 38n result in a (small and negligible) reduction of life years. ~enerdanaesthesiawas used in 60 pauents and expectancy. These data provide evidence that that in 19 had local anaesthesia. Type of operation included elderly patients, the indication to operate inguinal subtotal (32), lobectomy (28), total (5), near total (3) hernias should depend upon symptoms and suffering. and various other operations (11). Malignancy was In Europe there is no reason to operate asymptomatic diagnosed in nine patients. Minor cases because of a presumed risk of strangulation. post-operative complications occurred in16 patients These figures change dramatically in an environment and airway related difficulties were noted in eleven, like rural Africa where the mortality of a strangulated seven of who h2cl temporary voice change. There were hernia is much higher thus increasing the need for four tracheostomies performed, two permanent ones prophylactic surgery. before thyroidectomy and two temporary ones post- operatively. There was no record of iatrogenic Conclusion: permanent recurrent nerve palsy. Four patients had Contrary to current practice health policy should thyrotoxicosis one of which developed a thyroid crisis. encourage less hernia repair in industrialized countries Another patient developed hypocalcaernic crisis. There and probably more hernia repairs in rural Africa. was no post-operative mortality. Seventy-sevenpatients were followed-up and there were three readmissions, performed in the Department of Surgery of the two with terminal cancer and one with hypocalcaemic University Teaching Hospital between 1987 and 2000. crisis. The length of stay varied between 4.1 days early in the series to 1.3 days in 1999. Short-stay throidectomy The operative management is gven in detail including offers advantages and is safe where expertise is anaesthetic considerations, oropharyngeal packing, available. Early review following hospital discharge is positioning, the type of incision used, resection of the recommended. mandible, vascular control, the technique of reconstruction used by the author and the type of wound closure. General anaesthesia was administered FNAC of breast lumps in the for mandibulectomy and local anaesthesia for University Teaching ~ospital,Lusaka, tracheostomies. Elective tracheostomy was performed Zambia. in 22 patients as first step, followed by the mandibulectomy. The oropharynx was packed with Kasonde Bowa, iodinated cotton gauze as a routine. Patients were Department of Surgery, University restrained on the operating table with a belt to maintain Teaching Hospital, Lusaka. a reverse Trendelenburg position. The operative approach was lip splitting in 34 and submandibular This was a prospective study done to assess fine needle alone in 16. mandibular resection for lateral body aspiration cytology (FNAC). As a diagnostic tool in tumours started with division of bone at the ipsilateral the investigation of breast lumps in the University parasymphysis. Resection required control of the Teaching Hospital. Though this method is inexpensive inferior dental vessels either within the mandibular canal and has been shown to be highly accurate, it is not in or above the foramen. Troublesome bleeding from common use. pterygoid plexus of veins sometimes created Seventy-three female patients from surgical outpatients difficulties. Carotid vessels control and/or ligation of clinic were included in the study. Their average age the external carotid were rarely required and were done was 25 years. Most of the lumps were clinically benign in 10% of patients during the first few years of the (71%). All the patients consented to FNAC but only series. Twenty-three patients underwent 49% went on to have histopathological diagnosis. Of hemimandibulectomy, 14 segmental and 13 had all these, 31% were malignant while 69% were benign. various other operations. Half the patients were The average age of patients with malignant lumps was reconstructed with wire implant. The implant was 30 years while that of benign was 24 years. Patients buried deep to the pharyngeal dilators by using 4/0 above 25 years had a higher likelihood of malignancy nylon in three layers. The mucosa and the muscle layers than those below 25. In this study, it was found that were closed separately. The mucosa was closed with FNAC had a sensitivity of 73% and a specificity of catgut 2/0 or 3/0 everting stitches and the muscle layer 96%. This level of accuracy compares favourably with with a running suture. Skin was closed with vertical that reported in centres in the United Kingdom and mattress continuous suture preferably using absorbable meets the quality assurance requirements mono filament. Drains were not routinely used. The recommended for the United Kingdom. FNAC was found to be a safe and accurate method of screening commonest tumour excised was amelablastoma in 22 and investigating breast lumps in the University Teachmg patients. The most common complication was sepsis Hospital. Guidelines for its use in the Hospital are given in 21 patients. Three implants removed for exposure, fracture and migration. ONCOLOGY Mandibulectomy: Genetic epidemiological aspects of Technical consideration in 50 gastric cancer in Iceland. mandibulectomies. A personal series. A KIrnsland, BJ Eldon, S hijamarson et d, K L Erzingatsian, Iceland Professor of Surgery, University Teaching Hospital, Lusaka, Zambia. Purpose To describe genetic epidemiological aspects of gastric This paper describes the technique of mandibulectomy cancer in Iceland. as used by the author in a series of fifty patients with Background: associations between gastric cancer and large mandibular tumours. The operations were environmental factors e.g. diet and infections have been established and somatic genetic changes are well to be late. Investigations available will determine the described in adenocarcinomas of the stomach. Less is ability of early diagnosis or otherwise. We are now known regarding clinical features of hereditary gastric able to do, in addition to plain X-rays, C.T. scans, MRI cancer and whether other malignancies are associated scans and radio isotopic scans. Immunological studies with family clustering. such as HEGFR2 are still not available. Treatment has continued to be biopsy, amputation and adjuvant Methods chemotherapy of various combinations having high Family trees of all patients diagnosed with gastric cancer dose methotraxate as a major component. In Kenya in Iceland between 1955 and 1999 were identified in patients and parents are becoming increasingly reluctant the Genealogical Database of the University of Iceland. to accept amputation. In developed countries 90% of Probands with age of onset <60 years were used in all cases are treated with limb sparing surgery. the study. Families of all probands (N = 455 males and 161 females) all reported cancers were identified. Is this practical in developing The expected number of cases was calculated using countries? the age specific population rates in Iceland. Presented here are a number of osteosarcoma cases I Results treated and one case in which limb sparing operation was done and the problems that were encountered. A relative risk (RR) of 2.2 (95% C1-1.6 - 3.0) and 1.3 (95% C1 = 1.0 - 1.7) for the gastric cancer risk was observed was observed among 2846 first and 8658 second degree relatives of male probands respectively. INFECTIONS For female probands the correspondmg RR was 1.6 (95% Cl = 1.1 - 2.6)
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