East and Central African Journal of Surgery

Short-term outcomes of thyroid surgery at a regional referral hospital in Ruhengeri, northwest Rwanda: A 1-year retrospective study

Eugene Niyirera — 2022-08-28

Background: In the rural areas of sub-Saharan Africa, goitres are often undertreated due to the limited availability of thyroid surgery in referral hospitals. This study evaluated patient outcomes following surgical treatment for goitres at Ruhengeri Referral Hospital, a resource-limited hospital in northwest Rwanda.

Methods: We reviewed the medical records of patients who were surgically treated for goitres between December 2017 and November 2018. Data were collected on the following variables: patient sex, patient age, date of symptom onset, clinical diagnosis, indication for surgery, laboratory findings, fine needle aspiration findings, imaging findings, surgical procedure, anaesthetic review details, postoperative complications, length of hospital stay, and follow-up findings.

Results: Our analysis included 44 of the 48 patients who underwent thyroid surgery during the investigated period. Four patients who did not have postoperative follow-up visits were excluded from the analysis. The median patient age was 46 years (range, 18-77 years); 42 patients (95.5%) were women, and 2 patients (4.5%) were men. The most common indication for thyroidectomy was multinodular goitre (n=32, 72.7%), causing either pressure symptoms or cosmetic concerns. The most common surgical procedure conducted was subtotal thyroidectomy (n=34, 77.3%), followed by lobectomy (n=6, 13.6%). Two patients (4.5%) who presented with clinical features suggestive of Graves’ disease underwent total thyroidectomy. The average length of hospital stay was 24 hours. No postoperative complications were observed or reported in patients during their hospitalizations or the during the 2 weeks following hospital discharge.

Conclusions: A sizeable number of surgical procedures for goitre were conducted at Ruhengeri Referral Hospital, Rwanda. The absence of short-term postoperative complications suggests that thyroid surgery can be conducted safely in hospitals with limited resources if medical doctors have adequate surgical skills and if patient selection and preparation are properly undertaken.

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Multidisciplinary thyroid disease management in The Gambia: Results of a 6-year multinational collaboration

Saffie Jammeh — 2022-08-28

Background: Thyroid disease remains prevalent in West Africa, with pathogenetic contributions from dietary and genetic factors. Specialist services for the management of thyroid disease were previously unavailable at Serrekunda General Hospital, leaving a considerable unmet need at this large urban referral hospital in The Gambia.

This study sought to document clinical characteristics and outcomes among patients attending a multidisciplinary, collaborative, 1-stop clinic offering surgical and medical management of thyroid disease in The Gambia.

Methods: We retrospectively evaluated demographic, clinical, and outcome data from patients with thyroid disease who were medically or surgically treated from March 2012 through January 2018 by visiting teams representing Medicos en Accion (MEA), a Canadian nonprofit organization. Variables evaluated included history of presenting concern, comorbidities, current medications, thyroid function status, surgical procedure, histopathology, and postoperative outcomes, including surgical complications. Patients were followed up at least biannually; long-term follow-up was defined as ≥1 year after thyroidectomy. A subset of surgical specimens underwent histopathologic analysis.

Results: A total of 352 patients were assessed (331 female; median age, 36 years). Primary diagnoses included toxic multinodular goitre (MNG, 30.6%), nontoxic MNG (37.5%), solitary nodule (8.6%), and Graves’ disease (13.8%). Hyperthyroidism was present in 49.2% of patients at initial assessments, yet only 28.5% of these patients were on appropriate medical therapy. Hypertension was found in 33.8% of all patients, but less than half (42.9%) of these were on treatment at presentation.

Thyroidectomy was performed for 83 patients (23.6%): 35 total thyroidectomies and 48 partial thyroidectomies. At the end of a median follow-up duration of 12 months, all patients were disease-free with reference to their initial surgical indications. Serious postoperative complications occurred in 2 patients, both of whom recovered fully with no long-term sequelae.

Conclusions: This study demonstrated the feasibility of establishing a multidisciplinary thyroid clinic in a low-resource setting, leading to improved access to care and public awareness of thyroid disease, as evidenced by the annual increase in patients managed through the study period at Serrekunda General Hospital. These results provide previously unavailable evidence on the profile of thyroid disease in The Gambia.

Radiofrequency and laser ablation for chronic venous insufficiency: A single-centre, retrospective study at a multispeciality, private hospital in Nairobi, Kenya

C. Shango Irungu — 2022-08-28

Background: Chronic venous disease can be defined as any long-term morphological or functional abnormality of the venous system manifested by symptoms or signs indicating the need for care. There are limited data from sub-Saharan Africa regarding the management of this condition with venous ablation. This is an early report of the experience of a single centre with a relatively new technique.

Methods: We retrospectively reviewed cases of radiofrequency ablation and laser ablation for venous insufficiency between February 2016 and December 2020. Patients were selected based on symptoms; the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification system; and duplex ultrasonographic findings of reflux at the saphenopopliteal junction and saphenofemoral junction. Most procedures were day cases performed under spinal anaesthesia.

Results: There were 139 patients who underwent treatment. Of these, 27% were men, and 73% were women. The majority of patients, 54%, were classified as CEAP C3, with CEAP C5 accounting for the smallest proportion at 7%. Most patients (89%) underwent successful bilateral greater saphenous vein thermal ablation, and 53% underwent bilateral greater and lesser saphenous
vein thermal ablation.

Conclusions: Venous ablation therapy is a safe, efficacious, day procedure associated with rapid recovery.

A retrospective analysis of operative outcomes of symptomatic biliary stone disease at 2 referral hospitals in Addis Ababa, Ethiopia

Henok Seife — 2022-08-28

Background: Gallstone disease (also known as cholelithiasis) is a significant health problem in high-income countries, and while it is thought to be uncommon in Africa, cholelithiasis is currently diagnosed significantly more frequently than would be expected from previous studies. We assessed the magnitude of this disease and its associated surgical outcomes in Addis Ababa, Ethiopia.

Methods: We retrospectively analysed the medical records of patients encountered from 1 January 2015 through 31 December 2017 at the general surgery units of Tikur Anbessa Specialized Hospital and Zewditu Memorial Hospital—both in Addis Ababa. All necessary data from the patients’ charts were collected and collated via a pretested structured data collection form. Data were analysed using SPSS Statistics for Windows, version 20.

Results: Our analysis included 317 patients. Nearly half (49.4%) were between 36 and 55 years of age. The chief complaint of most patients (92.1%) was right upper quadrant abdominal pain. Open cholecystectomy and/or biliary surgery was performed on 298 patients (94.0%), while the other patients underwent laparoscopic cholecystectomies. Thirty-four per cent of the patients presented with at least 1 comorbidity, including hypertension (n=46, 14.5%) or HIV infection (n=33, 10.4%). Postoperative complications were reported in 10.4% of patients; these included wound infection (n=23, 7.3%), pneumonia (n=8, 2.5%) and biliary leakage (n=3, 0.9%). No deaths were reported.

Conclusions: Open surgery remains the commonest procedure used to treat symptomatic cholelithiasis at these 2 centres. In the absence of routine laparoscopic services, open cholelithiasis surgery is a safe and effective treatment option.

Craniometry of Nigerian skulls: A cadaveric study and review of the literature

Adeola A. Olusanya — 2022-08-28

Background: There have been several studies on clinical craniometry, particularly cephalic indices. However, published reports on the anatomical cranial indices of Nigerian anatomical specimens are scarce. This work aimed to add to the body of knowledge on the cranial indices of Nigerian skulls as well as review the literature on both Nigerian cranial and cephalic indices.

Methods: Sixty-eight adult skulls of unidentified gender were assessed, 61 of which had intact craniums and were included in the analysis. The skull specimens were placed in the Frankfurt plane, and standard craniometric measurements were obtained to the nearest millimetre using digital spreading and sliding callipers. The cranial index was calculated from the maximum cranial length and breadth, which was measured using standard anthropometric techniques.

Results: The mean cranial index was 74.1±5.6 mm, and the most common skull type was dolichocephalic. Twenty-three Nigerian articles were identified from the literature search, and only 3 were on anatomical specimens. The mesocephalic skull type was the most commonly documented in both the northern and southern parts of Nigeria, while the least common were the brachycephalic skull type in southern Nigeria and the dolichocephalic skull type in northern Nigeria.

Conclusions: The skull types of Nigerians appear to be more mesocephalic than dolichocephalic, and in regions where dolichocephalic values were obtained, more recent values show a tendency towards brachycephalization.

Complications arising from circumcisions performed by untrained providers: 5 cases managed at a tertiary paediatric surgery unit in Addis, Ababa, Ethiopia

Samuel Negash — 2022-08-28

Complications of circumcision are usually minor. Major complications with prolonged morbidity are rarely reported in well-resourced settings. However, unsafe circumcision is a problem in low-income countries. In this article, we share our recent experiences with this issue.

We illustrate the problem with 5 cases encountered at our institution in 2019. That patients in this series ranged from 2 months to 9 years of age, and 4 of the 5 patients were at least 5 years old. Four of the circumcisions were performed by traditional healers, and 1 was performed by an inadequately trained doctor. Phimosis is the most frequent complication. As described in the first case, phimosis presenting after traditional circumcision is often severe, with repair requiring general anaesthesia. The second child had an unusual presentation: incontinence due to severe meatal stenosis, which resulted in urinary obstruction and urethral calculi. The third child presented with the rare complication of a urethrocutaneous fistula arising from suture ligation obliterating the urethral lumen. Finally, 2 additional rare cases of complete glanular amputation are described.

A variety of complications occurred after circumcisions performed as part of traditional practice as well as by inexperienced providers. The scenario is worsened by late presentations to medical institutions. In our experiences, the delays further complicated management, as phimosis was not amenable to topical steroids, amputated glandes could not be primarily reattached, and simple meatal stenosis progressed to severe obstruction. Extensive work is required to train traditional healers in rural parts of the country.

Zinner syndrome detected as an incidental ultrasonographic finding in a 38-year-old Rwandan man

Emmanuel Kiniga — 2022-08-28

Congenital lesions of the seminal vesicles are rare. Zinner syndrome is an uncommon congenital syndrome comprising seminal vesicle cysts with unilateral renal agenesis and ipsilateral ejaculatory duct obstruction. Patients can be asymptomatic or present with symptoms, usually between the ages of 11 and 40 years. The clinical presentation is nonspecific but abdominal pain, pelvic pain, urinary irritation symptoms, and infertility have been reported previously. Diagnosis is mainly through computed tomography and magnetic resonance imaging. The management strategy for Zinner syndrome depends on the severity of symptoms and the size of the cysts. Small and asymptomatic cysts are managed conservatively. Surgical management can proceed through open, laparoscopic, or robotic approaches. Herein, we present a rare case of Zinner syndrome managed at a private multispeciality hospital in Kigali, Rwanda.