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Context: The advent of surgical energy devices has brought innovations with their use in thyroid surgeries. Despite the widespread use of Harmonic scalpel for decades since its inception in developed countries, there is a paucity of its use in low-resource countries. This report represents our early experience with Harmonic scalpel thyroidectomy in a low-resource setting. Subjects and Methods: A 16-month audit (June 2018 – September 2019) of thyroid surgeries in a tertiary/referral health facility in South-south, Nigeria was carried out. Eleven patients underwent harmonic scalpel thyroidectomy, however, only 10 patients had complete records and were included in the study. Relevant data including age, sex, pre-operative diagnosis, type of surgery, duration of surgery, blood loss, complication and duration of hospital stay were analyzed using IBM corporation Statistical Package for the Social Sciences (SPSS) statistics for windows, version 21.0. Armonk, New York, United States of America. Results: Median age was 36 years, 9 were female, most had non-toxic multinodular goitre (40%). Procedures include lobectomy/isthmusectomy (40%), subtotal thyroidectomy, near-total thyroidectomy, total thyroidectomy (20% each. Mean duration of surgery was 83.5±23.1mins. Mean Estimated Blood Loss was 145.0±76.2mls while 90% had mild pain. Weight of thyroid gland ranged from 99 – 420g with a median weight of 300g. Mean duration of hospital stay was 3.1±0.99 days. Transient voice change was noted in 10% of patients. These values were significantly lower than those obtained for conventional thyroidectomy during the period (one-sample t-test, p

Background: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these., Method: We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality., Results:  1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality., Conclusions: This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality., (© 2024. Crown.)

Background: Colonoscopy is an important armamentarium in the investigation of haematochezia. Patients with haematochezia are very anxious about the presence of blood in their faeces. They are usually referred for diagnostic colonoscopy based on the presence of blood in stool or anaemia., Aims/objectives: To highlight the causes of haematochezia in patients over a 9-year prospective period in the Premier tertiary health centre in the South-South zone of Nigeria., Materials and Methods: All Consecutive patients seen in our surgical services (June 1, 2009, to May 30, 2018) requiring colonoscopy for haematochezia were entered into a proforma. The demographics, findings at colonoscopy, and outcome of colonoscopy were analysed., Results: Three hundred and sixty-five colonoscopies were done during the study period; of these, 44% (160 patients) had a colonoscopy for haematochezia. Mean age of patients was 54.7 years. Age range was 16-86 years. Cluster age group was fifth to seventh decade (62.5%). The male-to-female ratio was 2:1. Causes of haematochezia were Haemorrhoids 32.5%, large bowel cancer 23.8%, diverticular disease 10%, inflammatory disease of the bowel 6.3%, polyps 3.8%. About 15% of the patients had more than one colonic site of bleeding. The most common subsites for colon cancer were rectum and sigmoid colon (79.6%), in 11 patients (6.8%) was the tumour within reach of the examining finger. Repeat colonoscopy occurred in 3 patients (0.8%). The most common complication of colonoscopy was bleeding (0.8%). Two patients (0.5%) had colonic perforation., Conclusion: Forty-four percent (44%) of colonoscopy in Benin, South-South Nigeria has haematochezia as its indication. The cluster age group is the fifth to seventh decade. One in four patients had colon cancer and in 6.8% the tumour was within reach of the examining finger. It is the authors' opinion that colonoscopy should be routinely done in patients with haematochezia in South-South Nigeria., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of the west African college of surgeons.)

Background: It is well documented that inappropriate use of antimicrobials is the major driver of antimicrobial resistance. To combat this, antibiotic stewardship has been demonstrated to reduce antibiotic usage, decrease the prevalence of resistance, lead to significant economic gains and better patients' outcomes. In Nigeria, antimicrobial guidelines for critically ill patients in intensive care units (ICUs), with infections are scarce. We set out to develop antimicrobial guidelines for this category of patients., Methods: A committee of 12 experts, consisting of Clinical Microbiologists, Intensivists, Infectious Disease Physicians, Surgeons, and Anesthesiologists, collaborated to develop guidelines for managing infections in critically ill patients in Nigerian ICUs. The guidelines were based on evidence from published data and local prospective antibiograms from three ICUs in Lagos, Nigeria. The committee considered the availability of appropriate antimicrobial drugs in hospital formularies. Proposed recommendations were approved by consensus agreement among committee members., Results: Candida albicans and Pseudomonas aeruginosa were the most common microorganisms isolated from the 3 ICUs, followed by Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. Targeted therapy is recognized as the best approach in patient management. Based on various antibiograms and publications from different hospitals across the country, amikacin is recommended as the most effective empiric antibiotic against Enterobacterales and A. baumannii, while colistin and polymixin B showed high efficacy against all bacteria. Amoxicillin-clavulanate or ceftriaxone was recommended as the first-choice drug for community-acquired (CA) CA-pneumonia while piperacillin-tazobactam + amikacin was recommended as first choice for the treatment of healthcare-associated (HA) HA-pneumonia. For ventilatorassociated pneumonia (VAP), the consensus for the drug of first choice was agreed as meropenem. Amoxycillin-clavulanate +clindamycin was the consensus choice for CAskin and soft tissue infection (SSIS) and piperacillin-tazobactam + metronidazole ±vancomycin for HA-SSIS. Ceftriaxone-tazobactam or piperacillin-tazobactam + gentamicin was consensus for CA-blood stream infections (BSI) with first choice+regimen for HA-BSI being meropenem/piperacillin-tazobactam +amikacin +fluconazole. For community-acquired urinary tract infection (UTI), first choice antibiotic was ciprofloxacin or ceftriaxone with a catheter-associated UTI (CAUTI) regimen of first choice being meropenem + fluconazole., Conclusion: Data from a multicenter three ICU surveillance and antibiograms and publications from different hospitals in the country was used to produce this evidence-based Nigerian-specific antimicrobial treatment guidelines of critically ill patients in ICUs by a group of experts from different specialties in Nigeria. The implementation of this guideline will facilitate learning, continuous improvement of stewardship activities and provide a baseline for updating of guidelines to reflect evolving antibiotic needs., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2023 by West African Journal of Medicine.)

Background: Gastric carcinoma is usually characterized with significant morbidity and mortality mainly because of late presentation. Late presentation of gastric carcinoma is a prominent feature in developing and poor countries., Aim of Study: The purpose of this study is to present our experience with the pattern and outcome of gastric tumors at the University of Benin Teaching Hospital, Benin City, Nigeria; with emphasis on late presentation of the patients., Patients and Methods: The case files of the patients that were managed at the University of Benin Teaching Hospital for gastric tumors over a 5-year period (January 2004 to December 2006) were analyzed for biodata, symptoms and signs of disease, findings at operation, treatment offered, and outcome of treatment., Results: The male/female ratio was 2.3:1, with the youngest patient being 38 years while the oldest patient was 76 years old. Upper abdominal pain and a palpable mass per abdomen were the commonest symptoms and signs, respectively. Alcohol ingestion was the commonest identifiable risk factor. Only 30.4% of the patients presented within a year of the onset of symptoms. The gastric antrum was affected in over 78% of the cases, and adenocarcinoma was found in about 90% of the patients. Partial gastrectomy with gastrojejunostomy was the commonest procedure carried out. The mortality rate was 39.1%, and of the patients that died, 66.7% occurred within a year from time of diagnosis., Conclusion: Most of the cases of gastric carcinoma presented in this study presented late with associated significant mortality. Health education is advised with a view to encouraging early presentation.

Background: In many centers in sub-Saharan Africa, adults and children aged over 12 years with indirect inguinal hernias are treated with Bassini's herniorrhaphy with many avoidable complications. The objective of this study was to determine the applicability of herniotomy in patients aged between 12 and 45 years., Methods: A prospective study was carried out on patients aged between 12 and 45 years with indirect inguinal hernias who were treated with herniotomy at the Leadeks Medical Center, Benin City, Nigeria, between January 2002 and December 2007., Results: A total of 316 patients aged between 12 and 45 years (mean 25 +/- 5.3 years), comprising 305 males and 11 females with a male:female ratio of 27.7:1, had 326 herniotomies, which accounted for 27.5% of pediatric operations during the study period. Two hundred and eighty-three (86.8%) patients had elective while 43 (13.2%) had emergency surgery following features of obstruction and strangulation, with a mean duration of surgery of 30 min (range 20-40 min). All of the patients were operated on day case with a mean observation period of 8 +/- 3.5 h (range 2-24 h), and no significant immediate postoperative complication was recorded. Postoperative pain was extremely statistically significant in those cases that had strangulation before operation (P < 0.0001), but paracetamol was an adequate analgesia. The patients resumed normal duties between 5 and 14 days after repair and have been followed up for 1-5 years, with one (0.3%) patient, who was also being treated for chronic cough, who had recurrence 3 years after operation., Conclusion: Herniotomy was found to be safe, applicable, beneficial, and cost-effective in this age group, with many advantages over Bassini's herniorrhaphy.