Compliance to the South African ventral hernia guidelines: inaugural results from the HIG(SA) registry.

BACKGROUND: The Hernia Interest Group (HIG) of South Africa (SA), following the publication of their inguinal and ventral hernia guidelines (in 2015 and 2016 respectively), developed a hernia registry, the HIG(SA) hernia registry. METHODS: A retrospective analysis of the prospectively maintained HIG(SA) hernia registry from 1 February 2019 to 29 February 2020. Compliance to six recommendations made in the HIG(SA) ventral hernia guidelines were assessed in both the public and private healthcare systems. RESULTS: Three hundred and fifty-three ventral hernia repair cases were included in the study. Fifty-four per cent were private and 46% were public sector cases. Laparoscopic repair for patients with a BMI > 35 kg/m2 occurred in 38% of eligible cases and a minimum 5 cm of mesh overlap was achieved in 50% of cases. Overall, 80% of elective cases occurred in non-smokers; 97% of the intraperitoneal on-lay mesh (IPOM) repairs used composite mesh; 96% of ventral hernias with defects of larger than 2 cm and 95% of incisional hernias were repaired with mesh. Non-smokers undergoing repair numbered 72% in public and 85% in private practice, p = 0.01. CONCLUSION: Ventral hernia repair practices in SA facilities overall had good compliance to four out of the six HIG(SA) ventral hernia guidelines highlighted for the purposes of this study. The two guidelines that had poor compliance overall were 'laparoscopic repair for patients with a BMI of > 35 kg/m2' and 'ensuring a mesh overlap of 5 cm'. The public sector had higher rates of current smokers undergoing elective ventral hernia repair.

Retrospective audit of laparoscopic inguinal hernia repair at a South African tertiary academic hospital.

BACKGROUND: Adoption of laparoscopic inguinal hernia repair (LIHR) in sub-Saharan Africa is poor. The aim of this study was to describe our experience of the feasibility and short-term efficacy of the LIHR service at a South African tertiary academic hospital. METHODS: A retrospective audit of all the adult, elective, laparoscopic inguinal hernia cases that were done between November 2011 and 31 October 2016. Data were collected regarding the patient demographics, index side of hernia, type of repair, conversion rate, peri- and postoperative complications, postoperative hernia recurrence, persistent groin pain for more than three months and procedure-related mortality. RESULTS: One hundred and eighty-six patients were evaluated. One hundred and twenty-six (68%) patients were followed up for a mean of 38 months (3.1 years; range 9-67 months). Sixty (32%) patients were lost to follow-up. Early hernia recurrence (onset in < 7 days) occurred in one case after a totally extra-peritoneal (TEP) repair had required conversion to a trans-abdominal pre-peritoneal (TAPP) repair. Late recurrence (onset in > 7 days) occurred in seven TEP repair cases (5.6%). Four recurrences (57%) occurred within the first two years. Recurrences in the next three years showed a 59% reduction giving a recurrence rate of 2.9%. At follow-up, six TEP cases (4.8%) had persistent groin pain persisting for 3-6 months in two cases and for more than one year in four cases. Five cases had seroma, six scrotal haematoma and one port-site sepsis. No death occurred. CONCLUSION: LIHR could be safely offered in a South African tertiary academic centre with acceptable results that are comparable with the South African private sector setting. LIHR could be implemented in other surgical training centres within a resource-limited environment.

Spontaneous untwisting in sigmoid volvulus--the case for 'prophylactic' surgery. A report of 3 cases.

Sigmoid volvulus may present in different ways, ranging from a dramatic acute onset to recurrent minor episodes, with symptoms varying in degree of severity in between. In elderly patients and those who already have gangrene of the colon at presentation, the operative morbidity and mortality are high. It has been suggested that perhaps half the patients presenting with acute sigmoid volvulus have a history of previous mild recurrent attacks that have reduced spontaneously. It should be possible to recognise these episodes of subclinical volvulus and to institute treatment before the development of obstruction or possible gangrene. In the 3 cases presented here, features suggestive of subclinical volvulus, viz. abdominal pains, distension, constipation and dramatic passage of flatus are highlighted. Redundant sigmoid colon on barium enema, plus the clinical features mentioned, are virtually diagnostic, and prophylactic surgery is justified to avoid the mortality and morbidity associated with established cases of sigmoid volvulus.

Distal splenorenal shunt for non-cirrhotic variceal bleeding in black South Africans.

Distal splenorenal shunt (DSRS) is a once-only form of treatment. It is suitable for many black South Africans with non-cirrhotic variceal bleeding who cannot attend repeated follow-up sclerotherapy sessions. However, persistent hyperbilirubinaemia and encephalopathy may occur following DSRS in schistosomiasis. Forty-one consecutive patients with DSRS have been treated over a 7-year period. The causes of portal hypertension were schistosomiasis (32), portal vein thrombosis (8) and diffuse nodular hyperplasia (1). Operative mortality was 6%. Encephalopathy was observed in 1 patient. Galactose elimination capacity (GEC) and technetium-diethylenetriamine penta-acetic acid hepatic perfusion index (HPI) were used to assess liver function and hepatic perfusion pre- and postoperatively, respectively, in schistosomiasis. GEC was 348 +/- 37 (M +/- SD) before, compared with 343 +/- 67 postoperatively (P = 0.78). HPI showed long-term preservation of hepatopetal portal venous flow following DSRS. Morbidity and mortality were observed only in patients with schistosomiasis associated with hepatitis B chronic active hepatitis. DSRS is ideal treatment in selected patients with non-cirrhotic variceal bleeding.