Isolated Roux-en-Y versus single loop pancreaticojejunal reconstruction after pancreaticoduodenectomy - a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Pancreaticoduodenectomy is a complex intra-abdominal operation used for the treatment of benign and malignant disease of the pancreatic head or periampullary region. Despite developments in surgical techniques, pancreaticoduodenectomy is still associated with high rate of postoperative complications. We performed this systematic review and meta-analysis to compare the surgical outcomes of isolated Roux-en-Y pancreaticojejunostomy (IRYPJ), and conventional pancreaticojejunostomy(CPJ). METHODS: We performed a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We searched the following electronic databases - PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinical-Trials.gov. Published trials comparing the efficacy and safety of IRYPJ and CPJ after pancreaticoduodenectomy were evaluated. The search terms were "pancreaticoduodenectomy," "Whipple," "pylorus-preserving pancreaticoduodenectomy," "pancreaticojejunostomy," "Roux-en-Y," and "isolated Roux loop pancreaticojejunostomy." Only randomised controlled trials comparing outcome of IRYPJ and CPJ after pancreaticoduodenectomy were included. The analysed outcome measures were postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), bile leak and delayed gastric emptying (DGE). RESULTS: The initial search yielded 342 results but only four randomised control trials fulfilled the inclusion criteria and were included for data synthesis and meta-analysis. Meta-analysis of POPF revealed that IRYPJ is associated with less POPF compared to CPJ but the difference was not statistically significant (risk ratio = 0.58, p = 0.56). A similar finding was also observed with CR-POPF (risk ratio = 0.17, p = 0.87) and DGE (risk ratio = 0.74, p = 0.46). CONCLUSION: Isolated Roux-en-Y pancreaticojejunostomy is not associated with a superior outcome when compared to CPJ.

Delayed Presentation of Posttraumatic Diaphragmatic Hernia Masquerading as Recurrent Acute Asthmatic Attack.

Diaphragmatic hernia following blunt abdominal injury is extremely rare and often diagnosed late. Missed diagnosis is also common with this condition. We herein present a delayed presentation of diaphragmatic hernia following blunt abdominal injury that was initially misdiagnosed as recurrent acute asthmatic attack due to repeated presentation with episodic difficulty in breathing.

Giant and complicated subcutaneous lipoma of the neck.

BACKGROUND: Although lipomas around the head and neck region are not uncommon, giant lipomas around the neck are rare. OBJECTIVE: To report the case of a long standing giant lipoma of the neck which was managed easily by simple surgical excision. CASE REPORT: A case of giant subcutaneous lipoma of the neck is reported in a 70 year old woman who presented with dragging sensation and bleeding from the site of pressure ulceration as the major complaint. The patient was evaluated and definitive diagnosis was arrived at using Fine Needle Aspiration Cytology (FNAC). She had a successful Surgical excision and was subsequently discharged but never came back for follow up. CONCLUSION: Lipoma should always be considered in the differential diagnosis of pedunculated lesions around the neck.

Use of protective eyewear among surgeons in a tertiary hospital in northern Nigeria.

The study was a prospective study during which a hand-held lens was used to examine the goggles of all surgeons who used them during surgery at Aminu Kano Teaching Hospital, Kano, Nigeria. Only 169 (54.8%) of the 308 surgeons used eye protection during surgery. There was at least a bloodstain on 70 (41.4%) of the goggles. There is need to enforce universal precautions during surgery to protect the eyes of surgeons from blood drops of the patient being operated.

Glomus tumour--the report of a case in an adult Nigerian.

BACKGROUND: Glomus tumour, a relatively common lesion in Caucasians is reported to be rare in blacks. METHOD: A case of glomus tumour is reported in an adult male Nigerian to highlight its distinctive clinical presentation and the literature reviewed. RESULT: A 60-year old man presented with a painful skin nodule on the ventral surface of his right forearm. The pain was far in excess of the size of the lesion. There was however no relief from previous medications. Following complete excision of the lesion, pain relief was dramatic. Histopathological examination of the lesion showed sheets of round to polyhedral glomus cells and elongated endothelium lined vascular channels diagnostic of glomus tumour. CONCLUSION: Severe pain is a very important feature of glomus tumour of the skin. This is relieved by complete excision of the lesion.

Typhoid enteric perforation in north western Nigeria.

BACKGROUND: Typhoid perforation is the most important surgical complication of typhoid enteritis and is associated with high morbidity and mortality. AIMS AND OBJECTIVES: To determine the pattern and outcome of management of typhoid perforation in Aminu Kano University Teaching Hospital, Kano. METHOD: A retrospective Analysis of patients treated for typhoid perforation over a 6-year period. RESULTS: There were 47 patients: 35 males and 12 females, ratio 2.9 to 1. The patients were aged 4 years to 58 years (mean 18.9 years). Typhoid perforation occurred all the year round with a peak prevalence in September; Six (12.8%) patients perforated in the first week, 29 (61.7%) second week, and 12 (25.5%) third week, of illness. Single perforation was found in 91.5% of cases, and two to three perforations in 8.5%. Surgical treatment was by simple closure in 72.3%, wedge resection in 8.5%, ileal resection in 17.1% and right hemi-colectomy in 2.1%. Of the 41 survivors (87.2%), wound infection was the most common postoperative complication in 44.7% of cases. The mortality rate was 12.8% mostly due to overwhelming sepsis. CONCLUSION: Typhoid perforation requiring surgical intervention is still endemic in our subregion, and emphasis should be on preventive measures such as safe drinking water and appropriate sewage disposal, and typhoid vaccination.

Childhood intestinal obstruction in Northwestern Nigeria.

BACKGROUND: Intestinal obstruction is a common cause of childhood surgical emergency in the tropics. The aim of this paper was to assess the pattern and the outcome of mangement of intestinal obstruction in Nigerian children. STUDY DESIGN: The clinical reccords of all the cases of childhood intestinal obstructions managed at a teaching hospital in northwestern Nigeria between 1999 and 2003 were retrospectively reviewed. RESULTS: There were 54 children, 44(81.5 %) were boys and 10 (8.5 %) were girls (m:f=4.4:1). Fifteen (27.8%) and 22 (46.2%) were neonates and infants, respectively. The causes of the intestinal obstruction were intussusception 16(29.6 %), Hirschprung's disease 14(25.9%), anorectal anomaly 12 (22.2%), external hernias 6(11.1%), atresia 5(9.3%) and congenital bands 1(1.9 %). The clinical features were consistent with those reported from other parts of the world, except that many patients with intussusception presented late with gangrenous intestines. The overall mortality was 6(11.1 %); the mortality in the neonates was 5(33.3 %). CONCLUSION: Apart from the obvious absence of worm infestation, the aetiological pattern and the clinical presentation of childhood intestinal obstruction in this study agrees with those reported from other parts of the country. Their management is associated with high mortality in our environment, especially when there are associated anomalies or the presentation is late.