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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 10 | Issue 3
Page Nos. 73-106

Online since Saturday, August 7, 2021

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ORIGINAL ARTICLES  

Prosthetic implants in abdominal wall hernia repair: A work in progress in South East Nigeria p. 73
AU Ogbuanya, CV Enemuo
DOI:10.4103/ais.ais_26_20  
Background: Globally, the demand for proper surgical services is on the increase, and subsequently, the need to universally adopt mesh implants for tensionless prosthetic repairs has become expedient. The hallmark of tension-free repair is the lower short- and long-term recurrence rates compared to suture-based techniques. The aim of this study was to document our early experience with the use of mesh in abdominal wall hernia repair. Patients and Method: This was a prospective study of all adult patients with abdominal wall hernias treated with mesh implants from January 2009 to December 2015. Recurrence, bilaterality, inguinoscrotal or inguinolabial status and voluminous sizes were the main factors considered. Results: A total of 110 patients with abdominal wall hernias had mesh implants repair. There were 66 (60.0%) males and 44 (40.0%) females. Majority (56.4%) were inguinal hernias followed by incisional hernias (20.9%). Of those with inguinal hernias, eight (12.9%) had bilateral hernias, 30 (48.4%) had primary inguinoscrotal hernias while 14 (22.6%) had recurrent inguinoscrotal hernias. Nearly a third (31.8%) of the entire patients had recurrent hernias. Nearly a third (31.8%) of the entire patients harbored recurrent hernias. Majority (82.7%) of the patients presented after 1 year of onset of the hernias. The overall complication rate was 12.7% and over 81% were discharged home by the 4th post-operative day. No recurrence or mortality was recorded. Conclusion: The use of mesh implants to repair abdominal wall hernias in our environment is safe and effective. Most of the challenges relating to the acceptance of mesh, comorbid conditions and post-operative complications can be minimized through discussions and facilitated consultations.
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Surgical ablation of the prostate in the elderly: A comparison of efficacy and outcomes of open and endoscopic methods p. 80
AT Lawal, M Ahmed, AO Ayodeji, S Abdullahi, A Mudi, N Oyelowo, MA Tolani, HB Kolapo, L Fidelis, L Khalid, A Bello, HY Maitama
DOI:10.4103/ais.ais_40_20  
Background: Prostatic obstruction is a common problem of elderly men. This will often times require surgical removal of the prostate. Geriatric surgeries are froth with risks and complications, partly due to depleted functional reserves and comorbities. This study is designed to compare the efficacy and outcomes of three methods of prostatic ablation amongst elderly men. Patients and Methods: This study was retrospective. The study population consisted of men who had surgery for relief of prostatic obstruction. Three surgeries were considered viz: Open prostatectomy/channelization, TURP, and transurethral diode laser vaporization of the prostate (DiLVP). Inclusion criteria were men aged ≥65 years, who had any of the above procedures. Exclusion criteria were synchronous urethral stricture, and prior history of prostatic, bladder or urethral surgery. Patients' demographic, pre-operative, intra-operative and post-operative details were extracted and filled into a proforma. The primary and secondary outcome measures were documented. Data analysis was done using SPSS version 20. Statistical significance was set at a P value of <0.05. Results: Records of 70 patients were reviewed. Thirty-seven of the patients (52.9%) had open prostatectomy/channelization, 21 (30%) had TURP/channelization, while the remaining 12 (17.1%) had DiLVP. The mean ages were 69.5, 73, and 67 years for groups 1, 2, and 3, respectively. The mean duration of procedure in minutes was 87.5, 75, and 70.5 for groups 1, 2, and 3, respectively (p = 0.12). The groups did not differ in terms of need for blood transfusion (p = 0.81). The groups differed significantly in terms of time to catheter removal and hospital stay. The differences in rates of post-operative complications were statistically significant (p = 0.00). The procedures had comparable long-term rates for satisfactory voiding. Conclusion: Elderly men have significant peri-operative risks. As such, the choice of surgical options for management of prostatic obstruction in them should be carefully considered. Endoscopic methods, especially DiLVP, are associated with fewer peri-operative complications in the elderly.
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A prospective observational study on the utility of smartphone-based Ureteral Stent Tracker (UST) application in preventing cases of forgotten ureteral double-J stents p. 86
S Sengupta, S Basu, K Ghosh
DOI:10.4103/ais.ais_41_20  
Background: The use of ureteral stents is an integral part of daily urological practice. These need to be removed after a specified time limit. Unfortunately, some of the DJ stents are forgotten and hence retained. This is where the usefulness of smartphone-based Ureteral Stent Tracker (UST) application comes into play. In this study, we have aimed to evaluate the efficacy and usefulness of smartphone-based UST application and compare the results with basic appointment card system to prevent forgotten ureteral stents (FUS). Patients and Methods: It is a prospective observational study including a total of 118 patients. They were divided into two groups. Those in group A, were recorded to UST application and those in group B, were provided with only the printed advice to remove their ureteral stent. The two groups were compared in terms of overdue days and lost to follow-up rates. Results: Groups A and B were comparable with no statistically significant differences among the groups regarding age, educational level and laterality of the ureteral stent. The mean overdue days were 4.25 ± 3.627 and 11.49 ± 6.273 in group A and B respectively. Conclusions: In our study, we checked the dashboard of the ST application every day to look for overdue days. Patients followed up with the stent tracker application had significantly less overdue days compared to those who were not. So, UST can be an important addition to daily urological practice to minimise the incidence of retained ureteral stents.
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Endoscopic suture lateralization of vocal cord with eyelet needle in patients with bilateral abductor paralysis p. 91
GM Mohammed, AM Kirfi, BT Gazali, BM Ahmad
DOI:10.4103/ais.ais_43_20  
Background: Vocal cord paralysis refers to absent or reduced function of vagus nerve or its distal branch, the recurrent laryngeal nerve. Several surgical procedures have been proposed for the management of respiratory distress secondary to bilateral vocal cord paralysis that are aimed at restoring glottic lumen sufficient to guarantee adequate breathing through the natural airway, without tracheotomy and preserving an acceptable voice quality. We aimed to present our experience in surgical management of bilateral abductor paralysis using endoscopic suture lateralization of vocal cord with eyelet needle. Patients and Method: A prospective study of all consenting patients presenting with bilateral abductor paralysis managed from November, 2010 to December, 2018 in National Ear Care Centre Kaduna, Nigeria. Ethical approval was obtained from the institution's Health Research Ethics Committee (HREC). All patients were evaluated by taking detailed history, thorough clinical examination including flexible endoscopy and investigations. Eleven patients underwent endoscopic suture lateralization using proline 0 suture. Results: Thyroid surgery was the main etiology, 8 out of a total of 11 that underwent lateralization procedure had tracheostomy elsewhere for duration of 1 to 2 years prior to presentation. All tracheostomized patients were successfully decannulated within 2 weeks after the procedure and final voice quality was subjectively good. None had any complications after surgery. Conclusion: Endoscopic suture lateralization with eyelet needle is reversible; less invasive cost-effective technique that ensures stable airway and preservation of laryngeal sphincter with acceptable quality of voice especially in a resource constrained setting where laser is not available.
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Management of benign bone tumors in a tertiary hospital in North West Nigeria p. 95
MI Maitama, YZ Lawal, LI Dahiru, FS Ejagwulu, KE Amaefule
DOI:10.4103/ais.ais_44_20  
Background: Tumors originating from bone and cartilage are mostly benign with distinct feature of non-metastasis. Such tumors may occur in any bone of the skeleton, and are more frequent in the younger age group. Complete excision and curettage as the main modality of treatment is in most of the cases adequate with satisfactory outcomes. This study reviewed the histological types of primary benign bone tumors and results of various surgical options of treatment offered. Patients and Methods: Thirty-nine patients with histologically confirmed benign bone tumors arising from upper and lower limbs were retrospectively selected over 13-year period from August 2007 to August 2020 and analyzed. Results: Twenty-two patients were males while 17 were females. Age range is between 3 and 53 years, mean of 24.8 years with highest frequency in the third decade. Histological types were 18 giant cell tumors, 14 osteochondromas, 3 Ecchondromas, 2 Enchondromas and 2 Ossifying fibromas. Twenty five patients had excisional biopsy alone, 6 had excisional biopsy and bone grafting, 3 had limb amputation/dis articulation, 2 had excision with limb reconstruction using dynamic external devices, a patient underwent excision with bone cementing, one had excision and joint replacement (hip hemiarthroplasty), and another one had excision and joint arthrodesis. Conclusion: Benign bone tumors remain largely asymptomatic accounting for the late presentation. Excisional biopsy alone remains the commonest modality of treatment with good result. Giant cell tumor remained the commonest benign tumor in our center. Population based study is needed to assess its true epidemiology.
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CASE REPORT Top

Humongous mediastinal goiter: Interesting case report with its management challenges p. 102
RB Panchangam, A Vennapusa, S Mayilvaganan
DOI:10.4103/ais.ais_32_20  
Goiters with mediastinal extension are very rare. Occasionally they necessitate thoracic exploration for complete surgical excision which may be associated with serious complications. A 50-year-old man presented with a simple multinodular goiter and huge thoracic extension. After adequate investigative workup and optimal preoperative preparation, he underwent successful total thyroidectomy via combined cervicotomy and complete sternotomy. The excised goiter was 1.85 kg in weight and 20 × 25 × 18 cm in dimensions occupying entire anterosuperior mediastinum and 60% of left pleural cavity. Postoperative recovery was uneventful with no major morbidity. Rarely, giant thoracic extensions such as this case can be encountered. We are arguably reporting one of the largest thoracic goiters ever reported.
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LETTER TO EDITOR Top

Cardiac gunshot wound complicated by missile migration to the inferior vena cava p. 105
Abdulsalam Y Taha
DOI:10.4103/ais.ais_39_20  
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