Surgery- Scholarly Publications

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    Open Access
    Pediatric Day Case Surgical Practice at a Tertiary Hospital in Lagos: How Have We Faired?
    (MedKnow, 2014) Elebute, OA; Ademuyiwa, AO; Bode, CO; Idiodi-Thomas, HOI
    Background: There has been a gradual increase in the number of patients treated as a day case surgery in our center. This study has been conducted to audit pediatric day case surgery practice at the Lagos University Teaching Hospital. Aims: The aim of the following study is to determine the morbidity and mortality from day case surgery in our center. Subjects and Methods: The type of study was a prospective study over a 2½ year period at the Lagos University Teaching Hospital. The patients scheduled for surgeries were assessed in the pediatric outpatient clinic and information obtained for each of the patients included age, sex, diagnosis and operation planned. Additional information collected included the (1) type of anesthesia (2) post‑operative complications and the cadre of the surgeon. The data was analyzed using SPSS version 19 (IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp, USA). Result: A total of 381 patients were operated during the study period. The age range of patients was 2 weeks to 15 years and the mean age was 2.9 years (3.0). There were 338 male patients (88.7%;338/381) and 43 females (11.3%;43/381). Inguinal hernias and hydroceles constituted almost half of the cases treated while 16.0% of cases were undescended testis. There were four morbidities and no mortality. Conclusion: Day case surgery is associated with a low morbidity and no mortality in our center.
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    Restricted
    Reverse gastric tube oesophageal substitution for staged repair of oesophageal atresia and tracheo-oesophageal fistula
    (MedKnow, 2014) Bode, CO; Ademuyiwa, AO
    The management of oesophageal atresia and tracheooesophageal atresia (OATOF) is very challenging. While in developed countries survival of patients with this condition has improved, the outcome in many developing countries has been poor. Primary repair through a thoracotomy (or video-assisted thoracoscopic surgery where available) is the gold standard treatment of OATOF. However, in our setting where patients typically present late and with minimum support resources such as Neonatal Intensive Care Unit and total parenteral nutrition; staged repair may be the only hope of survival of these patients and this communication highlights the essential steps of this mode of treatment.
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    Open Access
    Routine hemoglobin electrophoresis for pediatric surgery day case in at‑risk populations: Suggested algorithm for screening using clinical risk factors
    (MedKnow, 2015) Ademuyiwa, AO; Bode, CO; Adekola, OO; Desalu, I; Elebute, OA; Kushimo, OT
    Background: Hemoglobin electrophoresis (HBE) is a part of the preoperative routine requested by anesthetists. However, the prevalence of hemoglobinopathy in the population is low. This study aims to determine the clinical risk factors for hemoglobinopathies and propose clinical guidelines for preoperative screening of patients for pediatric day care surgery. Patients and Methods: A prospective study carried out over 12 months. Consecutive patients aged 6 months and older who had day case surgery were recruited to the study. Biodata and relevant clinical data were collated and documented in a proforma and analyzed using a statistical package for social sciences version 17. Results: There were 124 patients106 boys and 18 girls. The median age was 3 years. Scrotal lesions were the most common conditions managed (71.7%). Seventy-eight percent of patients had HbAA, 15.3% had HbAS, and 4.8% had HbAC while 0.8% each had both HbSC and HbSS. At least one parent of 78.2% knew their Hb phenotype, of which, 79% were HbAA. Ahistory of jaundice (P = 0.0001), hand and foot syndrome (P = 0.0001), frontal bossing (P = 0.0001), and low packed cell volume at surgery (P = 0.001) were found significant in predicting hemoglobinopathies. There was no mortality. Conclusion: Risk factors for hemoglobinopathies from this study included a positive history of jaundice, hand and foot syndrome, frontal bossing, and anemia. Proposed guidelines for HBE screening include the presence of hemoglobinopathy in one parent if one parent has sickle cell trait, and the other parent’s genotype is unknown or if any of the risk factors is present.
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    Open Access
    Neonatal neuroblastoma with adrenal primary and metastasis to the liver: A case report and a review of literature
    (MedKnow, 2016) Omoseebi, O; Odubanjo, MO; Akinde, OR; Ikeri, NZ; Ademuyiwa, AO; Adeyomoye, AAO
    We report the case of a 23‑day‑old neonate with neuroblastoma (NBL) in the right adrenal gland and widespread metastases to the liver. This raises the possibility of foetal NBL, which was missed during periodic ultrasonography done during the mother’s pregnancy. We hope that this report would increase the awareness of physicians about foetal, congenital and neonatal NBL; and of sonographers about space‑occupying lesions in the foetus. The clinicopathologic features and the management of neonatal NBL are discussed.
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    Open Access
    Assessment of Parents’ Satisfaction with Paediatric Surgery Services at a Tertiary Hospital in South West Nigeria: A Quality Control Check
    (2017) Ademuyiwa, AO; Mosaku, SK; Ogbolu, RE; Oshodi, YO; Bode, CO
    Background: Patient satisfaction is an important link in the chain of patient-physician interaction, patient care experience and patient health outcome. Patient satisfaction is relevant in the evaluation of quality of services received in health institutions based in low and middle income countries, and can provide important feedback for service improvement in such resource-poor settings. Aim: This study aimed to examine the patient’s level of satisfaction with pediatric surgery services in a Teaching Hospital. Subjects and Methods: Setting: Paediatric Surgery Unit of the Lagos University Teaching Hospital. Prospective questionnaire based survey. Consenting literate parents of paediatric post-op patients were serially recruited from the pediatric surgery unit of the Lagos University Teaching Hospital. The consent of the Institution’s Research Ethics’ Committee was sought and obtained. Using a general sociodemographic questionnaire and the patient satisfaction with services scale, patient experiences were obtained. Results were expressed as simple percentages and presented in tables. Results: One hundred and thirty-four post-op cases participated in this study. These participants were parents of children with varied surgical conditions such as: hernia (24.6%, 33/134), hydrocoele (8.2%, 11/134), among other conditions. Majority of the cases were follow-up cases (75.4%, 101/134), compared to 24.6% being new cases. Most respondents (parents/guardians) rated the ‘assistance from the records officer’ as good/ very good/excellent (82.1%, 110/134), while 14.9% (20/134) rated it as fair/poor. Respondents were quite satisfied with the ‘amount of information given about the health problem’ with 82.9% (111/134) rating it as good/very good/excellent and 8.2% (11/134) as fair/poor. The ‘suitability of the treatment plan to needs was considered good/very good/excellent by 61.9% and fair/poor by 9.0%. However, the ‘overall quality of care’ was rated as fair/poor in 12.0%, and good/very good/excellent by 88.0% of respondents. Conclusion: In conclusion, the study serves as a useful feedback tool which provides important information on certain aspects of patient satisfaction, it identifies aspects which respondents find less satisfying and as such need improvement.