Day case groin surgeries in children in Ibadan, Nigeria: spectrum of cases, trends over time and role of residents.

Authors

  • Dr. T.A. Lawal

Abstract

Background: Childhood groin lesions are mostly treatable in ambulatory settings. However, in view of inadequate paediatric surgical manpower in developing countries, there is a long waiting time to surgery that may result in untoward sequelae. The aim of this study was to review the spectrum of groin surgeries in a major teaching hospital in Nigeria, evaluate the timing of surgery and assess the cadre of surgeon operators.

Methods; This was a cross-sectional study conducted by retrospectively reviewing the surgical records of patients who had elective groin surgeries in a single unit between January 2003 and December 2014. Data was analysed using SPSS version 21 with p < 0.05 considered statistically significant.

Results: A total of 833 patients aged 2 weeks to 15 years (782 males) had 960 elective day case groin surgeries during the period. The groin lesions were inguinal hernia in 427 (51.3%), congenital hydrocele in 250 (30.0%) and undescended testis in 156 (18.7%) patients. May (101, 12.1%) and September (96, 11.5%) recorded the highest monthly averages of groin surgeries. The residents performed 55.8% of orchidopexies and 68.5% of herniotomies (p = 0.002). The proportion of surgeries performed by residents increased during the study (p < 0.001).

Conclusion: The commonest groin lesion requiring day case surgery in children is inguinal hernia. The
highest proportions of groin surgeries are done in May and September at the beginning of school terms.
The residents performed 56% of orchidopexies and 69% of herniotomies.

Keywords: Day case, groin lesions, hydrocele, inguinal hernia, paediatric surgery, undescended testis

Résumé
Contexte: Les lésions de l’aine à l’enfance sont principalement traitables dans les milieux ambulatoires. Cependant, compte tenu de l’insuffisance de la main-d’œuvre chirurgicale pédiatrique dans les pays en voie de développement, il y a un long temps d’attente pour intervention chirurgicale qui peut entraîner des séquelles désastreuses. L’objectif de cette étude était d’examiner le spectre des chirurgies de l’aine dans un majeur hôpital d’enseignement au Nigéria, d’estimer le temps de la chirurgie et d’évaluer le cadre des opérateurs de chirurgie.

Méthodes; Il s’agissait d’une étude transversale menée en examinant rétrospectivement les dossiers chirurgicaux des patients qui avaient des chirurgies électives de l’aine dans une seule unité entre janvier 2003 et décembre 2014. Les données ont été analysées à l’aide de SPSS version 21 avec p <0,05 considéré statistiquement significatif.

Résultats: Un total de 833 patients âgés de 2 semaines à 15 ans (782 garçons) ont eu 960 cas de chirurgies électives d’un jour de l’aine pendant la période. Les lésions de l’aine étaient la hernie inguinale chez 427 (51,3%), l’hydrocèle congénitale chez 250 (30,0%) et les testicules non descendus chez 156 patients (18,7%). Mai (101, 12,1%) et Septembre (96, 11,5%) ont enregistré les moyennes mensuelles les plus élevées des chirurgies de l’aine. Les résidents ont effectué 55,8% d’orchidopexies et 68,5% d’herniotomies (p = 0,002). La proportion de chirurgies effectuées par les résidents a augmenté au cours de l’étude (p <0,001).

Conclusion: La lésion de l’aine la plus commune nécessitant un cas de chirurgie d’un jour chez les enfants est la hernie inguinale. Les plus grandes proportions de chirurgies de l’aine sont effectuées en mai et septembre au début des trimestres scolaires. Les résidents ont effectué 56% des orchidopexies et 69% des herniotomies.

Mots clés: cas du jour, lésions de l’aine, hydrocèle, hernie inguinale, chirurgie pédiatrique, testicules non descendus

Correspondence: Dr. T.A. Lawal, Department of Surgery, College of Medicine, University of Ibadan, Ibada, Nigeria. E-mail: takeemlawal@gmail.com

References

Abdur-Rahman LO, Kolawole IK, Adeniran JO, et al. Paediatric day case surgery: experience from a tertiary health institution in Nigeria. Ann Afr Med. 2009;8(3):163-167.

Abantanga FA. Groin and scrotal swellings in children aged 5 years and below: a review of 535 cases. Paediatr Surg Int. 2003;19(6):446-450.

Redman JF and Reddy PP. Management of common disorders of the inguinal canal and scrotum in childhood and adolescence. J Ark Med Soc. 2002;99(3):89-91.

Efrat R, Kadari A and Katz S. The laryngeal mask airway in paediatric anaesthesia: experience with 120 patients undergoing elective groin surgery. J Pediatr Surg. 1994;29(2):206-208.

Ameh EA, Adejuyigbe O and Nmadu PT. Paediatric surgery in Nigeria. J Paediatr Surg. 2006;41(3):542-546.

Bickler SW and Rode H. Surgical services for children in developing countries. Bull World Health Organ. 2002;80(10):829-835.

Chirdan LB, Ameh EA, Abantanga FA, et al. Challenges of training and delivery of paediatric surgical services in Africa. J Pediatr Surg. 2010;45(3):610-618.

Blair GK. Children are waiting for care and answers. CMAJ. 2008;179(10):983-984.

Chen LE, Zamakhshary M, Foglia RP, et al. Impact of wait time on outcome for inguinal hernia repair in infants. Paediatr Surg Int. 2009;25(3):223-227.

World Health Organization. World Health Statistics 2015, pp 149-159. Geneva, Switzerland: WHO Press. 2015.

Hansrani VC, Fong A, Ferran N and Williams S. Surgical waiting times and patient choice: how much delay do patients really want? Eur J Orthop Surg Traumatol. 2015;25(1):77-81.

Leung V, Vanek J, Braga-Mele R, Punch D and Jin YP. Role of patient choice in influencing wait time for cataract surgery. Can J Ophthalmol. 2013;48(4):240-245.

Elebute O, Ademuyiwa A, Bode C and Idiodi-Thomas H. Paediatric day case surgical practice at a tertiary hospital in Lagos: how have we faired? Ann Med Health Sci Res. 2014;4(4):559-561.

Calder F, Hurley P and Fernandez C. Paediatric day-case surgery in a district general hospital: a safe option in a dedicated unit. Ann R Coll Surg Engl. 2001;83(1):54-57.

Bang SR. Neonatal anaesthesia: how we manage our most vulnerable patients. Korean J Anaesthesiol. 2015;68(5):434-441.

Lawal TA, Egbuchulem KI and Ajao AE. Obstructed Inguinal Hernia in Children: Case-Controlled Approach to Evaluate the Influence of Socio-Demographic Variables. J West Afr Coll Surg. 2014;4(2):76-85.

Fronza JS, Prystowsky JP, DaRosa D and Fryer JP. Surgical residents’ perception of competence and relevance of the clinical curriculum to future practice. J Surg Educ. 2012;69(6):792-797.

Sachs TE and Pawlik TM. See one, do one, and teach none: resident experience as a teaching assistant. J Surg Res. 2015;195(1):44-51.

Suwanabol PA, McDonald R, Foley E and Weber SM. Is surgical resident comfort level associated with experience? J Surg Res. 2009;156(2):240-244.

Gow KW, Drake FT, Aarabi S and Waldhausen JH. The ACGME case log: general surgery resident experience in paediatric surgery. J Pediatr Surg. 2013;48(8):1643-1649.

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Published

2020-09-02

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