The Burden of Emergency Abdominal Surgery Heavily Outweighs Elective Procedures in KwaZulu-Natal Province, South Africa

Ehlers, Vincent; Kohler, Charles; Tefera, Aida; Lutge, Elizabeth; Clarke, Damian

doi:10.1016/j.jss.2020.09.013

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…However, morbidity increases rapidly if there is a delay in treatment. 3,4,13 Furthermore, there are welldocumented significant discrepancies in the disease outcome depending on patients' racial, economic and geographical profiles. 14 The introduction of LA, over three decades ago, has added a further confounder to the discussion about discrepancies in outcomes for this common disease.…”

Section: Discussionmentioning

confidence: 99%

Experience and perceptions of laparoscopic appendectomy amongst surgical trainees in South Africa

Naidoo¹,

Kong²,

Clarke³

et al. 2022

S. Afr. j. surg.

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BACKGROUND: This study is a survey amongst surgical trainees in South Africa (SA) designed to document their exposure to laparoscopic appendicectomy (LA) and their perceptions about the procedure and to identify possible barriers to its uptake. METHODS: A structured survey was developed using a combination of quantitative and qualitative questions designed to determine the clinical exposure of surgical trainees to laparoscopic appendectomy and then probe possible factors limiting their access to the procedure. A questionnaire was created online, and a link was distributed to various surgical trainees in Southern Africa. A list of trainees was obtained from the Surgreg Training Association of South Africa (STA). RESULTS: One hundred and thirty-two (47%) trainees completed the survey out of an estimated 280 general surgery registrars. Ninety-five (72%) were male and 37 (28%) were female respondents. Their median age was 31 years (25-36). There were 14 (11%) year-1 and 21 (16%) year-2, 32 (24%) year-3, 37 (28%) year-4 and 28 (21%) year-5 trainees. The breakdown according to region was area 1 (inland and central) 47 (36%), area 2 (western seaboard) 12 (9%) and area 3 (eastern seaboard) 73 (55%). Forty-three (33%) respondents experienced face-to-face teaching on how to perform a LA. Forty-two (32%) had exposure to laparoscopic simulators. Respondents reported a general lack of experience in performing this procedure. Sixty-nine (52%) had performed this procedure without a senior (i.e., solo) and 13 (10%) had only assisted a senior to perform this procedure. Seventy-four (56%) respondents felt confident performing a LA independently. One hundred and thirteen (86%) respondents expected to be taught this procedure. One hundred and five respondents (80%) were keen to learn to perform LA. One hundred and five respondents (80%) stated that they would be interested in attending an online course on LA. The respondents felt that the following were the significant barriers to performing LA: resource constraints 49 (37%) and time constraints 46 (35%). Thirty per cent of respondents (22) in area 3 reported a reluctance by seniors to teach the procedure. CONCLUSION: There appears to be a lack of exposure to and confidence with LA amongst South African surgical trainees. This implies a deficiency in formal surgical training programmes. Addressing this deficiency will require innovative solutions.

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Section: Discussionmentioning

confidence: 99%

Experience and perceptions of laparoscopic appendectomy amongst surgical trainees in South Africa

Naidoo¹,

Kong²,

Clarke³

et al. 2022

S. Afr. j. surg.

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“…Conversely, in state hospitals, only 3% of appendectomies were performed laparoscopically, with longer hospital stays and a higher incidence of repeat surgeries, reflecting more severe disease and barriers to healthcare access (22,31,32). Thus, while laparoscopic surgery is widespread in the private sector, its use remains limited in state facilities in KZN (2,31,32).…”

Section: Contrasting Acute Appendicitis In South Africa With Global P...mentioning

confidence: 99%

“…Recognizing that disease profiles and outcomes are significantly influenced by various local factors, both within and beyond the control of individual surgeons, underscores the relevance of the adage "think globally, act locally" in modern surgery. Despite acute appendicitis being a common condition with a welldescribed and standardized surgical treatment, there are substantial outcome variations both locally and internationally (1)(2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

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Acute Appendicitis in Rural KwaZulu-Natal, South Africa

Clarke,

Naidoo,

KONG

2024

Impact Surgery

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The Lancet commission on Global Surgery identified a huge global burden of surgical illness which is not adequately treated, as the resources needed to effectively treat these many common surgical conditions are not readily available in many regions. This review aims to provide a comprehensive overview of the epidemiology, management, and outcomes of acute appendicitis in South Africa. Methods A scoping search was conducted across major electronic databases to identify relevant studies published between January 2000 and December 2023. Articles reporting on the incidence, presentation, diagnostic methods, surgical interventions, and outcomes of acute appendicitis in South Africa were included. Results The literature review revealed an increasing incidence of acute appendicitis among African patients in South Africa, potentially linked to dietary changes accompanying urbanization. Despite advancements in surgical techniques, open appendectomy remains the primary approach, particularly in public healthcare facilities, indicating disparities in access to laparoscopic surgery. Complications such as wound infections and hospital-acquired pneumonia contribute to prolonged hospital stays, high morbidity, and high mortality. However, outcomes in private healthcare settings demonstrate higher rates of laparoscopic procedures and lower complication rates compared to public institutions. Conclusion Acute appendicitis in South Africa presents unique challenges, including disparities in surgical access and outcomes between public and private healthcare sectors. Addressing these challenges requires efforts to improve healthcare infrastructure, enhance surgical training, and promote equitable access to laparoscopic techniques. Collaborative research endeavors and evidence-based interventions are essential for optimizing the management and outcomes of acute appendicitis across diverse socio-economic contexts in South Africa.

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“…[ 5 , 6 ] In Kwa Zulu Natal province, South Africa, there are huge racialized socio-economic differences which result in very heterogeneous access to surgical care. [7] A well-funded private health system caters for only sixteen percent of the population. The remaining eighty-four percent of the population depends on an overburdened, poorly managed and under-resourced state sector.…”

Section: Introductionmentioning

confidence: 99%

Developing a novel laparoscopic training model during the Covid-19 pandemic in a resource-limited setting

Mangray

Madziba

Harilal

et al. 2023

Surgery in Practice and Science

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The Burden of Emergency Abdominal Surgery Heavily Outweighs Elective Procedures in KwaZulu-Natal Province, South Africa

Cited by 7 publications

References 12 publications

Experience and perceptions of laparoscopic appendectomy amongst surgical trainees in South Africa

Experience and perceptions of laparoscopic appendectomy amongst surgical trainees in South Africa

Acute Appendicitis in Rural KwaZulu-Natal, South Africa

Developing a novel laparoscopic training model during the Covid-19 pandemic in a resource-limited setting

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