Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...

Background: The aim of this study was to review our experience with iliopsoas abscesses (IPAs) and evaluate the various drainage procedures.Methods: All consecutive patients with an IPA admitted to three university hospitals between September 2008 and June 2017 were retrospectively included.Results: Of the 26 patients, 17 (65.4%) were male and nine (34.6%) were female, with an average age of 30.7 (17-58) years. Fifteen (57.7%) cases had primary IPAs and Staphylococcus spp. was the most common isolate. Eleven (42.3%) cases had secondary IPAs, and spinal tuberculosis was the most common underlying condition. Lower-back or flank pain was the most common presentation (69.2%). Computed tomography (CT) scans confirmed all clinical diagnoses. All patients were managed via drainage and antibiotic therapy; seven (26.9%) were subjected to open surgical drainage and 19 (73.1%) received percutaneous drainage (PCD) under ultrasound (US) guidance. The average hospital stay was 9.5 days (range 5-18 days). The hospital stay was significantly shorter in patients treated via PCD compared to those who received open drainage: 8.5 days (range 5-14 days) vs. 12.1 days (range 6-18 days), respectively (p = 0.031). The overall recurrence rate was 11.5% (3/26). Recurrence developed in three patients treated via US-guided PCD and all were successfully treated via a second round of PCD. No mortality was recorded.Conclusions: US-guided PCD combined with appropriate antibiotic therapy is safe and effective with shorter hospital stay when used to treat IPAs. Open surgical drainage may be warranted if the IPA is multiloculated or if there is an underlying pathology.

BackgroundIn our study, we have defined and evaluated risk factors for the development of post‐operative complications in patients with gunshot wounds to the colon. The purpose of the study is to identify the most influential risk factors.MethodsA retrospective study of 172 patients admitted with gunshot wounds to the colon from 17 February 2011 to 31 December 2014. Age, gender, shock upon admission defined by vital signs and haemoglobin level, blood transfusion, injured site of the colon, the colon injury score, faecal contamination, surgical procedure, colon diversion, multiple organ injuries, delay time pre‐operation and duration of the operation were considered as risk factors. All patients were observed for any postoperative complications.ResultsOne hundred and sixty‐six patients (96.5%) were males, and six (3.5%) were female. The mean age was 28.5 years. On admission 104 (60.5%) patients were in shock, 89 (51.7%) required blood transfusion. Forty‐four (25.5%) patients had an injury to the ascending colon, while 53 (30.8%), 13 (7.6%), 23 (13.4%), 21 (12.2%) and 18 (10.5%) patients had an injury in transverse, descending, sigmoid, rectum and multiple colon injuries respectively. A colon diversion was used in 64 patients (37.2%). Post‐operative complications documented in 67 (38.9%) patients, 35 (20.3%) required re‐exploratory laparotomy, while the disability occurred in 18 (10.4%)) cases, and post‐operative mortality was 12 (6.9%).ConclusionSurgeons should be aware that shock state upon admission and blood transfusion are risk factors for postoperative complications in a patient with a gunshot penetrating injury to the colon.

Objective: For a suspected diagnosis of acute appendicitis, appendectomy is one of the most common emergency abdominal operations performed. However, the need for routine histopathological examination (HPE) of all appendectomy specimens has recently been questioned. The aim of this study was to assess whether a routine HPE of appendectomy specimens is needed and whether routine HPE has an impact on further management of patients. , all histopathology reports of 4012 consecutive appendectomy specimens for a clinical suspicion of acute appendicitis were retrospectively analyzed in two university hospitals.Results: Out of the 4012 cases, 3530 (88%) patients showed findings consistent with acute appendicitis on HPE. Perforation rate was 5.8% and was significantly higher in male patients (p< 0.001) and higher in the > 30 years age group (p= 0.024). Negative appendectomy rate was 5.6% and was significantly higher in female patients (p< 0.001). There were 256 (6.4%) patients who demonstrated unusual findings in their HPE, which included chronic appendicitis (n= 207; 5.2%) patients, Enterobius vermicularis (n= 14), Schistosoma (n= 8), Crohn's disease (n= 1), neuroma (n= 10), carcinoid tumour (n= 5) and mucinous cystadenoma (n= 5), mucocele (n= 4) and mucinous cystadenocarcinoma (n= 2).Conclusion: HPE of the appendix does not only confirm the diagnosis of acute appendicitis, but also detects other unusual diagnoses that may have an impact on a patient's management. A number of patients with unusual histopathological findings require anti-helmentic treatment, colectomy, gastroenterology follow-up or periodic surveillance. Hence, all appendectomy specimens must be submitted for routine HPE.

Background: Despite improvements in treatment, secondary peritonitis is still associated with high morbidity and mortality rates. Better knowledge of reallife clinical practices might improve management. Objectives: To identify the common causes and highlight the morbidity and mortality of secondary peritonitis in Al- Jala hospital, Benghazi, Libya. Patients and Methods: Retrospective study (January 2009–August 2010) of 137 patients with secondary peritonitis is reported. Results: Appendicitis and gastroduodenal perforations were the commonest causes of secondary peritonitis, occurring in 61% and 20% of the patients respectively. Other conditions (small bowel perforations, colonic perforations, biliary peritonitis, ruptured hydatid cyst and pancreatitis) accounted for less than 20% of cases. The overall mortality rate was 4.37%. Morbidity developed in 23% of Patients. Conclusions: Acute appendicitis is the most common cause of intra-abdominal infection in our study. The clinical outcomes associated with secondary peritonitis are highly dependent upon the site of contamination (versus others), as well as local and systemic factors.