Operation Hernia to Ghana

Kingsnorth, Andrew; Oppong, C.; Akoh, Jacob A; Stephenson, B. M.; Simmermacher, R. K. J.

doi:10.1007/s10029-006-0118-y

Cited by 32 publications

(26 citation statements)

References 12 publications

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“…7,10 It would limit the morbidity associated with the disease in the region currently. 7 There is a paucity of published research focusing on the cost of acute appendicitis in developing countries.…”

Section: Kong Aldous Handley Clarkementioning

confidence: 99%

“…6 The primary healthcare approach that has been advocated in the developing world emphasises preventative strategies rather than curative services. [7][8][9][10] However, acute appendicitis is not amenable to primary preventative strategies. Secondary prevention aims at limiting the complications of the disease process, and this depends on early recognition and early surgery.…”

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confidence: 99%

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The cost effectiveness of early management of acute appendicitis underlies the importance of curative surgical services to a primary healthcare programme

Kong

Aldous

Handley

et al. 2013

annals

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INTRODUCTION Appendicitis in the developing world is a cause of significant preventable morbidity. This prospective study from a regional hospital in South Africa constructs a robust cost model that demonstrates the cost effectiveness of an efficient curative surgical service in a primary healthcare-orientated system. METHODS A prospective audit of all patients with acute appendicitis admitted to Edendale Hospital was undertaken from September 2010 to September 2011. A microcosting approach was used to construct a cost model based on the estimated cost of operative and perioperative interventions together with the associated hospital stay. For cost analysis, patients were divided into the following cohorts: uncomplicated appendicitis, complicated appendicitis with localised intra-abdominal sepsis, complicated appendicitis with generalised intra-abdominal sepsis, with and without intensive care unit admission. RESULTS Two hundred patients were operated on for acute appendicitis. Of these, 36% (71/200) had uncomplicated appendicitis and 57% (114/200) had perforation. Pathologies other than appendicitis were present in 8% (15/200) and these patients were excluded. Of the perforated appendices, 45% (51/114) had intra-abdominal contamination that was localised while 55% (63/114) generalised sepsis. The mean cost for each patient was: 6,578 ZAR (£566) for uncomplicated appendicitis; 14,791 ZAR (£1,272) for perforation with localised intra-abdominal sepsis and 34,773 ZAR (£2,990) for perforation with generalised intra-abdominal sepsis without intensive care admission. With intensive care admission it was 77,816 ZAR (£6,692). The total cost of managing acute appendicitis was 4,272,871 ZAR (£367,467). Almost 90% of this total cost was owing to advanced disease with abdominal sepsis and therefore potentially preventable. CONCLUSIONS Early uncomplicated appendicitis treated appropriately carries little morbidity and is relatively inexpensive to treat. As the pathology progresses, the cost rises exponentially. An efficient curative surgical service must be regarded as a cost effective component of a primary healthcare orientated system.

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Section: Kong Aldous Handley Clarkementioning

confidence: 99%

mentioning

confidence: 99%

The cost effectiveness of early management of acute appendicitis underlies the importance of curative surgical services to a primary healthcare programme

Kong

Aldous

Handley

et al. 2013

annals

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“…38 We employ selective use of the Ramirez components separation technique and the use of fibrin sealant. 39 In a 24-month period, 116 patients with major incisional hernias were treated and assessed at follow-up with a quality-of-life questionnaire. Seromas occurred in 9.5% of patients, deep wound infection in 1.7% and recurrences in 3.4% at 15.4 months of follow-up.…”

Section: Incisional Herniamentioning

confidence: 99%

“…A second hernia treatment centre is being opened in Carpenter, Ghana and it is hoped to expand into Nigeria and Malawi. 39 …”

Section: 'Operation Hernia' In Africa (Ghana)mentioning

confidence: 99%

Hernia Surgery: From Guidelines to Clinical Practice

Kingsnorth

2009

annals

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INTRODUCTION Over the last 30 years, hernia surgery has developed into an evidence-based practice assisted by the development of guidelines. MATERIALS AND METHODS Prior to 1993, best practice in the UK was a nylon darn repair under general anaesthesia as an in-patient with prolonged recovery. The publication of The Royal College of Surgeons of England (RCSE) Guidelines on Groin Hernia Repair stimulated debate and coincided with the introduction of mesh hernioplasty and laparoscopic techniques. Further evolution of hernia management has occurred to enable the production of the European Hernia Society (EHS) guidelines in 2008. RESULTS The EHS guidelines cover all aspects of abdominal wall surgery including: indications for operation; investigations; organising surgical care; techniques; local anaesthesia; after-care, complications and outcome; and information for patients. CONCLUSIONS Surgeons have many choices when selecting an appropriate hernia operation for an individual patient. The EHS guidelines provide a basis for this decision-making.

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“…Second, several concentrated efforts were launched in the past decade to reduce the backlog of hernias in Ghana. In 2005, a UK-based non-governmental organization called ‘Operation Hernia' was created and had its first mission in Ghana [28]. This group provided herniorrhaphies and training for local medical officers with the expectation that they will continue to safely perform operations between or after missions [29].…”

Section: Discussionmentioning

confidence: 99%

Changing Epidemiology of Intestinal Obstruction in Ghana: Signs of Increasing Surgical Capacity and an Aging Population

Gyedu

Abantanga²,

Kyei³

et al. 2015

Dig Surg

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Introduction: This study aimed to describe the epidemiology and outcomes of intestinal obstruction at a tertiary hospital in Ghana over time. Methods: Records of all patients admitted to a tertiary hospital from 2007 to 2011 with intestinal obstruction were identified using ICD-9 codes. Sociodemographic and clinical data were compared to a previously published series of intestinal obstructions from 1998 to 2003. Factors contributing to longer than expected hospital stays and death were further examined. Results: Of the 230 records reviewed, 108 patients (47%) had obstructions due to adhesions, 50 (21%) had volvulus, 22 (7%) had an ileus from perforation and 14 (6%) had intussusception. Hernia fell from the 1st to the 8th most common cause of obstruction. Patients with intestinal obstruction were older in 2007-2011 compared to those presenting between 1998 and 2003 (p < 0.001); conditions associated with older age (e.g. volvulus and neoplasia) were more frequently encountered (p < 0.001). Age over 50 years was strong factor of in-hospital death (adjusted OR 14.2, 95% CI 1.41-142.95). Conclusion: Efforts to reduce hernia backlog and expand the surgical workforce may have had an effect on intestinal obstruction epidemiology in Ghana. Increasing aging-related pathology and a higher risk of death in elderly patients suggest that improvement in geriatric surgical care is urgently needed.

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Operation Hernia to Ghana

Cited by 32 publications

References 12 publications

The cost effectiveness of early management of acute appendicitis underlies the importance of curative surgical services to a primary healthcare programme

The cost effectiveness of early management of acute appendicitis underlies the importance of curative surgical services to a primary healthcare programme

Hernia Surgery: From Guidelines to Clinical Practice

Changing Epidemiology of Intestinal Obstruction in Ghana: Signs of Increasing Surgical Capacity and an Aging Population

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