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Article ; Online: The role of national population-based registries in pancreatic cancer surgery research.

Jonas, Eduard / Kloppers, Christo

International journal of surgery (London, England)

2024

Abstract: Research and innovation are critical for advancing the multidisciplinary management of pancreatic cancer. Registry-based studies (RBSs) are a complement to randomized clinical trials (RCTs). Compared with RCTs, RBSs offer cost-effectiveness, larger ... ...

Abstract	Research and innovation are critical for advancing the multidisciplinary management of pancreatic cancer. Registry-based studies (RBSs) are a complement to randomized clinical trials (RCTs). Compared with RCTs, RBSs offer cost-effectiveness, larger sample sizes, and representation of real-world clinical practice. National population-based registries (NPBRs) aim to cover the entire national population, and studies based on NPBRs are, compared to non-NPBRs, less prone to selection bias. The last decade has witnessed a dramatic increase in NPBRs in pancreatic cancer surgery, which has undoubtedly added invaluable knowledge to the body of evidence on pancreatic cancer management. However, several methodological shortcomings may compromise the quality of registry-based studies. These include a lack of control over data collection and a lack of reporting on the quality of the source registry or database in terms of validation of coverage and data completeness and accuracy. Furthermore, there is a significant risk of double publication from the most commonly used registries as well as the inclusion of historical data that is not relevant or representative of research questions addressing current practices.
Language	English
Publishing date	2024-04-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1097/JS9.0000000000001405
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Article ; Online: The prevalence and risk factors for phantom limb pain: a cross-sectional survey.

Limakatso, Katleho / Ndhlovu, F / Usenbo, A / Rayamajhi, S / Kloppers, C / Parker, R

BMC neurology

2024 Volume 24, Issue 1, Page(s) 57

Abstract: Background: We previously performed a systematic review and meta-analysis which revealed a Phantom Limb Pain (PLP) prevalence estimate of 64% [95% CI: 60.01-68.1]. The prevalence estimates varied significantly between developed and developing countries. ...

Abstract	Background: We previously performed a systematic review and meta-analysis which revealed a Phantom Limb Pain (PLP) prevalence estimate of 64% [95% CI: 60.01-68.1]. The prevalence estimates varied significantly between developed and developing countries. Remarkably, there is limited evidence on the prevalence of PLP and associated risk factors in African populations. Methods: Adults who had undergone limb amputations between January 2018 and October 2022 were recruited from healthcare facilities in the Western and Eastern Cape Provinces. We excluded individuals with auditory or speech impairments that hindered clear communication via telephone. Data on the prevalence and risk factors for PLP were collected telephonically from consenting and eligible participants. The prevalence of PLP was expressed as a percentage with a 95% confidence interval. The associations between PLP and risk factors for PLP were tested using univariate and multivariable logistic regression analyses. The strength of association was calculated using the Odds Ratio where association was confirmed. Results: The overall PLP prevalence was 71.73% [95% CI: 65.45-77.46]. Persistent pre-operative pain, residual limb pain, and non-painful phantom limb sensations were identified as risk factors for PLP. Conclusion: This study revealed a high prevalence of PLP. The use of effective treatments targeting pre-amputation pain may yield more effective and targeted pre-amputation care, leading to improved quality of life after amputation.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Phantom Limb ; Prevalence ; Quality of Life ; Risk Factors
Language	English
Publishing date	2024-02-06
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2041347-6
ISSN	1471-2377 ; 1471-2377
ISSN (online)	1471-2377
ISSN	1471-2377
DOI	10.1186/s12883-024-03547-w
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Article ; Online: Laparoscopic splenopexy for wandering spleen with absorbable mesh fixation.

Nel, D / Kloppers, C / Panieri, E

South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie

2021 Volume 59, Issue 1, Page(s) 30a–30b

Abstract: Summary: Wandering spleen is a rare condition characterised by lack of fixation of the spleen to its usual position in the left upper quadrant. Laparoscopic splenopexy has become the standard of care. Although a number of methods have been described, ... ...

Abstract	Summary: Wandering spleen is a rare condition characterised by lack of fixation of the spleen to its usual position in the left upper quadrant. Laparoscopic splenopexy has become the standard of care. Although a number of methods have been described, the use of an absorbable mesh to secure the spleen to the left upper quadrant has been shown to be safe, effective and quick to perform. We present a case of a 32-year-old female with this condition and describe our surgical technique for fixation of the spleen using an absorbable mesh.
MeSH term(s)	Adult ; Female ; Humans ; Laparoscopy ; Prostheses and Implants ; Surgical Mesh ; Wandering Spleen/diagnostic imaging ; Wandering Spleen/surgery
Language	English
Publishing date	2021-03-09
Publishing country	South Africa
Document type	Case Reports ; Journal Article
ZDB-ID	416504-4
ISSN	2078-5151 ; 0038-2361
ISSN (online)	2078-5151
ISSN	0038-2361
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Article ; Online: Laparoscopic subtotal cholecystectomy outcomes across a low-and middle-income country metropolitan health service.

Booyse, Karien / Lindemann, Jessica / Calitz, Mariska / Bernon, Marc / Jonas, Eduard / Kloppers, Christo

World journal of surgery

2024

Abstract: Background: Laparoscopic subtotal cholecystectomy (LSC) is a safe alternative for difficult cholecystectomies to prevent bile duct injury and open conversion. The primary aim was to detail the use and outcomes on LSCs.: Methods: Retrospective ... ...

Abstract	Background: Laparoscopic subtotal cholecystectomy (LSC) is a safe alternative for difficult cholecystectomies to prevent bile duct injury and open conversion. The primary aim was to detail the use and outcomes on LSCs. Methods: Retrospective analysis of a prospectively maintained database of laparoscopic cholecystectomy (LC). Relative clinical factors, outcomes, and 30-day follow-up between LSC and LC were compared using univariate and multivariate analyses. Results: Six hundred and twenty four cholecystectomies were performed and 53 (8.5%) required LSC. 81.8% were fenestrating LSC. Male sex was significantly overrepresented in the LSC group (p < 0.01) and patients requiring LSC were significantly older (p < 0.01). Same admission cholecystectomy was associated with a higher risk of LSC (p < 0.01). Patients with a history of previous surgery, preoperative ERCP, or percutaneous cholecystostomy had an increased risk of undergoing LSC (p < 0.01). A necrotic gallbladder was the most significant predictor of the need for a LSC (p < 0.001). A contracted gallbladder, extensive adhesions, gallbladder empyema, and severe inflammation were significant predictors of difficulty (all p < 0.01). Postoperative complications occurred in 26.4% of LSC patients. There were ten (18.9%) Clavien-Dindo Grade III complications, 5.7% required ERCPs, and 9.4% required relook laparotomies. Significantly, more patients in the LSC group developed bile leaks (n = 8, 15%) (p < 0.001). There were two readmissions within 30 days, one mortality, and no BDIs occurred in the LSC cohort. Conclusion: LSC provides a feasible surgical option that should be utilized in complex cholecystitis.
Language	English
Publishing date	2024-04-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1002/wjs.12180
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Article ; Online: Translation and linguistic validation of the EORTC QLQ-PAN26 questionnaire for assessment of health-related quality of life in patients with pancreatic cancer and chronic pancreatitis into isiXhosa and Afrikaans.

Gqada, K J / Kotze, U / Soldati, V / Kloppers, C / Krige, J / Jonas, E

South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie

2021 Volume 59, Issue 4, Page(s) 153–156

Abstract: Background: Health-related quality of life (HRQOL) parameters have become important components in the holistic management of pancreatic ductal adenocarcinoma (PDAC) and are now increasingly incorporated in treatment protocols. The European Organisation ... ...

Abstract	Background: Health-related quality of life (HRQOL) parameters have become important components in the holistic management of pancreatic ductal adenocarcinoma (PDAC) and are now increasingly incorporated in treatment protocols. The European Organisation for Research and Treatment of Cancer (EORTC) pancreatic cancer specific questionnaire (QLQ-PAN26) has also been validated for chronic pancreatitis (CP). The objective was to translate the EORTC QLQPAN26 questionnaire into and validate it for isiXhosa and Afrikaans. Methods: Following the EORTC translation procedure, two forward translations of the English version into isiXhosa and Afrikaans were performed independently by two language practitioners for each language, followed by reconciliation of disagreements. A back translation of the reconciled version into English by a second pair of language practitioners was done. The results of all the steps were summarised with comments in a report for review by the EORTC translation unit. After proofreading by an external proof-reader chosen by the translation unit, pilot testing was performed on a cohort of ten isiXhosa patients and ten Afrikaans patients with PDAC or chronic pancreatitis. Results were summarised in a pilottesting report, and the final version approved by the translation unit. Results: Thirteen patients diagnosed with PDAC and seven with CP were included in the study. The questionnaire was completed electronically ( Conclusion: The EORTC QLQ-PAN26 used in patients with PDAC and CP has been translated and linguistic validation performed in isiXhosa and Afrikaans. Availability of a questionnaire in patients' mother tongue should increase the validity of results.
MeSH term(s)	Humans ; Language ; Linguistics ; Pancreatic Neoplasms ; Pancreatitis, Chronic/diagnosis ; Pancreatitis, Chronic/therapy ; Quality of Life ; Reproducibility of Results ; Surveys and Questionnaires
Language	English
Publishing date	2021-12-10
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	416504-4
ISSN	2078-5151 ; 0038-2361
ISSN (online)	2078-5151
ISSN	0038-2361
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Article ; Online: Do upper GI bleed guidelines reach patient care: effect of a quality improvement initiative.

Rayamajhi, S / Aborkis, I / Kloppers, C / Spence, R / Thomson, S R

South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie

2021 Volume 58, Issue 4, Page(s) 204–209

Abstract: Background: Adherence is variable in clinical practice to consensus guidelines on the management of upper gastrointestinal bleeding. We aimed to assess the effect of a quality improvement program (QIP) on guideline adherence.: Methods: A QIP was ... ...

Abstract	Background: Adherence is variable in clinical practice to consensus guidelines on the management of upper gastrointestinal bleeding. We aimed to assess the effect of a quality improvement program (QIP) on guideline adherence. Methods: A QIP was undertaken over a two-month period. Data were collected retrospectively, for the one-year pre QIP and prospectively for one-year post QIP. The QIP goals were adherence to criteria for the timing of oesophagogastroduodenoscopy (OGD), achievement of dual endotherapy and blood transfusion triggers. Results: Fifty-one patients were pre QIP and 58 post QIP. The two groups' baseline data were comparable. Over 80% had their OGD within 24 hours (pre QIP 82.3%, post QIP 81.0%). The overall and high-risk groups (variceal and MBS > 10) had an insignificantly longer time to OGD (mean 19.2 and 17.8 hours respectively) in the post QIP cohort (mean 14.2 and 15.2 hours).The practice of dual endotherapy improved post QIP ( Conclusion: This QIP had no effect on time to OGD adherence which compares favorably to similar audits. Adherence to transfusion triggers and the ability to deliver dual endotherapy routinely were positive QIP outcomes.
MeSH term(s)	Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/therapy ; Guideline Adherence ; Humans ; Patient Care ; Quality Improvement ; Retrospective Studies
Language	English
Publishing date	2021-06-07
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	416504-4
ISSN	2078-5151 ; 0038-2361
ISSN (online)	2078-5151
ISSN	0038-2361
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Article ; Online: Reply to "Prognostic and recurrence factors after endoscopic injection sclerotherapy for esophageal varices: Multivariate analysis with propensity score matching" by Abe et al.

Krige, Jake / Kloppers, Christo / Jonas, Eduard

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society

2021 Volume 34, Issue 3, Page(s) 650

MeSH term(s)	Esophageal and Gastric Varices/diagnosis ; Esophageal and Gastric Varices/therapy ; Gastrointestinal Hemorrhage ; Humans ; Multivariate Analysis ; Prognosis ; Propensity Score ; Sclerosing Solutions ; Sclerotherapy
Chemical Substances	Sclerosing Solutions
Language	English
Publishing date	2021-12-10
Publishing country	Australia
Document type	Letter ; Comment
ZDB-ID	1171589-3
ISSN	1443-1661 ; 0915-5635
ISSN (online)	1443-1661
ISSN	0915-5635
DOI	10.1111/den.14204
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Article: Novel CABIN score outperforms other prognostic models in predicting in-hospital mortality after salvage transjugular intrahepatic portosystemic shunting.

Krige, Jake / Jonas, Eduard / Robinson, Chanel / Beningfield, Steve / Kotze, Urda / Bernon, Marc / Burmeister, Sean / Kloppers, Christo

World journal of gastrointestinal pathophysiology

2023 Volume 14, Issue 2, Page(s) 34–45

Abstract: Background: Transjugular intrahepatic portosystemic shunt (TIPS) is now established as the salvage procedure of choice in patients who have uncontrolled or severe recurrent variceal bleeding despite optimal medical and endoscopic treatment.: Aim: To ... ...

Abstract	Background: Transjugular intrahepatic portosystemic shunt (TIPS) is now established as the salvage procedure of choice in patients who have uncontrolled or severe recurrent variceal bleeding despite optimal medical and endoscopic treatment. Aim: To analysis compared the performance of eight risk scores to predict in-hospital mortality after salvage TIPS (sTIPS) placement in patients with uncontrolled variceal bleeding after failed medical treatment and endoscopic intervention. Methods: Baseline risk scores for the Acute Physiology and Chronic Health Evaluation (APACHE) II, Bonn TIPS early mortality (BOTEM), Child-Pugh, Emory, FIPS, model for end-stage liver disease (MELD), MELD-Na, and a novel 5 category CABIN score incorporating Creatinine, Albumin, Bilirubin, INR and Na, were calculated before sTIPS. Concordance (C) statistics for predictive accuracy of in-hospital mortality of the eight scores were compared using area under the receiver operating characteristic curve (AUROC) analysis. Results: Thirty-four patients (29 men, 5 women), median age 52 years (range 31-80) received sTIPS for uncontrolled (11) or refractory (23) bleeding between August 1991 and November 2020. Salvage TIPS controlled bleeding in 32 (94%) patients with recurrence in one. Ten (29%) patients died in hospital. All scoring systems had a significant association with in-hospital mortality ( Conclusion: The novel CABIN score had the best prediction capability with statistical superiority over seven other risk scores. Despite sTIPS, hospital mortality remains high and can be predicted by CABIN category B or C or CABIN scores > 10. Survival was 100% in CABIN A patients while mortality was 75% for CABIN B, 87.5% for CABIN C, and 83% for CABIN scores > 10.
Language	English
Publishing date	2023-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2583474-5
ISSN	2150-5330
ISSN	2150-5330
DOI	10.4291/wjgp.v14.i2.34
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Article ; Online: Percutaneous Cholecystostomy Placement in Cases of Non-operative Cholecystitis: A Retrospective Cohort Analysis.

Gandhi, Karan / Du Plessis, Rimon / Klopper, Juan / Kloppers, Christo

World journal of surgery

2020 Volume 44, Issue 12, Page(s) 4077–4085

Abstract: Background: Acute (calculous) cholecystitis (AC) is an extremely common surgical presentation, managed by cholecystectomy. Percutaneous cholecystostomy (PC) is an alternative; however, its safety and efficacy, along with subsequent cholecystectomy, are ... ...

Abstract	Background: Acute (calculous) cholecystitis (AC) is an extremely common surgical presentation, managed by cholecystectomy. Percutaneous cholecystostomy (PC) is an alternative; however, its safety and efficacy, along with subsequent cholecystectomy, are underreported in South Africa, where patients often present late and access to emergency operating theatre is constrained. The aim of the study was to demonstrate the outcomes of PC in patients with AC not responding to antimicrobials. Materials and methods: A retrospective cohort review of patient records, who underwent PC in Groote Schuur Hospital, Cape Town, between May 2013 and July 2016, was performed. Patients with PC for malignancy or acalculous cholecystitis were excluded. Technical success, clinical response, procedure-related morbidity and mortality were recorded. Interval LC parameters were investigated. Results: Technical success and clinical improvement was seen in 29 of 37 patients (78.38%) who had PC. Malposition (8.11%) was the most common complication. Two patients required emergency surgery (5.4%), while one tube was dislodged. Median tube placement duration was 25 days (range 1-211). Post-procedure, 16 patients (43.24%) went on to have LC, of which 50% (eight patients) required conversion to open surgery and 25% (four) had subtotal cholecystectomy. Median surgical time was 130 min. There were no procedure-related mortalities but eight patients (21.62%) died in the 90-day period following tube insertion. Conclusion: In patients with AC, PC is safe, with high technical success and low complication rate. Subsequent cholecystectomy should be performed, but is usually challenging. The requirement for PC may predict a more complex disease process.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Cholecystectomy ; Cholecystitis/epidemiology ; Cholecystitis/surgery ; Cholecystography ; Cholecystostomy ; Female ; Gallbladder/diagnostic imaging ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; South Africa/epidemiology ; Treatment Outcome ; Ultrasonography
Language	English
Publishing date	2020-08-28
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-020-05752-3
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Article: Mind the gap! Extraluminal percutaneous-endoscopic rendezvous with a self-expanding metal stent for restoring continuity in major bile duct injury: A case series.

Lindemann, Jessica / Kloppers, Christo / Burmeister, Sean / Bernon, Marc / Jonas, Eduard

International journal of surgery case reports

2019 Volume 60, Page(s) 340–344

Abstract: Introduction: Treatment of major iatrogenic and non-iatrogenic bile duct injury (BDI) often requires delayed surgery with interim external biliary drainage. Percutaneous transhepatic cholangiography (PTC) with biliary catheter placement and endoscopic ... ...

Abstract	Introduction: Treatment of major iatrogenic and non-iatrogenic bile duct injury (BDI) often requires delayed surgery with interim external biliary drainage. Percutaneous transhepatic cholangiography (PTC) with biliary catheter placement and endoscopic retrograde cholangiography (ERC) with stent placement have been used to bridge defects. In some patients, bridging the defect cannot be achieved through ERC or PTC alone. Materials and methods: Two patients with major BDIs, one iatrogenic and one non-iatrogenic underwent an extraluminal PTC/ERC rendezvous with placement of a fully covered self-expandable metal stent (SEMS) for the acute management of BDI with substantial loss of bile duct length. Results: In both patients the intraperitoneal PTC/ERC rendezvous with SEMS placement was successful with no complications after 12 and 18 months follow-up, respectively. Discussion: This study is the first to report a standardized approach to the acute management of iatrogenic and non-iatrogenic major BDIs using extraluminal intraperitoneal PTC/ERC rendezvous with placement of a fully covered SEMS. The described technique may serve as a "bridge to surgery" strategy for patients where definitive management of BDIs are deferred. However, long-term data of the success of this technique, specifically the use of a SEMS to bridge the defect, are lacking and further investigation is required to determine its role as a definitive treatment of BDIs with substance loss. Conclusion: PTC/ERC rendezvous with restoration of biliary continuity and internalization of bile flow is particularly useful for patients who have previously failed ERC and/or PTC alone, and in whom immediate surgical repair is not an option.
Language	English
Publishing date	2019-06-28
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2019.06.059
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