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  1. Article ; Online: Strategies for recovery of a surgical service in the COVID-19 era.

    Nel, D

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

    2022  Volume 60, Issue 3, Page(s) 154–159

    Abstract: The COVID-19 pandemic has resulted in a massive backlog of elective cases. Delays in the provision of "elective" surgical care have dire consequences for the patient: progression of disease and comorbidities, higher complication rates, and lower overall ... ...

    Abstract The COVID-19 pandemic has resulted in a massive backlog of elective cases. Delays in the provision of "elective" surgical care have dire consequences for the patient: progression of disease and comorbidities, higher complication rates, and lower overall survival. Delays in elective surgery also have significant consequences for the health system: added emotional strain on healthcare workers, a reduction in training opportunities, increased costs, and increased inequality in health-service provision. As the virus is likely to become endemic, the recovery of surgical services from the initial shock of the first three waves needs to be carefully planned, in order to mitigate the further loss of elective surgical services. This article presents a narrative review of the latest international guidelines and recommendations pertaining to surgical recovery strategies in the COVID-19 pandemic. To begin with, any recovery plan should be led by a local governance committee, who need to design and implement a number of strategies across the three phases of recovery. The preparation phase includes deciding on a system of case prioritisation, assessing and organising resources, and planning innovative ways to reorganise the service itself. The perioperative phase involves putting measures in place to reduce the risk of COVID-19 transmission. The post discharge phase includes the implementation of telemedicine for follow-up, as well as methods of service audit to enable continuous adjustment and improvement. Surgical service recovery presents many challenges; however, these also present a unique opportunity to reassess and improve the efficiency of surgical care delivery.
    MeSH term(s) Aftercare ; COVID-19/epidemiology ; Elective Surgical Procedures ; Humans ; Pandemics/prevention & control ; Patient Discharge
    Language English
    Publishing date 2022-09-22
    Publishing country South Africa
    Document type Journal Article ; Review
    ZDB-ID 416504-4
    ISSN 2078-5151 ; 0038-2361
    ISSN (online) 2078-5151
    ISSN 0038-2361
    DOI 10.17159/2078-5151/SAJS3783
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The impact of thromboelastography on patients with penetrating abdominal trauma requiring intensive care.

    Hannington, M / Nel, D / Miller, M / Nicol, A / Navsaria, P

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

    2023  Volume 61, Issue 2, Page(s) 133–138

    Abstract: Background: Trauma-induced coagulopathy (TIC) is a complex multifaceted process which contributes to higher mortality rates in severely injured trauma patients. Thromboelastography (TEG) is effective in detecting TIC which assists in instituting goal- ... ...

    Abstract Background: Trauma-induced coagulopathy (TIC) is a complex multifaceted process which contributes to higher mortality rates in severely injured trauma patients. Thromboelastography (TEG) is effective in detecting TIC which assists in instituting goal-directed therapy as part of damage control resuscitation.
    Methods: This retrospective study included all adult patients over a 36-month period with penetrating abdominal trauma who required a laparotomy, blood products and admission for critical care. Analysis included demographics, admission data, 24-hour interventions, TEG parameters and 30-day outcomes.
    Results: Eighty-four patients with a median age of 28 years were included. The majority (93%; 78/84) suffered from a gunshot injury, with 75% (63/84) receiving a damage control laparotomy. Forty-eight patients (57%) had a TEG. Injury severity score and total fluid and blood product administered in the first 24 hours were all significantly higher in patients who had a TEG (
    Conclusion: TIC is common in severely injured penetrating trauma patients. The usage of a thromboelastogram did not impact on 24-hour or 30-day mortality but did result in a decreased intensive care stay and a decreased high-grade complication rate.
    MeSH term(s) Adult ; Humans ; Retrospective Studies ; Thrombelastography ; Abdominal Injuries/diagnosis ; Abdominal Injuries/surgery ; Critical Care ; Intensive Care Units
    Language English
    Publishing date 2023-06-28
    Publishing country South Africa
    Document type Journal Article
    ZDB-ID 416504-4
    ISSN 2078-5151 ; 0038-2361
    ISSN (online) 2078-5151
    ISSN 0038-2361
    DOI 10.36303/SAJS.3950
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  3. Article ; Online: Sentinel lymph node biopsy in a resourcelimited setting: a retrospective comparison of sentinel lymph node biopsy before and after the introduction of Sentimag at an academic breast unit.

    Yousef, M / Roodt, L / Masu, A / Nel, D / Malherbe, F

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

    2023  Volume 61, Issue 2, Page(s) 91–95

    Abstract: Background: Sentinel lymph node biopsy (SLNB) is performed for staging and prognostication of breast cancer (BC) in cases with a clinically and radiologically negative axilla. Using blue dye and a radioactive colloid injection is considered the gold ... ...

    Abstract Background: Sentinel lymph node biopsy (SLNB) is performed for staging and prognostication of breast cancer (BC) in cases with a clinically and radiologically negative axilla. Using blue dye and a radioactive colloid injection is considered the gold standard for SLNB. This study aims to evaluate the SLNB outcomes before and after the introduction of Sentimag at an academic breast unit. Sentimag uses an injection of superparamagnetic iron oxide which is then detected in the sentinal lymph node using a magnetometer.
    Methods: A retrospective cohort study was performed comparing SLNBs done from 1 January 2017 to 31 December 2018. During 2017, a nuclear medicine technique was used for all SLNBs, while the Sentimag system was used in 2018.
    Results: There was no difference between the two groups comparing age, T-stage, size of tumour, and molecular status. The only statistically significant difference found was more higher-grade tumours in the group where a nuclear medicine technique was used in 2017 (
    Conclusion: This result demonstrates the feasibility of the magnetic technique for SLNB in a resource-limited setting. This new method shows promise as a safe and effective technique for SLNB - it is a valuable alternative in the absence of nuclear medicine (N.Med) facilities.
    MeSH term(s) Humans ; Female ; Sentinel Lymph Node Biopsy ; Breast Neoplasms/surgery ; Mastectomy ; Retrospective Studies ; Lymph Nodes/diagnostic imaging ; Lymph Nodes/surgery
    Language English
    Publishing date 2023-06-28
    Publishing country South Africa
    Document type Journal Article
    ZDB-ID 416504-4
    ISSN 2078-5151 ; 0038-2361
    ISSN (online) 2078-5151
    ISSN 0038-2361
    DOI 10.36303/SAJS.3962
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  4. 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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  5. Article ; Online: Competency Assessment of General Surgery Trainees: A Perspective From the Global South, in a CBME-Naive Context.

    Nel, D / McNamee, L / Wright, M / Alseidi, A A / Cairncross, L / Jonas, E / Burch, V

    Journal of surgical education

    2023  Volume 80, Issue 10, Page(s) 1462–1471

    Abstract: Objective: Before proceeding with local implementation of competency-based medical education-related assessment practices designed and evaluated in the Global North, we sought to challenge the assumption that this would be perceived as both necessary ... ...

    Abstract Objective: Before proceeding with local implementation of competency-based medical education-related assessment practices designed and evaluated in the Global North, we sought to challenge the assumption that this would be perceived as both necessary and acceptable in our context where training and assessment is based on a traditional, knowledge-focused approach. The aim of this study was to determine the perspectives of general surgery trainees and consultants towards the assessment of competence, how this has been achieved previously, and how it should be performed in the future at the University of Cape Town (UCT), South Africa.
    Design: Semi-structured interviews were conducted with consultants and trainees. Interviews were transcribed and then analyzed using a Reflexive Thematic Analysis approach.
    Setting and participants: Ten consultants (5 senior and 5 junior) and 10 trainees (5 South African and 5 international) from the Division of General Surgery at UCT in August 2022.
    Results: Five unique themes were developed: (1) Assessment of competence is essential, (2) competence includes multiple domains of practice, (3) a surgeon must be able to operate, (4) previously used methods were inadequate to assess competence, and (5) frequent assessment with feedback is desired. The themes were considered in the context of Situated Learning Theory, particularly Communities of Practice and their role in the training for, and authentic assessment of, competence in general surgery trainees.
    Conclusions: Participants described a need to develop and implement a new competency assessment program for general surgery training in this context, which is aligned with described competency-based medical education principles. Thoughtful integration of the formative and summative use of direct observation in the workplace, with a clear emphasis on procedural ability and the provision of high-quality feedback, may enhance the successful implementation of a strategy for competency-based assessment in general surgery training programs.
    MeSH term(s) Humans ; Competency-Based Education/methods ; Internship and Residency ; Program Evaluation ; Surgeons ; Clinical Competence
    Language English
    Publishing date 2023-07-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2277538-9
    ISSN 1878-7452 ; 1931-7204
    ISSN (online) 1878-7452
    ISSN 1931-7204
    DOI 10.1016/j.jsurg.2023.06.027
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  6. Article ; Online: Erratum: Anaesthetists' knowledge of airborne infections.

    Elghobashy, Ahmed / Scribante, Juan / Perrie, Helen / Nel, Dorinka

    Southern African journal of infectious diseases

    2022  Volume 37, Issue 1, Page(s) 456

    Abstract: This corrects the article DOI: 10.4102/sajid.v37i1.351.]. ...

    Abstract [This corrects the article DOI: 10.4102/sajid.v37i1.351.].
    Language English
    Publishing date 2022-08-31
    Publishing country South Africa
    Document type Published Erratum
    ZDB-ID 3046282-4
    ISSN 2313-1810 ; 2312-0053
    ISSN (online) 2313-1810
    ISSN 2312-0053
    DOI 10.4102/sajid.v37i1.456
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  7. Article ; Online: Disparity in oesophageal cancer management in South Africa: a comparison between two tertiary centres with special focus on the palliation of dysphagia.

    Nel, D / Omar, M / Chinnery, G / Jonas, E

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

    2019  Volume 57, Issue 2, Page(s) 10–15

    Abstract: Background: For most patients with oesophageal cancer worldwide, palliation of dysphagia is the goal which is most commonly achieved with self-expanding metal stents (SEMS). The aim of this study was to assess the profile and management of oesophageal ... ...

    Abstract Background: For most patients with oesophageal cancer worldwide, palliation of dysphagia is the goal which is most commonly achieved with self-expanding metal stents (SEMS). The aim of this study was to assess the profile and management of oesophageal cancer patients at Frere Hospital in the Eastern Cape, and compare this to a similar cohort from Groote Schuur Hospital (GSH) in the Western Cape Province.
    Method: This study is a retrospective comparative cohort which reviewed all patients diagnosed with oesophageal cancer by the Frere Hospital and GSH endoscopy units from January to December 2015. Independent prospective electronic databases for the two hospitals were merged for comparative analysis.
    Results: During the study period, 346 and 108 patients were diagnosed with oesophageal cancer at Frere Hospital and GSH respectively. The rate of curative intended intervention was similarly low, with 3% of cases at Frere Hospital undergoing oesophagectomy or definitive radiotherapy as compared to 5% at GSH (p=0.48). In terms of palliation, significantly more patients received palliative oncological therapy at GSH as compared to Frere Hospital (21% vs 8%, p < 0.001). At Frere Hospital, 281 patients (81%) were treated primarily with serial dilatations. At GSH, 9 patients received a single dilatation, all as a bridge to radiotherapy or stenting. At Frere Hospital, 28 patients (8%) were stented, as compared to GHS where 69 patients (64%) were managed with a stent (p < 0.001).
    Conclusion: This study shows significant differences in the oncological and endoscopic palliation of patients between the two institutions, highlighting a gross disparity in healthcare provision between them. The reasons for these disparities should be investigated and equipoise addressed by national health policy makers.
    MeSH term(s) Aged ; Deglutition Disorders/epidemiology ; Deglutition Disorders/therapy ; Esophageal Neoplasms/epidemiology ; Esophageal Neoplasms/therapy ; Esophagoscopy ; Female ; Humans ; Male ; Middle Aged ; Palliative Care ; Retrospective Studies ; South Africa/epidemiology ; Stents
    Language English
    Publishing date 2019-07-25
    Publishing country South Africa
    Document type Comparative Study ; Journal Article ; Multicenter Study
    ZDB-ID 416504-4
    ISSN 2078-5151 ; 0038-2361
    ISSN (online) 2078-5151
    ISSN 0038-2361
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  8. Article ; Online: Surgery for Pheochromocytoma: A Single-Center Review of 60 Cases from South Africa.

    Nel, D / Panieri, E / Malherbe, F / Steyn, R / Cairncross, L

    World journal of surgery

    2020  Volume 44, Issue 6, Page(s) 1918–1924

    Abstract: Background: There is a paucity of data on the presentation and surgical management of pheochromocytoma in developing nations, particularly in Africa.: Methods: This study was a retrospective review, which included all patients managed by the Groote ... ...

    Abstract Background: There is a paucity of data on the presentation and surgical management of pheochromocytoma in developing nations, particularly in Africa.
    Methods: This study was a retrospective review, which included all patients managed by the Groote Schuur Hospital/University of Cape Town Endocrine Surgery unit for pheochromocytoma and abdominal paragangliomas, from January 2002 to June 2019.
    Results: Sixty patients were included in the study, of which 33% were male and 67% female. The mean age was 47 years (range 14-81). The median tumor size was 6 cm, with 45% larger than 6 cm. 92% were located in the adrenal gland (87% unilateral, 5% bilateral), and 8% were extra-adrenal. The conversion rate for laparoscopic cases was 20%, with 55% of cases overall completed laparoscopically. Eleven patients with tumors > 6 cm were initially attempted laparoscopically, of which 3 were converted to open, without any associated increased morbidity. A major adverse event was recorded for 5 cases (8%), including 1 mortality. Overall morbidity, blood loss, operating time and hospital stay were all significantly reduced in the laparoscopic group. There were 5 patients with malignant disease (8%).
    Conclusion: This large series, from an established academic endocrine surgery unit in Africa, can serve as a benchmark for units with similar settings and resource limitations, to compare their surgical management and perioperative outcomes.
    MeSH term(s) Adolescent ; Adrenal Gland Neoplasms/pathology ; Adrenal Gland Neoplasms/surgery ; Adrenal Glands/pathology ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Pheochromocytoma/pathology ; Pheochromocytoma/surgery ; Retrospective Studies ; Young Adult
    Language English
    Publishing date 2020-02-13
    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 10.1007/s00268-020-05420-6
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  9. Article ; Online: Compliance to the South African ventral hernia guidelines: inaugural results from the HIG(SA) registry.

    Gouws, J / Nel, D / Bougard, H C / Koto, Z / Oodit, R / Kloppers, J C

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

    2021  Volume 59, Issue 4, Page(s) 145–148

    Abstract: Background: The Hernia Interest Group (HIG) of South Africa (SA), following the publication of their inguinal and ventral hernia guidelines (in 2015 and 2016 respectively), developed a hernia registry, the HIG(SA) hernia registry.: Methods: A ... ...

    Abstract Background: The Hernia Interest Group (HIG) of South Africa (SA), following the publication of their inguinal and ventral hernia guidelines (in 2015 and 2016 respectively), developed a hernia registry, the HIG(SA) hernia registry.
    Methods: A retrospective analysis of the prospectively maintained HIG(SA) hernia registry from 1 February 2019 to 29 February 2020. Compliance to six recommendations made in the HIG(SA) ventral hernia guidelines were assessed in both the public and private healthcare systems.
    Results: Three hundred and fifty-three ventral hernia repair cases were included in the study. Fifty-four per cent were private and 46% were public sector cases. Laparoscopic repair for patients with a BMI > 35 kg/m
    Conclusion: Ventral hernia repair practices in SA facilities overall had good compliance to four out of the six HIG(SA) ventral hernia guidelines highlighted for the purposes of this study. The two guidelines that had poor compliance overall were 'laparoscopic repair for patients with a BMI of > 35 kg/m
    MeSH term(s) Hernia, Ventral/surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Public Opinion ; Recurrence ; Registries ; Retrospective Studies ; South Africa ; Surgical Mesh
    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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  10. Article ; Online: The introduction of competency-based medical education for postgraduate training in South Africa.

    Nel, D / Burch, V / Adam, S / Ras, T / Mawela, D / Buch, E / Green-Thompson, L

    South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde

    2022  Volume 112, Issue 9, Page(s) 742–743

    Abstract: speci. ...

    Abstract -speci.
    MeSH term(s) Clinical Competence ; Competency-Based Education ; Education, Medical, Graduate ; Humans ; South Africa
    Language English
    Publishing date 2022-08-30
    Publishing country South Africa
    Document type Editorial
    ZDB-ID 390968-2
    ISSN 2078-5135 ; 0038-2469 ; 0256-9574
    ISSN (online) 2078-5135
    ISSN 0038-2469 ; 0256-9574
    DOI 10.7196/SAMJ.2022.v112i9.16717
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