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Article ; Online: To mesh or not to mesh-the known unknowns of preventing parastomal hernias.

Rajaretnam, Niroshini / Smart, Neil J

2021 Volume 109, Issue 1, Page(s) 1–2

MeSH term(s)	Humans ; Incisional Hernia/etiology ; Incisional Hernia/prevention & control ; Randomized Controlled Trials as Topic ; Rectal Neoplasms/surgery ; Surgical Mesh/adverse effects ; Surgical Stomas/adverse effects
Language	English
Publishing date	2021-10-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znab334
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Article ; Online: Abdominal stab wounds with retained knife: 15 years of experience from a major trauma centre in South Africa.

Kong, V / Cheung, C / Buitendag, J / Rajaretnam, N / Xu, W / Varghese, C / Bruce, J / Laing, G / Clarke, D

Annals of the Royal College of Surgeons of England

2022 Volume 105, Issue 5, Page(s) 407–412

Abstract: Introduction: This study reviews our cumulative experience with the management of patients presenting with a retained knife following an abdominal stab wound (SW).: Methods: A retrospective study was conducted at a major trauma centre in South Africa ...

Abstract	Introduction: This study reviews our cumulative experience with the management of patients presenting with a retained knife following an abdominal stab wound (SW). Methods: A retrospective study was conducted at a major trauma centre in South Africa over a 15-year period from July 2006 to December 2020 including all patients who presented with a retained knife in the abdomen following a SW. Results: A total of 42 cases were included: 37 males (93%) with a mean age of 26 years. A total of 18 knives (43%) were in the anterior abdomen and 24 were posterior abdomen. Plain radiography was performed in 88% (37/42) of cases and computed tomography was performed in 81% (34/42); 90% (38/42) underwent extraction in the operating theatre. Laparotomy was performed in 62% (26/42). Of all the laparotomies performed, 77% (20/26) were positive for intra-abdominal organ or visceral injury. Overall morbidity was 31%. There were two mortalities (5%). Laparotomy was less commonly required for the posterior abdomen (33% (8/24) vs 100% (18/18), Conclusions: Uncontrolled extraction of a retained knife in the abdomen outside of the operating theatre must be avoided. Retained knives in the anterior abdomen usually require formal laparotomy, but this is generally not required for posterior abdomen.
MeSH term(s)	Male ; Humans ; Adult ; South Africa/epidemiology ; Trauma Centers ; Retrospective Studies ; Wounds, Stab/epidemiology ; Wounds, Stab/surgery ; Abdominal Injuries/epidemiology ; Abdominal Injuries/surgery ; Abdomen ; Laparotomy
Language	English
Publishing date	2022-02-17
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2021.0321
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Article ; Online: A comparative study on analgesic and non-analgesic outcomes of inter pleural analgesia compared to thoracic epidural analgesia in open pancreatico-duodenectomy.

Yao, Lu / Rajaretnam, Niroshini / Smith, Natalie / Massey, Lisa / Aroori, Somaiah

Annals of hepato-biliary-pancreatic surgery

2022 Volume 26, Issue 3, Page(s) 270–276

Abstract: Backgrounds/aims: Thoracic epidural analgesia (TEA) is an established analgesic method in open Kausch-Whipple pancreaticoduodenectomy (KWPD). Although, it can cause hemodynamic instability and neurological complications. Inter pleural analgesia (IPA) is ...

Abstract	Backgrounds/aims: Thoracic epidural analgesia (TEA) is an established analgesic method in open Kausch-Whipple pancreaticoduodenectomy (KWPD). Although, it can cause hemodynamic instability and neurological complications. Inter pleural analgesia (IPA) is an alternative option. We aim to evaluate the effectiveness of IPA versus TEA after KWPD. Methods: We retrospectively studied the efficacy of IPA against TEA in patients, operated by a single surgeon. The primary outcome was the analgesic efficacy and secondary outcomes were analgesia-related complications, inotrope use, and duration. Results: Forty patients (TEA, 22; IPA, 18) were included. Both groups were well matched for patient characteristics, type, and duration of surgery. TEA was associated with higher analgesia-related complications (n = 8, 36.4% vs. n = 1, 5.6%; Conclusions: In open KWPD, IPA is not inferior to TEA in its efficacy of pain control. IPA was associated with less analgesia-related complications and shorter inotrope requirements. However, this was a small retrospective study. Larger randomized controlled trials are needed to study the effectiveness of IPA.
Language	English
Publishing date	2022-04-11
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	3012179-6
ISSN	2508-5859 ; 2508-5778
ISSN (online)	2508-5859
ISSN	2508-5778
DOI	10.14701/ahbps.21-148
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Article ; Online: High-grade renal trauma in children and adolescents can be successfully managed non-operatively.

Thirayan, V / Kong, V Y / Elsabagh, A / Xu, W / Rajaretnam, N / Conradie, B / Cheung, C / Clarke, D L / Bruce, J L / Laing, G L / Manchev, V / Bekker, W

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

2023 Volume 61, Issue 1, Page(s) 56–60

Abstract: Background: This paper reviews our experience with management of renal injuries in children and adolescents with a focus on the outcome of non-operative management (NOM).: Methods: Retrospective review of the clinical characteristics, injury grade (I- ...

Abstract	Background: This paper reviews our experience with management of renal injuries in children and adolescents with a focus on the outcome of non-operative management (NOM). Methods: Retrospective review of the clinical characteristics, injury grade (I-III, low grade and IV and V high grade), management and outcomes of children ≤ 18 years old with renal trauma presenting to a major trauma centre in South Africa between December 2012 and October 2020. Results: Sixty-one children with a renal injury were identified with a median age of 13 (range 0-18) years. Forty-five were boys; blunt and penetrating mechanisms of trauma were sustained by 55 (90%) and six (10%) children, respectively. The median American Association for the Surgery of Trauma (AAST) grade of renal injury was 3 (range 1-5): this included eight (13%) with grade I, six (10%) with grade II, 17 (28%) with grade III, 20 (46%) with grade IV and 10 (16%) with grade V injuries. Forty children (66%) were successfully managed non-operatively and 21 required a laparotomy; of these six (28%) required nephrectomy. The overall renal salvage rate was 55/61 (90%). Children who required laparotomy were significantly more likely to have sustained a penetrating mechanism of injury (24% vs 2%) and have greater length of hospital stay (median 9 vs 3 days) compared to children managed non-operatively ( Conclusion: Paediatric renal trauma can be successfully managed non-operatively in over two-thirds of cases in this middle-income country. High grade of renal injury does not absolutely predict need for surgery or nephrectomy and can be managed non-operatively.
MeSH term(s)	Male ; Humans ; Child ; Adolescent ; Infant, Newborn ; Infant ; Child, Preschool ; Female ; Wounds, Nonpenetrating/diagnosis ; Wounds, Nonpenetrating/therapy ; Injury Severity Score ; Kidney ; Nephrectomy ; Retrospective Studies ; Trauma Centers
Language	English
Publishing date	2023-04-13
Publishing country	South Africa
Document type	Review ; Journal Article
ZDB-ID	416504-4
ISSN	2078-5151 ; 0038-2361
ISSN (online)	2078-5151
ISSN	0038-2361
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Article ; Online: Assessment of the inferior mesenteric vein diameter as a surrogate marker to evaluate response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma.

Akingboye, A A / Rajaretnam, N / Daniels, I R

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2017 Volume 20, Issue 1, Page(s) 75–76

MeSH term(s)	Adenocarcinoma ; Biomarkers ; Chemoradiotherapy ; Humans ; Mesenteric Veins ; Neoadjuvant Therapy ; Rectal Neoplasms ; Treatment Outcome
Chemical Substances	Biomarkers
Language	English
Publishing date	2017-10-12
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.13915
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Article ; Online: Surgical Management of Primary Small Bowel NET Presenting Acutely with Obstruction or Perforation.

Rajaretnam, N S / Meyer-Rochow, G Y

World journal of surgery

2020 Volume 45, Issue 1, Page(s) 203–207

Abstract: Up to 35% of small bowel neuroendocrine tumors (SBNETs) may present with an acute intra-abdominal complication including obstruction, perforation, bleeding or ischemia and may require emergency surgical treatment in centers not normally accustomed to ... ...

Abstract	Up to 35% of small bowel neuroendocrine tumors (SBNETs) may present with an acute intra-abdominal complication including obstruction, perforation, bleeding or ischemia and may require emergency surgical treatment in centers not normally accustomed to managing patients with neuroendocrine tumors. These patients may have a known diagnosis of SBNET, be suspected as suffering from SBNET or have SBNET diagnosed as an incidental finding on presenting radiology or postoperative pathology. Perioperative priorities include obtaining both clinical and radiological staging with cross-sectional imaging and clinical examination, screening for the presence of carcinoid syndrome and right-sided cardiac disease and assessment of prognosis. Intraoperatively careful attention should be paid to noting the presence and location of multifocal primary and metastatic disease. Ideally, surgical resection with mesenteric lymph node dissection is the treatment of choice for obstructing and perforating lesions. Extended lymphadenectomy along the SMA, SMV and behind the pancreas should be primarily considered an elective procedure. In unwell patients with advanced disease surgical bypass (jejuno or ileocolic) or proximal defunctioning should be undertaken but, given the excellent long-term survivals in patients with stage IV disease, could be considered bridging procedures to elective resection following formal staging and multidisciplinary review.
MeSH term(s)	Humans ; Intestinal Neoplasms/complications ; Intestinal Neoplasms/diagnostic imaging ; Intestinal Neoplasms/surgery ; Lymph Node Excision ; Neuroendocrine Tumors/complications ; Neuroendocrine Tumors/diagnostic imaging ; Neuroendocrine Tumors/surgery ; Pancreatic Neoplasms/surgery ; Stomach Neoplasms
Language	English
Publishing date	2020-07-21
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/s00268-020-05689-7
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Article ; Online: Management of penetrating thoracic trauma with retained knife blade: 15-year experience from a major trauma centre in South Africa.

Kong, V / Cheung, C / Buitendag, J / Rajaretnam, N / Varghese, C / Elsabagh, A / Bekker, W / Bruce, J / Laing, G / Clarke, D

Annals of the Royal College of Surgeons of England

2021 Volume 104, Issue 4, Page(s) 308–313

Abstract: Introduction: This study reviews our experience with the management a retained knife in the setting of thoracic stab wounds.: Methods: A retrospective study was conducted at a major trauma in South Africa over a 15-year period from January 2004 to ... ...

Abstract	Introduction: This study reviews our experience with the management a retained knife in the setting of thoracic stab wounds. Methods: A retrospective study was conducted at a major trauma in South Africa over a 15-year period from January 2004 to December 2018. Results: There were 40 patients, of whom 37 were males (93%). Median age was 24 years; 78% of cases (31 of 40) were a retained knife and 23% (9 of 40) were a retained blade. The locations of the stab wounds were 19 (48%) anterior and 21 (53%) posterior. Plain x-ray was performed in 85% (34) of patients and computed tomography angiography was performed in 85% (34). Six patients had haemodynamic instability and were expedited to the operating room without further imaging. Three of these had cardiac tamponade and three a massive haemothorax. Simple extraction and wound exploration were performed in 58% (23 of 40) of cases and the remaining 43% (17 of 40) required operative exploration and extraction. The operative approach was anterolateral thoracotomy in nine cases, posterolateral thoracotomy in four and median sternotomy in three cases. One patient required extraction and concurrent vertebral laminectomy due to cord compression. Twelve patients (30%) experienced complications (nine wound sepsis and three hospital-acquired pneumonia). There was one mortality (3%). The median length of hospital stay was 6 days. Conclusion: Uncontrolled extraction of a retained thoracic knife outside the operating room must be avoided. An unstable patient should proceed directly for operative exploration. For stable patients, cross-sectional imaging will allow for planned extraction in operating room.
MeSH term(s)	Adult ; Humans ; Male ; Retrospective Studies ; South Africa/epidemiology ; Trauma Centers ; Wounds, Penetrating/surgery ; Wounds, Stab/epidemiology ; Wounds, Stab/surgery ; Young Adult
Language	English
Publishing date	2021-12-21
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2021.0182
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Article ; Online: Re: risk factors and natural history of parastomal hernia after radical cystectomy and ileal conduit.

John, Joseph B / Rajaretnam, Niroshini / McGrath, John S / Smart, Neil J

BJU international

2022 Volume 130, Issue 3, Page(s) 394–395

MeSH term(s)	Cystectomy/adverse effects ; Humans ; Incisional Hernia/etiology ; Risk Factors ; Urinary Bladder Neoplasms/complications ; Urinary Diversion/adverse effects
Language	English
Publishing date	2022-08-23
Publishing country	England
Document type	Letter ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	1462191-5
ISSN	1464-410X ; 1464-4096 ; 1358-8672
ISSN (online)	1464-410X
ISSN	1464-4096 ; 1358-8672
DOI	10.1111/bju.15814
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Article ; Online: Surgical tracheostomy in morbidly obese patients: technical considerations and a two-flap technique for access.

Khoo, S G / Rajaretnam, N

The Journal of laryngology and otology

2012 Volume 126, Issue 4, Page(s) 435–438

Abstract: Objective: In an era in which percutaneous tracheostomies are frequently performed in 'suitable' necks, more technically complex cases are referred to the otolaryngologist. We describe the surgical technique used and close cooperation required in ... ...

Abstract	Objective: In an era in which percutaneous tracheostomies are frequently performed in 'suitable' necks, more technically complex cases are referred to the otolaryngologist. We describe the surgical technique used and close cooperation required in securing the airway of a morbidly obese patient. Case report: A 52-year-old, morbidly obese man with significant comorbidities was referred for surgical tracheostomy following spinal fractures. This was complicated by a previous percutaneous dilatational tracheostomy scar. Tension-free skin advancement was not possible with a deeply plunging trachea; a vertical skin incision was dropped inferiorly to the sternum for access. A size 8 Shiley XLT Proximal Extension cuffed tracheostomy tube was inserted successfully. Conclusion: We describe safe airway surgery in a morbidly obese man, and outline requirements including the use of a specially designed operating table, the need for an elongated proximal limb tracheostomy tube, and the use of a distal two-flap technique for access to a deeply plunging trachea.
MeSH term(s)	Body Mass Index ; Cicatrix/complications ; Cicatrix/surgery ; Clinical Competence ; Humans ; Intubation, Intratracheal/instrumentation ; Male ; Middle Aged ; Neck/anatomy & histology ; Neck/surgery ; Obesity Hypoventilation Syndrome/complications ; Obesity, Morbid/complications ; Obesity, Morbid/surgery ; Otolaryngology/methods ; Pulmonary Disease, Chronic Obstructive/complications ; Spinal Fractures/complications ; Surgical Flaps ; Tracheostomy/instrumentation ; Tracheostomy/methods
Keywords	covid19
Language	English
Publishing date	2012-04
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	218299-3
ISSN	1748-5460 ; 0022-2151
ISSN (online)	1748-5460
ISSN	0022-2151
DOI	10.1017/S0022215111003380
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Article ; Online: The neglected epidemic of trauma from interpersonal violence against the elderly in South Africa.

Lee, L / Kong, V Y / Cheung, C / Rajaretnam, N / Thirayan, V / Bruce, J L / Manchev, V / Mills, R P / Laing, G L / Clarke, D L

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

2022 Volume 60, Issue 4, Page(s) 278–283

Abstract: Background: Geriatric injuries comprise a significant burden in the developed world but much less are known in the developing world setting. This study aims to review our experience of geriatric injuries with a focus on interpersonal violence (IPV) ... ...

Abstract	Background: Geriatric injuries comprise a significant burden in the developed world but much less are known in the developing world setting. This study aims to review our experience of geriatric injuries with a focus on interpersonal violence (IPV) managed at a major trauma centre in South Africa. Methods: This was a retrospective study on all patients who were aged > 65 years admitted to our trauma centre from January 2013 to December 2020, based in Pietermaritzburg, South Africa. Results: Over the 8-year study period, 323 cases were included (62% male, mean age 72 years). Mechanism of injury: 80% blunt, 16% penetrating and 4% others. The median injury severity score (ISS) was 9. The median Charlson comorbidity index (CCI) for all 323 cases was 3. Diabetes ( Conclusion: Although the burden of geriatric trauma in South Africa appears to be relatively low, it is associated with significant morbidity and mortality. Trauma from interpersonal violence is especially common and is associated with significantly worse outcomes than that of non-interpersonal violence-related trauma. Elderly rural trauma victims have worse outcomes than their urban counterparts.
MeSH term(s)	Humans ; Male ; Aged ; Female ; Wounds, Gunshot ; Retrospective Studies ; South Africa/epidemiology ; Violence
Language	English
Publishing date	2022-12-07
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	416504-4
ISSN	2078-5151 ; 0038-2361
ISSN (online)	2078-5151
ISSN	0038-2361
DOI	10.17159/2078-5151/SAJS3794
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