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Cawich SO, Dixon E, Shukla PJ, Shrikhande SV, Deshpande RR, Mohammed F, Pearce NW, Francis W, Johnson S, Bujhawan J. Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center: Value of tailored peri-pancreatectomy protocols. World J Gastrointest Surg 2024; 16:681-688. [PMID: 38577074 PMCID: PMC10989354 DOI: 10.4240/wjgs.v16.i3.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/03/2024] [Accepted: 01/27/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is a technically complex operation, with a relatively high risk for complications. The ability to rescue patients from post-PD complications is as a recognized quality measure. Tailored protocols were instituted at our low volume facility in the year 2013. AIM To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality. METHODS A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1, 2013 and June 30, 2023. Standardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications, and the modified Clavien-Dindo classification was used to classify post-PD complications. RESULTS Over the study period, 113 patients at a mean age of 57.5 years (standard deviation [SD] ± 9.23; range: 30-90; median: 56) underwent PDs at this facility. Major complications were recorded in 33 (29.2%) patients at a mean age of 53.8 years (SD: ± 7.9). Twenty-nine (87.9%) patients who experienced major morbidity were salvaged after aggressive treatment of their complication. Four (3.5%) died from bleeding pseudoaneurysm (1), septic shock secondary to a bile leak (1), anastomotic leak (1), and myocardial infarction (1). There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores ≤ 2 (93.3% vs 25%; P = 0.0024). CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring PD. Despite low volumes at our facility, we demonstrated that 87.9% of patients were rescued from major complications. We attributed this to several factors including development of rescue protocols, the competence of the pancreatic surgery teams and continuous, and adaptive learning by the entire institution, culminating in the development of tailored peri-pancreatectomy protocols.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
| | - Elijah Dixon
- Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alberta T2N2T9, Canada
| | - Parul J Shukla
- Department of Surgery, Weill Cornell Medical College, New York, NY 10065, United States
| | - Shailesh V Shrikhande
- Department of Surgical Oncology, Tata Memorial Center, Homi Bhabha National University, Mumbai 400012, India
| | - Rahul R Deshpande
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Fawwaz Mohammed
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
| | - Neil W Pearce
- University Surgical Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Wesley Francis
- Department of Surgery, University of the West Indies, Nassau N-1184, Bahamas
| | - Shaneeta Johnson
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Johann Bujhawan
- Department of Surgery, General Hospital in Port of Spain, Port of Spain 000000, Trinidad and Tobago
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Cawich SO, Plummer JM, Griffith S, Naraynsingh V. Colorectal resections for malignancy: A pilot study comparing conventional vs freehand robot-assisted laparoscopic colectomy. World J Clin Cases 2024; 12:488-494. [PMID: 38322459 PMCID: PMC10841952 DOI: 10.12998/wjcc.v12.i3.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Laparoscopic colectomy is widely accepted as a safe operation for colorectal cancer, but we have experienced resistance to the introduction of the FreeHand® robotic camera holder to augment laparoscopic colorectal surgery. AIM To compare the initial results between conventional and FreeHand® robot-assisted laparoscopic colectomy in Trinidad and Tobago. METHODS This was a prospective study of outcomes from all laparoscopic colectomies performed for colorectal carcinoma from November 29, 2021 to May 30, 2022. The following data were recorded: Operating time, conversions, estimated blood loss, hospitalization, morbidity, surgical resection margins and number of nodes harvested. All data were entered into an excel database and the data were analyzed using SPSS ver 20.0. RESULTS There were 23 patients undergoing colectomies for malignant disease: 8 (35%) FreeHand®-assisted and 15 (65%) conventional laparoscopic colectomies. There were no conversions. Operating time was significantly lower in patients undergoing robot-assisted laparoscopic colectomy (95.13 ± 9.22 vs 105.67 ± 11.48 min; P = 0.045). Otherwise, there was no difference in estimated blood loss, nodal harvest, hospitalization, morbidity or mortality. CONCLUSION The FreeHand® robot for colectomies is safe, provides some advantages over conventional laparoscopy and does not compromise oncologic standards in the resource-poor Caribbean setting.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Joseph Martin Plummer
- Department of General Surgery and Consultant General and Colorectal Surgeon, Department of Surgery, University of the West Indies, Kingston, KIN7, Jamaica
| | - Sahle Griffith
- Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Vijay Naraynsingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
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Naraynsingh V, Cawich SO, Hassranah S. Alternative to mesh repair for ventral hernias: Modified rectus muscle repair. World J Surg Proced 2023; 13:14-21. [DOI: 10.5412/wjsp.v13.i3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections, adhesions, seromas, fistula formation and significant postoperative pain. The modified rectus muscle repair (RMR) is as an option to repair midline ventral hernias without mesh.
AIM To evaluate the short term outcomes when the modified RMR was used to repair ventral hernias.
METHODS This was a 5-year prospective study that examined the outcome of all consecutive patients with ventral abdominal wall hernias > 5 cm in maximal diameter who underwent repair using the modified RMR technique in a single surgeon unit. Patients were reviewed in an outpatient clinic at 3, 6 and 12 mo and evaluated for hernia recurrence on clinical examination. Each patient’s abdominal wall was also assessed with using ultrasonography at 24 mo to detect recurrences. All data were examined with SPSS ver 18.0.
RESULTS Over the 5-year study period, there were 52 patients treated for ventral hernias at this institution. Four patients were excluded and there were 48 in the final study sample, at a mean age of 56 years (range 28-80). The mean maximal diameter of the hernia defect was 7 cm (range 5-12 cm). There were 5 (10.4%) seromas and 1 recurrence (2.1%) at a mean of 36 mo follow-up.
CONCLUSION The authors recommend the modified RMR as an acceptable alternative to mesh repair of ventral hernias. The seroma rate can be further reduced with routine use of drains. The modified RMR also has the benefit of eliminating all mesh-specific complications.
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Affiliation(s)
- Vijay Naraynsingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Shamir O Cawich
- Department of Surgery, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Samara Hassranah
- Department of Surgery, Medical Associate Hospital, St. Joseph, Trinidad and Tobago
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Cawich SO, Shukla PJ, Shrikhande SV, Dixon E, Pearce NW, Deshpande R, Francis W. Time to retire the term "high volume" and replace with "high quality" for HPB centers: A position statement from Caribbean chapter of AHPBA. Surgeon 2023:S1479-666X(23)00149-X. [PMID: 38135631 DOI: 10.1016/j.surge.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Shamir O Cawich
- University of the West Indies, St Augustine, Trinidad & Tobago, West Indies.
| | - Parul J Shukla
- Northwell Health, Professor of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | | | | | - Neil W Pearce
- Southampton University Hospital NHS Trust, Southampton, United Kingdom
| | - Rahul Deshpande
- Manchester Royal Infirmary and Christie Hospital, Manchester, UK
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Cawich SO, Harnanan D, Coye A, Johnson LJ, Sanchez HE, Nicholas T. Aggressive Resection for a Primary Leiomyosarcoma of the Vena Cava Masquerading as a Pancreatic Head Tumor. Cureus 2023; 15:e46634. [PMID: 37936996 PMCID: PMC10627094 DOI: 10.7759/cureus.46634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
Smooth muscle is a normal component of the inferior vena cava (IVC) wall. Although uncommon, the smooth muscle component may undergo neoplastic change. Benign neoplasms are termed leiomyomas, and when there is a malignant change, the nomenclature is changed to an IVC leiomyosarcoma. Leiomyosarcomas of the IVC are rare, with less than 150 cases reported in medical literature. Unfortunately, the majority of IVC leiomyosarcomas are diagnosed at advanced disease stages. Surgical resection of locally advanced lesions is technically challenging, but complete resection is the mainstay of treatment as leiomyosarcomas respond poorly to chemo-radiotherapy. Due to the advanced disease stage at diagnosis and the technical complexity of IVC resection and reconstruction, most patients are transferred to high-volume centers in developed nations. We report a case of a patient with a locally advanced leiomyosarcoma masquerading as a pancreatic head tumor. This patient could not access care in a high-volume center and required aggressive maneuvers to resect the IVC leiomyosarcoma in a resource-poor, low-volume center. We present this case to highlight the steps in operative management and also to show that these procedures can be carried out in resource-poor environments once there is meticulous planning, appropriate equipment, and multidisciplinary care.
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Affiliation(s)
| | - Dave Harnanan
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Adrian Coye
- Cardiothoracic Surgery, Karl Heusner Memorial Hospital, Belize City, BLZ
| | | | - Hugh E Sanchez
- Pathology, Karl Heusner Memorial Hospital, Belize City, BLZ
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Mencia MM, Skeete R, Pablo Hernandez Cruz P, Cawich SO. Preoperative echocardiography for patients with hip fractures undergoing surgery in a low-resource setting: Asset or obstacle? J Perioper Pract 2023; 33:276-281. [PMID: 35904049 DOI: 10.1177/17504589221110332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this study was to determine the rate of preoperative transthoracic echocardiography in hip fracture patients and to evaluate its effects on time to surgery and length of stay. We conducted a retrospective review of all patients with hip fractures treated at a tertiary referral hospital. Data examined included age, sex, comorbidities, time to surgery, length of stay, fracture type and transthoracic echocardiography findings. Forty-eight patients with hip fractures underwent surgery (men 41.7%; mean age 77.2 (49-95)). Nine patients (18.7%) had a preoperative transthoracic echocardiography. Preoperative transthoracic echocardiography was associated with a significantly longer time to surgery an abbreviation for days e.g dys should be added after the values to indicate what time frame is being measured (14.7 versus 6.8, p = 0.0051) and length of stay (23.6 versus 10.4, p = 0.0002). This study demonstrates a high rate of preoperative transthoracic echocardiography in hip fracture patients. The role of transthoracic echocardiography should be reassessed in view of its association with significant surgical delays.
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Affiliation(s)
- Marlon M Mencia
- Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Rondell Skeete
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | | | - Shamir O Cawich
- Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
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Cawich SO, Griffith SP, Greenidge CW, Bonadie K, Mohammed F, Padmore GM, Algu T, Ramcharran H, Naraynsingh V. Multicenter Study of Laparoscopic Common Bile Duct Exploration for Choledocholithiasis in the English-Speaking Caribbean. Cureus 2023; 15:e42949. [PMID: 37667693 PMCID: PMC10475270 DOI: 10.7759/cureus.42949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
Background Common bile duct (CBD) exploration to address choledocholithiasis is not widely practiced in the English-speaking Caribbean. This study sought to determine the frequency of laparoscopic CBD explorations in the English-speaking Caribbean and to document the stone clearance rates and short-term outcomes of this procedure. Methods We accessed records for all practicing laparoscopic surgeons in the English-speaking Caribbean who performed laparoscopic CBD explorations over a 10-year period from January 1, 2013, to June 30, 2023. The following data were extracted retrospectively from patient records: demographic details, operating time, stone clearance rates, retained stone rates, conversions, and complications. All data were analyzed with SPSS version 20 (IBM Corp., Armonk, NY). Results Over the 10-year study period, 35 patients underwent laparoscopic cholecystectomy and synchronous CBD exploration in Barbados, Cayman Islands, Guyana, Grenada, St Lucia, and Trinidad & Tobago. The procedure was performed at low volumes of only 0.7 procedures per surgical team per annum. The conversion rate to open CBD exploration was 13% and when laparoscopic CBD exploration was completed, it resulted in 96.3% stone clearance, 3.7% retained stones, mean hospitalization of two days, 9.7% minor morbidity, and no mortality. Conclusion Laparoscopic CBD exploration is feasible in the resource-poor Caribbean setting, and it yields good results, with 96.3% stone clearance rates, 9.7% minor morbidity, and no mortality. These results are better than those reported in Caribbean literature for stone extraction with endoscopic retrograde cholangiopancreaticography (ERCP).
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Affiliation(s)
| | | | - Charles W Greenidge
- Surgery, St Jude Hospital, Vieux Fort, LCA
- Surgery, Tapion Hospital, Castries, LCA
| | - Kimon Bonadie
- Surgery, Cayman Islands National Hospital, Grand Cayman, CYM
| | | | | | | | | | - Vijay Naraynsingh
- Surgery, University of the West Indies, St. Augustine, TTO
- Surgery, Medical Associates Hospital, St. Joseph, TTO
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Cawich SO, Spence R, Senasi R, Naraynsingh V. Robot-Assisted Common Bile Duct Exploration in Trinidad & Tobago. Cureus 2022; 14:e30965. [DOI: 10.7759/cureus.30965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
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Cawich SO, Thomas DA, Pearce NW, Naraynsingh V. Whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago. World J Clin Oncol 2022; 13:738-747. [PMID: 36212600 PMCID: PMC9537505 DOI: 10.5306/wjco.v13.i9.738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many authorities advocate for Whipple’s procedures to be performed in high-volume centers, but many patients in poor developing nations cannot access these centers. We sought to determine whether clinical outcomes were acceptable when Whipple’s procedures were performed in a low-volume, resource-poor setting in the West Indies.
AIM To study outcomes of Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1, 2013 to June 30, 2021.
METHODS This was a retrospective study of all patients undergoing Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1, 2013 to June 30, 2021.
RESULTS This center performed an average of 11.25 procedures per annum. There were 72 patients in the final study population at a mean age of 60.2 years, with 52.7% having American Society of Anesthesiologists scores ≥ III and 54.1% with Eastern Cooperative Oncology Group scores ≥ 2. Open Whipple’s procedures were performed in 70 patients and laparoscopic assisted procedures in 2. Portal vein resection/reconstruction was performed in 19 (26.4%) patients. In patients undergoing open procedures there was 367 ± 54.1 min mean operating time, 1394 ± 656.8 mL mean blood loss, 5.24 ± 7.22 d mean intensive care unit stay and 15.1 ± 9.53 d hospitalization. Six (8.3%) patients experienced minor morbidity, 10 (14%) major morbidity and there were 4 (5.5%) deaths.
CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring Whipple’s procedures. Low volume centers in resource poor nations can achieve good short-term outcomes. This is largely due to the process of continuous, adaptive learning by the entire hospital.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Dexter A Thomas
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Neil W Pearce
- Department of Surgery, Southampton General Hospital National Health Services Trust, Southampton SO16 6YD, United Kingdom
| | - Vijay Naraynsingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
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Mencia MM, Bidaisee S, Quan Soon C, Cawich SO. Greater Gender Diversity Observed at Orthopaedic Conferences in the Caribbean Than in the United States or England. Cureus 2022; 14:e28224. [PMID: 36158370 PMCID: PMC9487172 DOI: 10.7759/cureus.28224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 11/05/2022] Open
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Cawich SO, Pearce NW, Naraynsingh V, Shukla P, Deshpande RR. Whipple’s operation with a modified centralization concept: A model in low-volume Caribbean centers. World J Clin Cases 2022; 10:7620-7630. [PMID: 36158490 PMCID: PMC9372853 DOI: 10.12998/wjcc.v10.i22.7620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/05/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
Conventional data suggest that complex operations, such as a pancreaticoduodenectomy (PD), should be limited to high volume centers. However, this is not practical in small, resource-poor countries in the Caribbean. In these settings, patients have no option but to have their PDs performed locally at low volumes, occasionally by general surgeons. In this paper, we review the evolution of the concept of the high-volume center and discuss the feasibility of applying this concept to low and middle-income nations. Specifically, we discuss a modification of this concept that may be considered when incorporating PD into low-volume and resource-poor countries, such as those in the Caribbean. This paper has two parts. First, we performed a literature review evaluating studies published on outcomes after PD in high volume centers. The data in the Caribbean is then examined and we discuss the incorporation of this operation into resource-poor hospitals with modifications of the centralization concept. In the authors’ opinions, most patients who require PD in the Caribbean do not have realistic opportunities to have surgery in high-volume centers in developed countries. In these settings, their only options are to have their operations in the resource-poor, low-volume settings in the Caribbean. However, post-operative outcomes may be improved, despite low-volumes, if a modified centralization concept is encouraged.
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Affiliation(s)
- Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine 000000, Trinidad and Tobago
| | - Neil W Pearce
- University Surgical Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine 000000, Trinidad and Tobago
| | - Parul Shukla
- Department of Surgery, Weill Cornell Medical College, New York, NY 10065, United States
| | - Rahul R Deshpande
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
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Cawich SO, Singh Y, Naraynsingh V, Senasi R, Arulampalam T. Freehand-robot-assisted laparoscopic colorectal surgery: Initial experience in the Trinidad and Tobago. World J Surg Proced 2022; 12:1-7. [DOI: 10.5412/wjsp.v12.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/11/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic colorectal surgery is still developing in the Anglophone Caribbean, having been first performed in the region in the year 2011. We report the initial outcomes using a robot camera holder to assist in laparoscopic colorectal operations.
AIM To report our initial experience using the FreeHand® robotic camera holder (Freehand 2010 Ltd., Guildford, Surrey, United Kingdom) for laparoscopic colorectal surgery in Trinidad & Tobago.
METHODS We retrospectively collected data from all patients who underwent laparoscopic colorectal resections using the Freehand® (Freehand 2010 Ltd., Guildford, Surrey, United Kingdom) robotic camera holder between September 30, 2021 and April 30, 2022. The following data were recorded: patient demographics, robotic arm setup time, operating time, conversions to open surgery, conversions to a human camera operator, number and duration of intra-operative lens cleaning. At the termination of the operation, before operating notes were completed, the surgeons were administered a questionnaire recording information on ergonomics, user-difficulty, requirement to convert to a human camera operator and their ability to carry out effective movements to control the robot while operating.
RESULTS Nine patients at a mean age of 58.9 ± 7.1 years underwent colorectal operations using the FreeHand robot: Right hemicolectomies (5), left hemicolectomy (1), sigmoid colectomies (2) and anterior resection (1). The mean robot docking time was 6.33 minutes (Median 6; Range 4-10; SD ± 1.8). The mean duration of operation was 122.33 ± 78.5 min and estimated blood loss was 113.33 ± 151.08 mL. There were no conversions to a human camera holder. The laparoscope was detached from the robot for lens cleaning/defogging an average of 2.6 ± 0.88 times per case, with cumulative mean interruption time of 4.2 ± 2.15 minutes per case. The mean duration of hospitalization was 3.2 ± 1.30 days and there were no complications recorded. When the surgeons were interviewed after operation, the surgeons reported that there were good ergonomics (100%), with no limitation on instrument movement (100%), stable image (100%) and better control of surgical field (100%).
CONCLUSION Robot-assisted laparoscopic colorectal surgery is feasible and safe in the resource-poor Caribbean setting, once there is appropriate training.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Yardesh Singh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Surgery, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Ramdas Senasi
- Department of Surgery, South Tyneside and Sunderland NHS Trust, South Shields NE34 0PL, United Kingdom
| | - Tan Arulampalam
- Department of General Surgery, Colchester Hospital University National Health Services Foundation Trust, Colchester, Essex, England, Colchester CO4 5JL, United Kingdom
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Cawich SO, Narayansingh G, Ramdass MJ, Mencia M, Thomas DA, Barrow S, Naraynsingh V. Responses to disrupted operative care during the coronavirus pandemic at a Caribbean hospital. World J Meta-Anal 2022; 10:74-80. [DOI: 10.13105/wjma.v10.i3.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/19/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
The coronavirus pandemic was thrust upon all nations in the year 2020 and required swift public health responses. Resource-poor health care facilities, such as those in the Caribbean, were poorly prepared but had to respond to the threat. In this experience report we examined the response by the surgical specialty to evaluate the lessons learned and to identify positive changes that may continue post-pandemic.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Gordon Narayansingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Michael J Ramdass
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Marlon Mencia
- Department of Clinical Surgical Sciences, University of the West Indies, St. Joseph, Trinidad and Tobago
| | - Dexter A Thomas
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Shaheeba Barrow
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
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Cawich SO, Dapri G. Emergency single-incision laparoscopic cholecystectomy for acute cholecystitis: A multi-center study. Med Int (Lond) 2022; 2:21. [PMID: 36699509 PMCID: PMC9829208 DOI: 10.3892/mi.2022.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/17/2022] [Indexed: 01/28/2023]
Abstract
Single-incision laparoscopy is accepted as a safe alternative to multiple port laparoscopy for elective cholecystectomy; however, there are limited data on its use in patients with acute cholecystitis. The present multi-center study evaluated the outcomes of emergency single-incision surgeries for acute cholecystitis in hospitals in Belgium, Jamaica, and Trinidad and Tobago over a 5-year period. Standardized definitions of uncomplicated and complicated acute cholecystitis were used and the data were compared using SPSS software. The results revealed that over the 5-year period, 108 patients with a mean age of 48±15 years and a mean body mass index of 27±4.2 kg/m2 underwent emergency single-incision cholecystectomies. The surgeries were successful in 92.1% of cases without supplemental trocars being used. The overall morbidity rates (9.3%) were also comparable to the historic controls with multiple port cholecystectomy. As was expected, the complicated cholecystitis group required a significantly longer operating time (86.11±30.16 vs. 66.79±16.8; P<0.00194), as well as supplemental trocars (7.9%) vs. 0; P=0.0413). On the whole, the present study demonstrates that emergency single-incision cholecystectomy is a technically feasible and safe procedure for patients with acute cholecystitis. These findings advocate a low threshold to place additional ports to assist with dissection and exposure.
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Affiliation(s)
- Shamir O. Cawich
- Department of Surgery, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago, I-24125 Bergamo, Italy,Correspondence to: Professor Shamir O. Cawich, Department of Surgery, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Giovanni Dapri
- International School of Reduced Scar Laparoscopy, Minimally Invasive General and Oncologic Surgery Center, Humanitas Gavazzeni University Hospital, I-24125 Bergamo, Italy
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Cawich SO, Phillips E, Moore S, Ramkissoon S, Padmore G, Griffith S. Colorectal cancer in an Eastern Caribbean nation: are we missing an opportunity for secondary prevention? Rev Panam Salud Publica 2022; 46:e18. [PMID: 35432501 PMCID: PMC9004695 DOI: 10.26633/rpsp.2022.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
Objective. To establish whether there was any difference in disease stage in patients with screening-detected colorectal cancer (CRC) in a Caribbean country. Methods. The mode of presentation (elective vs. emergent), method of diagnosis (screening vs. symptomatic), and disease stage were retrospectively compared in all consecutive patients who had resections for CRC over a five-year period. Early CRC was defined as disease that could be completely resected with no involvement of adjacent organs, lymph nodes, or distant sites. Locally advanced CRC was disease that involved contiguous organs without distant metastases that was still amenable to curative resection. Results. There were 97 patients at a mean age of 64.9 ± 12.2 years treated for CRC, and only 21 (21.6%) had their diagnoses made through screening. Significantly more screening-detected lesions were early-stage CRCs (21.7% vs. 9.3%; p < 0.001). At the time of diagnosis, patients who did not have screening-detected lesions had a greater proportion of locally advanced (42.3% vs. 0) and metastatic (26.8% vs. 0) CRC. Those who did not have screening-detected lesions had a greater incidence of emergency presentations at diagnosis (26.8% vs. 0). Conclusions. The incidence of screening-detected CRC in this Caribbean nation was low. Consequently, most patients presented with locally advanced or metastatic CRC, for which there is less opportunity to achieve a cure. Significantly more screening-detected lesions were early-stage CRCs. It is time for policymakers to develop a national CRC screening program.
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Affiliation(s)
- Shamir O. Cawich
- Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
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16
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Naraynsingh V, Jarvis JK, Milne DM, Cawich SO, Harnanan D, Singh Y, Islam S. The Pushing Sign for Early Skin Tethering in Breast Cancer. Cureus 2021; 13:e20471. [PMID: 34976543 PMCID: PMC8682950 DOI: 10.7759/cureus.20471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/05/2022] Open
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Abstract
Laparoscopic hepatectomy brings many physiologic advantages over open hepatectomy and adheres to all oncologic principles. It is currently considered the standard of care. However, these are technically difficult operations to perform. Consequently, the expertise may not be universally available for all patients to benefit from laparoscopic hepatectomy. We report a unique situation where remote mentoring was used to guide bariatric surgeons in Jamaica to complete a laparoscopic hepatectomy.
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18
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Dapri G, Bascombe NA, Cawich SO, Fichera A. Laparoscopic Right Hemicolectomy With Complete Mesocolic Excision by Suprapubic Single-Incision With Different Intracorporeal Anastomoses. Dis Colon Rectum 2021; 64:e727. [PMID: 34413277 DOI: 10.1097/dcr.0000000000002243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Giovanni Dapri
- International School Reduced Scar Laparoscopy, Brussels, Belgium
| | - Nigel A Bascombe
- International School Reduced Scar Laparoscopy, Brussels, Belgium
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Abstract
Although advanced minimally invasive surgery and robotic surgery were well accepted in developed countries by the turn of the 21st century, they did not enjoy the same popularity in the Anglophone Caribbean. Advanced minimally invasive surgery only became available in select Caribbean countries from the year 2010. And up to the year 2021, robotic surgery was completely non-existent in the Anglophone Caribbean. Surgical leaders in the Anglophone Caribbean recognized a need to encourage the introduction of advanced surgical techniques in the region and engaged local and international stakeholders in an attempt to stimulate this development. In the year 2021, through a collaborative effort by a local medical university, a government-funded hospital, and industry partners in the United Kingdom, robot-assisted minimally invasive surgery was successfully introduced to the Caribbean. We report our experience of introducing robot-assisted minimally invasive surgery in the Eastern Caribbean. By discussing the pitfalls and successes from our experience, we hope that the lessons can be used to guide the introduction of robot-assisted minimally invasive surgery in other resource-poor countries in the Caribbean.
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Affiliation(s)
| | - Tan Arulampalam
- School of Medicine, Anglia Ruskin University, Cambridge, GBR
| | - Ramdas Senasi
- Radiology, Sunderland NHS Foundation Trust, Sunderland, GBR
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Cawich SO, Kluger MD, Francis W, Deshpande RR, Mohammed F, Bonadie KO, Thomas DA, Pearce NW, Schrope BA. Review of minimally invasive pancreas surgery and opinion on its incorporation into low volume and resource poor centres. World J Gastrointest Surg 2021; 13:1122-1135. [PMID: 34754382 PMCID: PMC8554718 DOI: 10.4240/wjgs.v13.i10.1122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/19/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreatic surgery has been one of the last areas for the application of minimally invasive surgery (MIS) because there are many factors that make laparoscopic pancreas resections difficult. The concept of service centralization has also limited expertise to a small cadre of high-volume centres in resource rich countries. However, this is not the environment that many surgeons in developing countries work in. These patients often do not have the opportunity to travel to high volume centres for care. Therefore, we sought to review the existing data on MIS for the pancreas and to discuss. In this paper, we review the evolution of MIS on the pancreas and discuss the incorporation of this service into low-volume and resource-poor countries, such as those in the Caribbean. This paper has two parts. First, we performed a literature review evaluating all studies published on laparoscopic and robotic surgery of the pancreas. The data in the Caribbean is examined and we discuss tips for incorporating this operation into resource poor hospital practice. Low pancreatic case volume in the Caribbean, and financial barriers to MIS in general, laparoscopic distal pancreatectomy, enucleation and cystogastrostomy are feasible operations to integrate in to a resource-limited healthcare environment. This is because they can be performed with minimal to no consumables and require an intermediate MIS skillset to complement an open pancreatic surgeon’s peri-operative experience.
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Affiliation(s)
- Shamir O Cawich
- Clinical Surgical Sciences, University of the West Indies, Tunapuna 331333, Trinidad and Tobago
| | - Michael D Kluger
- Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY 10032, United States
| | - Wesley Francis
- Department of Surgery, University of the West Indies, Nassau N-1184, Bahamas
| | - Rahul R Deshpande
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Fawwaz Mohammed
- Department of Clinical Surgical Sciences, University of the West Indies, Tunapuna 331333, Trinidad and Tobago
| | - Kimon O Bonadie
- Department of Surgery, Health Service Authority, Georgetown 915 GT, Cayman Islands
| | - Dexter A Thomas
- Department of Clinical Surgical Sciences, University of the West Indies, Tunapuna 331333, Trinidad and Tobago
| | - Neil W Pearce
- Department of Surgery, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Beth A Schrope
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
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Abstract
When the COVID-19 pandemic unfolded in March 2020, surgical care was impacted globally. The developing nations in the Caribbean were unprepared with fragile, resource poor healthcare systems. A series of rapid policy changes in response to the pandemic radically changed surgical care and prevented the usual oversight in the operating theatre. Attending surgeons responded utilising readily available technology for distance mentoring. Using this model, postgraduate surgical residents were able to complete 96% of trauma laparotomies safely without major complications.
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Affiliation(s)
- Shamir O Cawich
- Professor, Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Marlon Mencia
- Senior Consultant, Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Dexter Thomas
- Senior Consultant, Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Richard Spence
- Fellow, Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - David Milne
- Fellow, Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Vijay Naraynsingh
- Professor, Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Shaheeba Barrow
- Senior Consultant, Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
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Cawich SO, Mahabir AH, Arthurs M. Clinical yield of screening colonoscopies in Jamaica. Trop Doct 2021; 52:104-106. [PMID: 34427133 DOI: 10.1177/00494755211039591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is still no organised national screening programme for colorectal cancer in Jamaica. We sought to evaluate the detection of colorectal cancer precursor lesions in patients who underwent opportunistic screening over three years. Patients with colorectal polyps were selected for further study. In 431 procedures, there were 84 (19.5%) patients with colorectal polyps identified at screening colonoscopy, which gave a 19.5% sensitivity to identify patients with polyps at risk of developing colorectal cancer, 9.5% being <50 years of age. At the time of examination, 16.7% had already developed invasive adenocarcinoma. We conclude that it is time for policy makers to develop a national colorectal cancer screening programme to diagnose patients early and improve their therapeutic outcomes.
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Affiliation(s)
- Shamir O Cawich
- Professor of Surgery, Department of Surgery, Port of Spain General Hospital, Port of Spain, West Indies
| | - Avidesh H Mahabir
- Professor of Surgery, Department of Surgery, Port of Spain General Hospital, Port of Spain, West Indies
| | - Milton Arthurs
- Consultant Gastroenterologist, Department of Gastroenterology, University Hospital of the West Indies, Jamaica, West Indies
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Pran L, Harnanan D, Baijoo S, Short A, Cave C, Maharaj R, Cawich SO, Naraynsingh V. Major Lower Limb Amputations: Recognizing Pitfalls. Cureus 2021; 13:e16972. [PMID: 34540383 PMCID: PMC8423325 DOI: 10.7759/cureus.16972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/21/2022] Open
Abstract
Major lower extremity amputations have been an area of much concern in the Caribbean population. Hence, the purpose of this research was to investigate the current trends in major lower-extremity amputations. Data regarding all major lower-extremity amputations performed at a tertiary care institution in Trinidad and Tobago, from January 2010 to December 2016 were reviewed. The variation of yearly trends, gender, type of amputation and reason for amputation were analysed. The yearly amputation rate demonstrated a progressive increase from 2010 to 2016, the average for the seven years was 28 per 105/year. Males accounted for 59% of cases, and 60% of amputations were done above the level of the knee joint. The most common reason for amputation was control of sepsis in 71.5% of cases. A strong association between major amputations and prior intervention for a foot-related problem was observed, as 52% of the sample had a pre-existing wound or a prior minor amputation (32%). Overall, 14.5% of all amputees were able to acquire a prosthesis. Diabetes mellitus was the most consistently associated co-morbidity occurring in 91% of the study population. Major limb amputations continue to affect our population significantly, with a rise in the amputation rate despite the introduction of a Vascular Surgical Unit. Diabetes and its foot-related complications are one of the leading causes of major lower extremity amputations. Prosthetic limb acquisition for our amputee population continues to be lacking, reflected by the low prosthetic acquisition rate observed.
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Affiliation(s)
- Lemuel Pran
- Vascular Surgery, Eric Williams Medical Sciences Complex, Mount Hope, TTO
| | - Dave Harnanan
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Shanta Baijoo
- Surgery, Eric Williams Medical Sciences Complex, Mount Hope, TTO
| | - Andy Short
- Statistics, Eric Williams Medical Sciences Complex, Mount Hope, TTO
| | - Cristo Cave
- Surgery, Eric Williams Medical Sciences Complex, Mount Hope, TTO
| | - Ravi Maharaj
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Shamir O Cawich
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Vijay Naraynsingh
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO
- Surgery, Medical Associates Hospital, St. Joseph, TTO
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24
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Cawich SO, Mahabir A, Arthurs M. Epidemiology of neoplastic colorectal polyps in a Caribbean country. Med Int (Lond) 2021; 1:10. [PMID: 36698431 PMCID: PMC9713806 DOI: 10.3892/mi.2021.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/27/2021] [Indexed: 01/28/2023]
Abstract
Screening is practiced to identify and remove neoplastic colorectal polyps prior to their transformation into colorectal cancer (CRC). The aim of the present study was to document the epidemiology of neoplastic colorectal polyps in order to obtain important data that may then be used to guide screening protocols in Jamaica. For this purpose, an audit was performed to identify all consecutive patients who had neoplastic polyps detected at a screening colonoscopy at a facility in Jamaica from January 1, 2015 to December 30, 2018. The following data were collected: Patient demographics, polyp location, polyp synchronicity and histopathological information. The results revealed that a total of 480 colonoscopies were performed over the study period. With the exclusion of 2 patients with innumerable polyps as a part of polyposis syndrome, there were a total of 92 neoplastic polyps in 68 patients. Polyps were most commonly located in the right colon (55.6%), followed by the left colon (38%) and rectum (6.5%). Upon the histological evaluation, 63 polyps were found to be benign adenomas with mild to moderate dysplastic alterations, 15 were adenomas with severe dysplasia and/or carcinoma in situ and 14 had foci of invasive carcinomas. On the whole, the present study demonstrates that ~15% of the patients screened had neoplastic polyps that were recognized as precursor lesions for CRC. The majority of these were in the right colon. These results support the call for policy makers to institute national CRC screening programs, such as the National Comprehensive Cancer Network harmonized guidelines for the Caribbean.
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Affiliation(s)
- Shamir O. Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago,Correspondence to: Professor Shamir O. Cawich, Department of Clinical Surgical Sciences, University of The West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Avidesh Mahabir
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Milton Arthurs
- Department of Medicine, University of The West Indies, Mona Campus, Kingston, Jamaica
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Cawich SO, Mahabir AH, Griffith S, FaSiOen P, Naraynsingh V. Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice. Trop Doct 2021; 51:539-541. [PMID: 34162285 DOI: 10.1177/00494755211010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.
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Affiliation(s)
- Shamir O Cawich
- Professor of Liver and Pancreas Surgery, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad & Tobago, West Indies
| | - Avidesh H Mahabir
- Surgery House Officer, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad & Tobago, West Indies
| | - Sahle Griffith
- Consultant General Surgeon, Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados, West Indies
| | - Patrick FaSiOen
- Consultant General Surgeon, Department of Surgery, Sint Elizabeth Hospital, Curacao, Dutch Caribbean
| | - Vijay Naraynsingh
- Professor of Surgery, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad & Tobago, West Indies
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Cawich SO, Naraynsingh V, Pearce NW, Deshpande RR, Rampersad R, Gardner MT, Mohammed F, Dindial R, Barrow TA. Surgical relevance of anatomic variations of the right hepatic vein. World J Transplant 2021; 11:231-243. [PMID: 34164298 PMCID: PMC8218342 DOI: 10.5500/wjt.v11.i6.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/18/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Variations in the anatomy of hepatic veins are of interest to transplant surgeons, interventional radiologists, and other medical practitioners who treat liver diseases. The drainage patterns of the right hepatic veins (RHVs) are particularly relevant to transplantation services.
AIM The aim was to identify variations of the patterns of venous drainage from the right side of the liver. To the best of our knowledge, there have been no reports on RHV variations in in a Caribbean population.
METHODS Two radiologists independently reviewed 230 contrast-enhanced computed tomography scans performed in 1 year at a hepatobiliary referral center. Venous outflow patterns were observed and RHV variants were described as: (1) Tributaries of the RHV; (2) Variations at the hepatocaval junction (HCJ); and (3) Accessory RHVs.
RESULTS A total of 118 scans met the inclusion criteria. Only 39% of the scans found conventional anatomy of the main hepatic veins. Accessory RHVs were present 49.2% and included a well-defined inferior RHV draining segment VI (45%) and a middle RHV (4%). At the HCJ, 83 of the 118 (70.3%) had a superior RHV that received no tributaries within 1 cm of the junction (Nakamura and Tsuzuki type I). In 35 individuals (29.7%) there was a short superior RHV with at least one variant tributary. According to the Nakamura and Tsuzuki classification, there were 24 type II variants (20.3%), six type III variants (5.1%) and, five type IV variants (4.2%).
CONCLUSION There was significant variation in RHV patterns in this population, each with important relevance to liver surgery. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Neil W Pearce
- University Surgical Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Rahul R Deshpande
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Robbie Rampersad
- Department of Radiology, University of the West Indies, St. Augustine 000000, Trinidad and Tobago
- Department of Radiology, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Michael T Gardner
- Section of Anatomy, Basic Medical Sciences, University of the West Indies, Kingston 000000, Jamaica
| | - Fawwaz Mohammed
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Roma Dindial
- Department of Radiology, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Tanzilah Afzal Barrow
- Department of Radiology, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
- Department of Radiology, University of the West Indies, St Augustine 000000, Trinidad and Tobago
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Cawich SO, Sinanan A, Deshpande RR, Gardner MT, Pearce NW, Naraynsingh V. Anatomic variations of the intra-hepatic biliary tree in the Caribbean: A systematic review. World J Gastrointest Endosc 2021; 13:170-183. [PMID: 34163564 PMCID: PMC8209542 DOI: 10.4253/wjge.v13.i6.170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the classic descriptions of the human liver, the common hepatic duct forms at the confluence of left and right hepatic ducts. Many authors have documented variations in the intra-hepatic ductal system, but to the best of our knowledge there has been no report on bile duct variations in Caribbean populations.
AIM To evaluate the variations in bile duct anatomy using magnetic resonance cholangiography (MRC) in unselected patients at a major hepatobiliary referral centre in the Eastern Caribbean. Knowledge of the intra-hepatic biliary anatomy is important to optimize service delivery for any physician treating liver and biliary disorders.
METHODS This study was carried out at a tertiary referral hospital for hepatobiliary diseases in the Eastern Caribbean. We retrospectively evaluated magnetic resonance cholangiograms in 152 consecutive patients at this facility over a two-year period from April 1, 2017 to March 31, 2019. Two consultant radiologists experienced in MRC interpretation reviewed all scans and described biliary anatomy according to the Huang’s classification. A systematic review of published studies was performed and relevant data were extracted in order to calculate the global prevalence of each biliary variant. The variants in our population were compared to the global population.
RESULTS There were 152 MRCs evaluated in this study in 86 males and 66 females. There were 109 (71.7%) persons with “classic” biliary anatomy (type A1) and variants were present in 43 (28.3%) persons. There was no statistical relationship between the presence of anatomic variants and gender or ethnicity. We encountered the following variants: 29 (19.1%) type A2, 7 (4.6%) type A3, 6 (3.95%) type A4, 0 type A5 and a single variant (quadrification) that did not fit the classification system. Compared to the global prevalence, our population had a significantly greater occurrence of A1 anatomy (71.7% vs 62.6%; P = 0.0227) and A2 trifurcations (19.1% vs 11.5%; P = 0.0069), but a significantly lower incidence of A3 variants (4.61% vs 11.5%; P = 0.0047).
CONCLUSION There are significant differences in intra-hepatic biliary anatomy in this unselected Eastern Caribbean population compared to global statistics. Specifically, persons of Caribbean descent have a greater incidence of Huang A2 trifurcations and a lower incidence of Huang A3 variants.
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Affiliation(s)
- Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine 000000, Trinidad and Tobago
| | - Alexander Sinanan
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine 000000, Trinidad and Tobago
| | - Rahul R Deshpande
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Michael T Gardner
- Department of Anatomy, University of the West Indies, Kingston KIN7, Jamaica
| | - Neil W Pearce
- Department of Surgery, Southampton University NHS Trust, Southampton SO16DP, Southampton, United Kingdom
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine 000000, Trinidad and Tobago
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Milne DM, Rambhajan A, Ramsingh J, Cawich SO, Naraynsingh V. Managing the Open Abdomen in Damage Control Surgery: Should Skin-Only Closure be Abandoned? Cureus 2021; 13:e15489. [PMID: 34268021 PMCID: PMC8261903 DOI: 10.7759/cureus.15489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/05/2022] Open
Abstract
During damage control laparotomy, surgery is abbreviated to allow for the correction of physiologic disturbances, with a plan to return to the operating theatre for definitive surgical repair. Re-entry into the abdomen is facilitated by temporary abdominal closure (TAC). Skin-only closure is one of the many techniques described for TAC Numerous sources advise against the use of this technique because of the risk of complications. This case report describes the use of skin-only closure during a damage control laparotomy. We reviewed the literature surrounding the various options for TAC to elucidate the potential role of skin-only closure after damage control laparotomy.
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Affiliation(s)
- David M Milne
- General Surgery, General Hospital Port of Spain, Port of Spain, TTO
| | - Amrit Rambhajan
- General Surgery, General Hospital Port of Spain, Port of Spain, TTO
| | - Jason Ramsingh
- General Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, GBR
| | - Shamir O Cawich
- Surgery, The University of the West Indies, St. Augustine, TTO
| | - Vijay Naraynsingh
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO.,Surgery, Medical Associates Hospital, St. Joseph, TTO
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Griffith S, Padmore G, Moore S, Walkes K, Gohar AA, Cawich SO. Epidemiology of colorectal cancer in Barbados: A short report. Trop Doct 2021; 51:532-534. [PMID: 34080910 DOI: 10.1177/00494755211020573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Barbados is a Caribbean island with a high incidence of colorectal cancer. This study collected epidemiologic data from Barbadian patients with colorectal cancer. There was an opportunity for targeted screening in patients actively enrolled in clinics for management of chronic diseases, accounting for 72% of cases. We also identified areas of high incidence where resources should be directed in a screening programme.
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Affiliation(s)
- Sahle Griffith
- Attending Surgeon, Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Greg Padmore
- Surgical Registrar, Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Sierra Moore
- Administrative Researcher, Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Keisha Walkes
- House Officer, Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Abdelaziz A Gohar
- Assistant Professor, Department of Surgery, South Valley University, Qena, Egypt
| | - Shamir O Cawich
- Professor of Surgery, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
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Cawich SO, Gardner MT, Shetty R, Lodenquai P, Ramkissoon S, Ho P, Chow A. Clinically Oriented Classification of Anatomic Variants of the Umbilical Fissure for Ligamentum Teres in the Human Liver. Cureus 2021; 13:e15460. [PMID: 34258122 PMCID: PMC8256764 DOI: 10.7759/cureus.15460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background In the classic descriptions of the human liver, the umbilical fissure (UF) is a long, narrow groove on the visceral surface that receives the ligamentum teres hepatis. In this study, we document the UF variations encountered in a series of cadaveric dissections. Methods We reported UF variations using the following classification: Type I refers to "normal" anatomy where there is a long, narrow groove. In type II, the UF was covered by a fibrotic band devoid of hepatic parenchyma. In type III variants, an extension of hepatic parenchyma partially covered but did not obliterate the UF. In type IV variants, the hepatic parenchyma formed a bridge over the UF, completely obliterating the groove. After institutional review board approval, we observed all consecutive cadaveric dissections over five years and recorded the characteristics and dimensions of each UF and its immediate relations. Results There were 69 cadavers, and variant UFs were present in 38 (55.1%) cadavers: type II (1.5%), type III (20.3%), and type IV (33.3%). Conclusions In this Jamaican population, only 44.9% of persons had conventional "normal" anatomy and 55.1% had UF variants. These variants are clinically significant, as they lead to misinterpretation of patient imaging and can hinder operative procedures on the liver.
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Affiliation(s)
| | | | - Ramanand Shetty
- Section of Anatomy, University of the West Indies, Kingston, JAM
| | | | | | - Peter Ho
- Anatomy, University of the West Indies, Kingston, JAM
| | - Amanda Chow
- Anatomy, University of the West Indies, Kingston, JAM
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Cawich SO, Hassranah D, Thomas D, Simpson L. Emergency Laparoscopic Cholecystectomy Should be Performed for Acute Cholecystitis in Trinidad and Tobago. Popul Health Manag 2021; 24:633-634. [PMID: 34030483 DOI: 10.1089/pop.2021.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shamir O Cawich
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Dale Hassranah
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Dexter Thomas
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Lindberg Simpson
- Department of Surgery, Kingston Public Hospital, Kingston, Jamaica
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Cawich SO, Burgess PE, Ranglin-Robinson D, Ewing R. Single-Incision Laparoscopic Cholecystectomy: Initial Report From the Turks and Caicos Islands. Cureus 2021; 13:e14891. [PMID: 34109080 PMCID: PMC8180239 DOI: 10.7759/cureus.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There has been no prior report of single-incision laparoscopic surgery (SILS) from the Caribbean island of Turks and Caicos. We report our initial experience with SILS cholecystectomy to show that SILS in this environment is feasible with minimal change to the existing hardware. It is a safe alternative to conventional multi-trocar laparoscopic cholecystectomy in this setting.
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Affiliation(s)
| | | | | | - Rufus Ewing
- Surgery, Cheshire Hall Medical Center, Providenciales, TCA
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Griffith S, Padmore G, Phillips E, Ramkissoon SS, Moore S, Walkes K, Gohar AA, Cawich SO. Colorectal cancer demographics in Barbados. Med Int (Lond) 2021; 1:2. [PMID: 36698684 PMCID: PMC9855272 DOI: 10.3892/mi.2021.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023]
Abstract
Barbados is an island in the Eastern Caribbean that is reported to have the 8th highest incidence of colorectal cancer (CRC) worldwide. However, these figures are based only on estimates, and there is little available epidemiological data collected from Barbadians with CRC. The present study sought to collect epidemiologic data from patients in Barbados diagnosed with CRC. This information is considered important to shape national public health policies. For this purpose, hospital admission registers at all tertiary care facilities in Barbados were retrospectively audited over a four-year period from January 1, 2014 to December 31, 2018 to identify patients who underwent operative treatment for CRC. The following data were extracted: Age, sex, ethnicity, the location of the primary tumour and tumour stage. Descriptive statistical analyses were generated using SPSS version 21.0. The results revealed that there were 97 patients with CRC at a mean age of 64.9 years (SD ±12.2) and a male preponderance (1.3:1). The majority (93.8%) were from the African diaspora. Only 18.5% of diagnoses were made at (opportunistic) screening. Consequently, two thirds of the patients had advanced-stage disease at diagnosis. The disease staging of the patients was as follows: Stage 0 (1%), stage I (10.3%), stage II (23.7%), stage III (38.1%) and stage IV (26.8%). Right-sided primary tumours were most common (44.3%), followed by left-sided (41.2%) and rectal lesions (14.4%). Women were significantly more likely to have right-sided lesions (55 vs. 45%) and males were more likely to have rectal lesions (77 vs. 23%). On the whole, the present study highlights the need to implement a national screening programme in this high-risk population of African origin with a predominantly right-sided distribution of CRC primary tumours. This is reinforced by the fact that 10% of patients will be diagnosed before the age of 50 years with more aggressive disease.
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Affiliation(s)
- Sahle Griffith
- Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Greg Padmore
- Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Emil Phillips
- Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Solange S.K. Ramkissoon
- Department of Clinical Surgical Sciences, University of The West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Sierra Moore
- Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Keisha Walkes
- Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | | | - Shamir O. Cawich
- Department of Clinical Surgical Sciences, University of The West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago,Correspondence to: Professor Shamir O. Cawich, Department of Clinical Surgical Sciences, University of The West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
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Mencia MM, Cawich SO, Sandiford N. Partial Single Stage Exchange Arthroplasty With Retention of a Well Fixed Cemented Femoral Stem for the Treatment of Culture Negative Infection in a Bipolar Hemiarthroplasty: A Case Report. Geriatr Orthop Surg Rehabil 2021; 12:21514593211001844. [PMID: 33786206 PMCID: PMC7961682 DOI: 10.1177/21514593211001844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Prosthetic joint infection (PJI) is the second most common cause for revision following hip hemiarthroplasty (HHA) resulting in a mortality rate of 5.6%. The treatment of PJI is both challenging and controversial, without general consensus on best practice. In an attempt to avoid surgery, patients are commonly prescribed antibiotics, reducing the chance of detecting a microorganism, and culture negative infections are reported to occur in up to 21% of all PJI. Two stage revision is arguably the gold standard treatment but frequently these patients are too frail to undergo such extensive procedures. Some surgeons have attempted to avoid this by leaving well fixed implants undisturbed, effectively performing a partial single-stage revision. Case Presentation: A previously well 83 -year-old female patient presented with a gradual onset of increasing pain and difficulty walking. Just over 1 year prior to this presentation she fell at home and underwent an uncomplicated bipolar hemiarthroplasty. Clinical examination as well as serological and radiological investigations were suspicious for a periprosthetic infection. Her rapidly deteriorating clinical picture required prompt surgical intervention. In theater the patient underwent a single stage partial exchange arthroplasty leaving the well cemented femoral stem undisturbed. Although multiple samples were taken, no microorganism was identified. The patient has been followed up for 1 year and remains well, with no recurrence of infection. Her inflammatory markers have returned to normal and radiographs demonstrate no evidence of loosening of the total hip replacement. Conclusion: The burden of infection following hip hemiarthroplasty is likely to parallel the predicted increase in hip fractures. The combination of physiologic frailty, osteoporosis and multiple medical comorbidities are pertinent factors for consideration in the development of a treatment strategy. A partial single stage revision THR performed by an experienced arthroplasty surgeon, along with expertly led antimicrobial therapy may be considered in carefully selected patients.
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Affiliation(s)
- Marlon M Mencia
- Department of Clinical Surgical Sciences, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Shamir O Cawich
- Department of Clinical Surgical Sciences, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Nemandra Sandiford
- Joint Reconstruction Unit, Southland Hospital, Invercargill, New Zealand
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Cawich SO, Gardner MT, Shetty R, Pearce NW, Deshpande R, Naraynsingh V, Armstrong T. Human liver umbilical fissure variants: pons hepatis (ligamentum teres tunnel). Surg Radiol Anat 2021; 43:795-803. [PMID: 33538876 DOI: 10.1007/s00276-021-02688-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/16/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE In the classical description of normal liver anatomy, the umbilical fissure is a long, narrow groove that receives the ligamentum teres hepatis. The pons hepatis is an anatomic variant, where the umbilical fissure is converted into a tunnel by an overlying bridge of liver parenchyma. We carried out a study to evaluate the existing variations of the umbilical fissure in a Caribbean population. METHODS We observed all consecutive autopsies performed at a facility in Jamaica and selected cadavers with a pons hepatis for detailed study. A pons hepatis was considered present when the umbilical fissure was covered by hepatic parenchyma. We recognized two variants: an open-type (incomplete) pons hepatis in which the umbilical fissure was incompletely covered by parenchyma ≤ 2 cm in length and a closed type (complete) pons hepatis in which the umbilical fissure was covered by a parenchymal bridge > 2 cm and thus converted into a tunnel. We measured the length (distance from transverse fissure to anterior margin of the parenchymatous bridge), width (extension across the umbilical fissure in a coronal plane) and thickness (distance from the visceral surface to the hepatic surface measured at the mid-point of the parenchymal bridge in a sagittal plane) of each pons hepatis. A systematic literature review was also performed to retrieve data from relevant studies. The raw data from these retrieved studies was used to calculate the global point prevalence of pons hepatis and compared the prevalence in our population. RESULTS Of 66 autopsies observed, a pons hepatis was present in 27 (40.9%) cadavers. There were 15 complete variants, with a mean length of 34.66 mm, mean width of 16.98 mm and mean thickness of 10.98 mm. There were 12 incomplete variants, with a mean length of 17.02 mm, width of 17.03 mm and thickness of 9.56 mm. The global point prevalence of the pons hepatis (190/5515) was calculated to be or 3.45% of the global population. CONCLUSIONS We have proposed a classification of the pons hepatis that is reproducible and clinically relevant. This allowed us to identify a high prevalence of pons hepatis (41%) in this Afro-Caribbean population that is significantly greater than the global prevalence (3.45%; P < 0.0001).
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Affiliation(s)
- Shamir O Cawich
- Port of Spain General Hospital, Port of Spain, Trinidad and Tobago.
| | - Michael T Gardner
- Section of Anatomy, University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Ramnanand Shetty
- Section of Anatomy, University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Neil W Pearce
- Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Rahul Deshpande
- Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | | | - Thomas Armstrong
- Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
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Abstract
Introduction: Total knee replacement (TKR) utilization is expected to increase by 673% in 2030, with patients between the ages of 45 to and 64 years representing the fastest-growingfastest growing age group requiring joint replacement. This group not only demands a higher- performinghigher performing, durable prosthesis but are is also the most likely to be dissatisfied if their expectations are not met. Hypo-allergenic implants have been developed by some implant manufacturers to fill this need, so the occurrence of allergic skin reactions after surgery is unanticipated and can have unwanted consequences if not recognized and managed appropriately. Case Report: We present the case of a 55-year-old woman who underwent bilateral staged TKR using oxidized zirconium implants and subsequently developed eczematous skin reactions. In both instances, she presented with a peri-incisional erythematous blistering skin reaction that was successfully treated with topical corticosteroids. Investigations revealed no evidence of infection or allergic-typeallergic type reactions to the metals contained in the knee replacements. Conclusion: Allergic skin reactions following TKR are very rare, and are not necessarily due to a metal hypersensitivity. Infection must be excluded in all cases and a trial of topical corticosteroids is useful before prior to more aggressive treatment, with the removal of the implant reserved as a last resort. To the best of our knowledge, this is the first case in the literature that reports the occurrence of allergic skin reactions following oxidized zirconium TKRs, and highlights the fact that allergic skin reactions can occur when using hypo-allergenic implants. Surgeons should be aware of this possibility and counsel their patients appropriately during the informed consent process.
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Affiliation(s)
- Marlon M Mencia
- Department of Orthopaedics, Westshore Medical Private Hospital, Cocorite, Trinidad, West Indies
| | - Shamir O Cawich
- Department of Orthopaedics, Westshore Medical Private Hospital, Cocorite, Trinidad, West Indies
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Pau L, Navez J, Cawich SO, Dapri G. Laparoscopic Management of Blunt and Penetrating Abdominal Trauma: A Single-Center Experience and Review of the Literature. J Laparoendosc Adv Surg Tech A 2021; 31:1262-1268. [PMID: 33428516 DOI: 10.1089/lap.2020.0552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Trauma is a leading cause of death in young patients. The prevalence of blunt and penetrating trauma varies widely across the globe. Similarly, the global experience with laparoscopy in trauma patients also varies. There is a growing body of evidence to suggest that laparoscopy is feasible in trauma patients. We sought to contribute to these data by reporting our experience with laparoscopic management of blunt and penetrating trauma in a Belgian center. Materials and Methods: We retrospectively collected data on all trauma patients admitted to the Saint-Pierre University Hospital in Brussels, Belgium, over the 4-year period from January 2014 to December 2017. Hospital records for patients subjected to exploratory laparoscopy were retrospectively reviewed, and a descriptive analysis was reported. Results: There were 26 patients at a mean age of 40 years treated with laparoscopic exploration for injuries from blunt trauma (7), stab wounds (14), and gunshot injuries (5). The median interval between the arrival at the emergency unit and diagnostic laparoscopy was 175 minutes (range: 27-1440), and the median duration of operation was 119 minutes (range: 8-300). In all patients who underwent laparoscopy for trauma, there were 27% overall morbidity, no mortality, 11% reoperation rate, 7.4% conversions, and 19% incidence of negative laparoscopy. The median intensive care unit stay was 3 days (range: 0-41), and median total hospital stay was 7 days (range: 2-78). Conclusions: Laparoscopy is a safe, feasible, and effective tool in the surgical armamentarium to treat hemodynamically stable patients with blunt and penetrating abdominal trauma. It allows complete and thorough evaluation of intra-abdominal viscera, reduces the incidence of nontherapeutic operations, and allows therapeutic intervention to repair a variety of injuries. However, it requires appropriate surgeon training and experience with advanced laparoscopic techniques to ensure good outcomes.
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Affiliation(s)
- Luca Pau
- Department of Gastrointestinal Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Navez
- Department of Surgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Giovanni Dapri
- Department of Gastrointestinal Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Cawich SO, Mohanty SK, Bonadie K, Simpson L, Ramnarace R, Fa Si Oen P, Singh Y, Naraynsingh V, Francis W. Laparoscopic Completion Cholecystectomy: An Audit from the Americas Hepato-Pancreato-Biliary Association (AHPBA) Caribbean Chapter. Cureus 2020; 12:e11126. [PMID: 33240719 PMCID: PMC7682921 DOI: 10.7759/cureus.11126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective Removal of a gallbladder remnant occasionally becomes necessary when retained stones become symptomatic. Although the laparoscopic approach has been described, it is not yet considered the standard of care. We sought to determine the outcomes after completion cholecystectomies in the resource-poor setting within the Caribbean. Methods We carried out an audit of the databases from all hepatobiliary surgeons in the Anglophone Caribbean. We identified all patients who had completion cholecystectomy over the five-year period from July 1, 2012 to June 30, 2018. Retrospective chart review was performed to extract the following data: patient demographics, diagnoses, presenting complaints, operative details, morbidity, mortality, and clinical outcomes. Descriptive statistics were generated using Statistical Packaging for Social Sciences (SPSS), version 12.0 (SPSS Inc., Chicago IL) Results There were 12 patients who were subjected to laparoscopic completion cholecystectomy for acute cholecystitis (7), severe biliary pancreatitis (3), and chronic cholecystitis (2) secondary to stones in a gallbladder remnant. There were 10 women and two men at a mean age of 47.4 years (range 32-60; standard deviation (SD) +/-7.81; median 48; mode 52) and a mean body mass index (BMI) of 30.8 Kg/M2 (SD +/-3.81; range 26-38; median 29.5). The mean interval between the index operation and the completion operation was 14.8 months (SD +/- 12.3; range 1-48; median 13; mode 18). Five (42%) patients had their original cholecystectomy using the open approach. Five (42%) index operations were done on an emergent basis and the gallbladder remnant was deliberately left behind in three (25%) index operations. The completion cholecystectomies were all completed laparoscopically in 130.5 minutes (SD +/- 30.5; range 90-180, median 125; mode 125) without any conversions or mortality. There were two minor bile leaks that resolved without intervention through an indwelling drain. Discussion Completions cholecystectomy can be completed via the laparoscopic approach with good outcomes and acceptable morbidity and mortality rates. The patients derive the same advantages as elective cholecystectomies. Therefore, the laparoscopic approach, when performed by hepatobiliary surgeons with advanced laparoscopic expertise in specialized centers, should be the new standard of care.
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Affiliation(s)
| | | | - Kimon Bonadie
- Surgery, Cayman Islands National Hospital, Grand Cayman, CYM
| | | | - Rene Ramnarace
- Gastroenterology, Southern Medical Hospital, San Fernando, TTO
| | | | - Yardesh Singh
- Surgery, University of the West Indies, St. Augustine, TTO
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Cawich SO, Dapri G, Fa Si Oen P, Thomas D, Naraynsingh V. Single Incision Laparoscopic Surgery: Feasibility of the Direct Fascial Puncture Technique Without Working Trocars. Cureus 2020; 12:e10742. [PMID: 33145144 PMCID: PMC7599059 DOI: 10.7759/cureus.10742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction As single-incision laparoscopic surgery (SILS) became popular, many access platforms and techniques emerged. When we initially described the direct fascial puncture (DFP) technique, many suggested it was not practical for three reasons: (1) increased hernia formation, (2) inability to complete operations without instrument changes and (3) insurmountable instrument drag. This study sought to determine whether the technique was a feasible approach by evaluating the outcomes with DFP-SILS in a single surgeon unit. Methods This was a retrospective audit of all consecutive patients who had unselected SILS operations by a single surgeon. For the DFP-SILS operation, a single optical trocar was used at the umbilicus, a second was rail-roaded beside the optical trocar and a third was directly passed across the fascia at the left-lateral extent of the skin wound. We recorded the number of conversions or failed operations and examined the patients routinely after operation to evaluate for incisional herniae. Results There were 50 DFP-SILS operations performed: 37 cholecystectomies, 12 appendectomies and one jejunal resection. The operations were successful in all cases with no conversions or mortality recorded. One patient (2%) developed a superficial surgical site infection after SILS-DFP appendectomy. The therapeutic outcomes were comparable to existing series of multi-port laparoscopy. There were no incisional herniae detected. Conclusion Even in the resource-poor setting, SILS operations are feasible and safe using the DFP technique. The theoretic concerns have not been realized in clinical practice.
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Affiliation(s)
| | - Giovanni Dapri
- Surgery, International School of Reduced Scar Laparoscopy, Brussels, BEL
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Cawich SO, Johnson P, Gardner MT, Pearce NW, Sinanan A, Gosein M, Shah S. Venous drainage of the left liver: an evaluation of anatomical variants and their clinical relevance. Clin Radiol 2020; 75:964.e1-964.e6. [PMID: 32958222 DOI: 10.1016/j.crad.2020.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/02/2020] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the variations in venous drainage from the left liver. MATERIALS AND METHODS A retrospective evaluation was performed of all consecutive abdominal computed tomography (CT) examinations at a tertiary referral facility between 1 January and 30 June 2018. Osirix (Pixmeo SARL, Bernex, Switzerland) was used to examine the major hepatic veins and their tributaries in each scan. The classification of variants as proposed by Nakamura and Tsuzuki was used to describe the findings. The following information was collected: ramification pattern, number, length and diameter of middle (MHV) and left (LHV) hepatic vein tributaries. Two researchers collected data independently, and the average measurements were used as the final dimensions. RESULTS Of 102 examinations evaluated, only 27 demonstrated the conventional venous drainage patterns. The LHV and MHV combined to form a common trunk that emptied into the inferior vena cava (IVC) in 75 (73.5%) cases. The common trunk had a mean length of 8.89 mm and mean diameter of 20.18 mm. Other patterns included Nakamura and Tsuzuki type I (27.5%), type II (29.4%) and type III variants (16.7%). In addition, 4.9% of patients had absent superior middle veins and 80% had supernumerary short hepatic veins (4%). CONCLUSION Only 26.5% of patients in this population had conventional venous drainage from the left liver. Surgeons and radiologists in hepatobiliary practice should be aware of these variants in order to minimise morbidity when performing invasive procedures.
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Affiliation(s)
- S O Cawich
- Department of Surgery, General Hospital, Port of Spain, Trinidad and Tobago.
| | - P Johnson
- Department of Surgery, Radiology, Anaesthetics and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - M T Gardner
- Department of Basic Medical Sciences, University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - N W Pearce
- University Surgical Unit, Southampton General Hospital, Southampton, UK
| | | | - M Gosein
- Department of Surgery, General Hospital, Port of Spain, Trinidad and Tobago
| | - S Shah
- Department of Surgery, Radiology, Anaesthetics and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona Campus, Kingston 7, Jamaica
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Cawich SO, Ali RRA, Gardner MT, Charles J, Sandy S, Pearce NW, Naraynsingh V. Hepatic surface grooves in Trinidad and Tobago. Surg Radiol Anat 2020; 42:1435-1440. [PMID: 32737520 DOI: 10.1007/s00276-020-02540-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/23/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Hepatic surface grooves (HSGs) are prominent depressions on the antero-superior surface of the liver. We sought to document the prevalence of HSGs in an Eastern Caribbean population. METHODS We observed all consecutive autopsies performed at a facility in Trinidad and Tobago and recorded the presence, number, location, width, length and depth of any HSG identified. Each liver was then sectioned to document intra-parenchymal abnormalities. RESULTS Sixty Autopsies were observed. There were HSGs in 9 (15%) cadavers (5 females and 4 males), at an average age of 66 years (range 48-83, Median 64, SD ± 10.4). The HSGs were located on the diaphragmatic surface of the right hemi-liver in 8 (89%) cadavers, left medial section in 4 (44%), left lateral section in 3 (33%) and coursing along Cantlie's plane in 3 (33%) cadavers. Eight (89%) cadavers with HSGs had other associated anomalies: accessory inferior grooves (5), parenchymal nutmeg changes (5), abnormal caudate morphology (4), hyperplastic left hemi-liver (3), lingular process (2), bi-lobar gallbladder (1) and/or abnormal ligamentous attachments (1). CONCLUSIONS Approximately 15% of unselected Afro-Caribbean persons in this Eastern Caribbean population have HSGs. Every attempt should be made to identify HSGs on pre-operative imaging because they can alert the hepatobiliary surgeon to: (1) associated anatomic anomalies in 89% of cases, (2) associated hepatic congestion in 56% of persons, (3) increased risk of bleeding during liver resections and (4) increased technical complexity of liver resections. The association between HSGs, cardiovascular complications, hepatic congestion and nutmeg liver prompted us to propose a new aetiologic mechanism for HSG formation, involving localized hyperplasia at growth zones due to upregulation of beta-catenin levels.
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Affiliation(s)
- Shamir O Cawich
- Port of Spain General Hospital, Port of Spain, Trinidad and Tobago.
| | - Reyad R A Ali
- Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | | | - Janet Charles
- Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Sherrise Sandy
- Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Neil W Pearce
- Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
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Singh Y, Arra A, Cawich SO, Ramlakhan S, Naraynsingh V. A case report of blunt cardiac rupture. Int J Surg Case Rep 2020; 73:244-247. [PMID: 32717678 PMCID: PMC7385032 DOI: 10.1016/j.ijscr.2020.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 01/12/2023] Open
Abstract
Cardiac rupture is a full thickness laceration of the myocardium that occurs after blunt chest trauma. They are notoriously fatal, with only a handful of patients documented to have survived this injury. In cases where there is laceration of the pericardium, cardiac injury may not be obvious on initial assessment. A high degree of suspicion along with early recognition and prompt operative intervention can reduce mortality for these disastrous injuries. Despite its rarity, a differential diagnosis of cardiac rupture should be entertained in patients with low velocity blunt chest trauma who present with haemothorax.
Introduction Cardiac rupture is a full thickness laceration of the myocardium that occurs after blunt chest trauma. They are notoriously fatal, with only a handful of patients documented to have survived. These injuries are not commonly associated with low energy chest trauma and may be overlooked as a differential in trauma cases if health care providers are not aware of their possibility. We now report the case of a patient who survived this injury. We believe this is the 16th reported survivor of blunt cardiac rupture. Presentation of case A 46-year-old construction worker was brought to the emergency department following blunt chest trauma. On arrival he was hypotensive and tachycardic. There was a transient response to intravenous fluid resuscitation. He was found to have a contusion to the left anterior chest wall and left haemothorax on imaging with normal mediastinum. Emergency left anterolateral thoracotomy revealed a pericardial and left ventricular laceration which was repaired. He was weaned off ventilatory support on day 4 post exploration and had an uneventful recovery. Discussion Survival after blunt cardiac rupture is extremely low. In the past 60 years, only 15 cases have been described where patients survived this injury. They are usually immediately fatal and are caused by high velocity injuries. Our case was interesting because, this injury was due to a low velocity injury resulting in ventricular laceration due to a displaced rib fracture. We believe this is the 16th reported survivor of blunt cardiac rupture. Conclusion It is important, therefore, for first responders to recognize that blunt cardiac rupture can also result from seemingly innocuous, low velocity injuries so that the diagnosis can at least be entertained early. Survival depends on early diagnosis and prompt thoracotomy.
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Affiliation(s)
- Yardesh Singh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
| | - Ammiel Arra
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies.
| | - Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
| | - Shammi Ramlakhan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
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Cawich SO, Gardner MT, Barrow M, Barrow S, Thomas D, Ragoonanan V, Mahabir A, Ali R, Naraynsingh V. Inferior Hepatic Fissures: Anatomic Variants in Trinidad and Tobago. Cureus 2020; 12:e8369. [PMID: 32617240 PMCID: PMC7326303 DOI: 10.7759/cureus.8369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
Classic descriptions of the visceral surface of the human liver only define three fissures: transverse, sagittal and umbilical fissures. Any additional fissures that are present on the visceral surface of the liver are considered variant inferior hepatic fissures (IHFs). This study was carried out to document the prevalence of IHFs in the Eastern Caribbean. Knowledge of these variants is important to clinicians who treat liver disorders in persons of the Caribbean diaspora. In this study, two independent researchers observed all consecutive autopsies performed at the facility over a period of 10 weeks. They examined the visceral surface of the unfixed liver in situ. Any specimen with variant IHFs was selected for detailed study. We documented the relation of the variant IHFs to nearby viscera and then explanted the livers using a standardized technique. The following details were recorded for each liver: number, location, depth, length, and width of IHFs. All measurements were checked independently by two researchers and the average measurement was used as the final dimension. Each liver was then sectioned in 1 cm sagittal slices to document the relationship of intraparenchymal structures. We observed 60 consecutive autopsies in unselected cadavers. Variant IHFs were present in 21 (35%) cadavers at a mean age of 68.25 years (range: 61 - 83; median 64.5; standard deviation (SD) ± 8.45). The variants included a deep fissure in the coronal plane between segments V and VI in 19 (31.7%) cadavers (related to the right branch of the portal vein in 63.2% of cases), a well-defined segment VI fissure running in a sagittal plane in four (6.7%) cadavers, a well-defined fissure incompletely separating the caudate process from the caudate lobe proper in five (8.3%) cadavers, a consistent fissure that arose from the left side of the transverse fissure and coursed between segments II and III in three (5%) cadavers, and a deep coronal fissure dividing the quadrate to form an accessory quadrate lobe in one (1.7%) cadaver. Almost one in three unselected persons in this population have anatomically variant fissures on the visceral surface of the liver. The variants include Rouvière's sulci (31.7%), caudate notches (8.3%), segment VI fissures (6.7%), left medial segment fissures (5%), and quadrate fissures (1.7%). The clinical relevance of these variants is discussed. Any clinician treating liver diseases in persons of Caribbean extract should be aware of their presence.
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Affiliation(s)
| | | | | | - Shaheeba Barrow
- Pathology, Port of Spain General Hospital, Port of Spain, TTO
| | - Dexter Thomas
- Surgery, Port of Spain General Hosptial, Port of Spain, TTO
| | | | | | - Reyad Ali
- Pathology, Port of Spain General Hosptial, Port of Spain, TTO
| | - Vijay Naraynsingh
- Surgery, Medical Associates Hospital, St. Joseph, TTO
- Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
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Abstract
Oncologic surgery in the Caribbean has evolved over the past decade, with increasing reports of advanced minimally invasive operations being performed. However, the minimally invasive approach has not been used for peri-ampullary lesions. This is because a laparoscopic Whipple's operation is a technically demanding and time-consuming operation. We report the first case of a totally laparoscopic Whipple's operation to be performed in the Caribbean.
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Affiliation(s)
- Yardesh Singh
- Surgery, University of the West Indies, St. Augustine, TTO
| | | | | | | | - Vijay Naraynsingh
- Surgery, Medical Associates Hospital, St. Joseph, TTO.,Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
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Cawich SO, Kabiye D. Developing Laparoscopic Surgery on the Caribbean Island of St. Lucia: A Model for Public-Private Partnership. Cureus 2019; 11:e6011. [PMID: 31815075 PMCID: PMC6881080 DOI: 10.7759/cureus.6011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022] Open
Abstract
The first recorded laparoscopic operation in the Caribbean was a cholecystectomy performed in 1991. After a temporary peak in basic laparoscopic operations in subsequent years, the initial interest waned. While laparoscopic surgery was being popularized in the developed world, there was a stagnation in the Caribbean. There were many reasons for this stagnation, including a lack of surgical expertise, the negative attitudes of health-care workers, active opposition from surgical leaders, and equipment deficiencies, all exacerbated by the global financial recession in the early twenty-first century. A similar situation existed on the Caribbean island of St. Lucia, where laparoscopic surgery remained relatively dormant. After a strong desire by community surgeons to incorporate advanced laparoscopy into surgical practice, surgical leaders in St. Lucia engineered a public-private partnership to achieve this. This review article evaluates the available data, documents the obstacles encountered, and explains the mechanisms to overcome these obstacles to incorporate advanced laparoscopy in St. Lucia. This information is important because it can serve as a template for other developing Caribbean countries.
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Abstract
Laparoscopic liver resections require advanced laparoscopic skill sets. In the Caribbean, a unique situation exists where centers of excellence for liver resections exist, but surgeons who are trained in advanced laparoscopic surgery are not available throughout the region. Therefore, many patients who are candidates for liver resection in the Caribbean do not have the opportunity to receive laparoscopic operations. We report a case of distance mentoring using readily available, inexpensive equipment to complete a laparoscopic liver resection, mentored by an expert hepatobiliary surgeon. It may be considered, in special cases, as a way to increase the availability of laparoscopic operations. We acknowledge that there are many limitations to the use of this technology and we discuss the pros and cons of distance mentoring for this purpose.
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Affiliation(s)
| | | | - Marlon Mencia
- Surgery, University of the West Indies, St. Augustine, TTO
| | | | - Neil W Pearce
- Surgery, Southampton University Hospital National Health Service (NHS) Trust, Southampton, GBR
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Dapri G, Cawich SO, Bascombe NA, Bobb AK, Arabadjiev A, Gomez-Galdon M. Simultaneous transanal endolaparoscopic resection of a large anal canal and low rectal polyps - a video vignette. Colorectal Dis 2019; 21:976-977. [PMID: 31058407 DOI: 10.1111/codi.14669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 02/08/2023]
Affiliation(s)
- G Dapri
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.,Laboratory of Anatomy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium
| | - S O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - N A Bascombe
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.,Department of Clinical Surgical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - A K Bobb
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.,Department of Clinical Surgical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - A Arabadjiev
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - M Gomez-Galdon
- Department of Pathology, Jules Bordet University Institut, Brussels, Belgium
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Cawich SO, Naraynsingh V, Jonallagadda R, Wilkinson C. Caribbean “substitution culture” is a barrier to effective treatment of persons with diabetic foot infections. World J Surg Proced 2019; 9:12-18. [DOI: 10.5412/wjsp.v9.i2.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/15/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetes-related amputation rates are high in the Caribbean. Many authorities have identified independent risk factors for diabetes-related amputations, but cultural factors remain underappreciated. We coined the term “Caribbean substitution culture” to describe the attitude of patients with diabetic foot infections in which they refuse to access medical care, instead voluntarily choosing to substitute “bush medicines” or other alternative therapies in the place of conventional treatment. Recognizing that the Caribbean substitution culture is a barrier to effective treatment of diabetic foot infections is the first step in curbing these practices. In this paper, we discuss the issues related to the Caribbean substitution culture, including the demographics of the population at risk, the alternative therapeutic practices and potential public health strategies to combat this practice.
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Affiliation(s)
- Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
| | - Ramesh Jonallagadda
- Department of Surgery, University of the West Indies, Cave Hill, Barbados, West Indies
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Cawich SO, Naraynsingh V, Jonallagadda R, Wilkinson C. Caribbean “substitution culture” is a barrier to effective treatment of persons with diabetic foot infections. World J Surg Proced 2019. [DOI: 10.5412/wjsp.v9.i2.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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50
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Cawich SO, FaSiOen P, Singh Y, Francis W, Mohanty SK, Naraynsingh V, Dapri G. Single incision laparoscopic surgery from a caribbean perspective. Int J Surg 2019; 72S:13-18. [PMID: 31132463 DOI: 10.1016/j.ijsu.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022]
Abstract
Conventional laparoscopy with multiple ports has recently gained a strong foothold in the Caribbean, but single incision laparoscopic surgery (SILS) has lagged behind. In this paper, we compare the data on SILS and conventional multi-port laparoscopy in the English-speaking Caribbean.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago.
| | - Patrick FaSiOen
- Department of Surgery, St Elizabeth Hospital, Dutch Caribbean, Curacao
| | - Yardesh Singh
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago
| | - Wesley Francis
- Department of Surgery, Princess Margaret Hosptial, Nassau, Bahamas
| | - Sanjib K Mohanty
- Department of Surgery, Cayman Islands Hospital, West Indies, Cayman Islands
| | - Vijay Naraynsingh
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago
| | - Giovanni Dapri
- Department of Surgery, Saint Pierre University Hospital, Brussels, Belgium
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