Browsing by Author "Apostolou, C"
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- ItemOpen AccessNational survey of surgeons' attitude to laparoscopic surgical training in SA(2004) Apostolou, C; Panieri, EAim. Laparoscopic surgery forms an integral component of modern surgical practice. The perception exists that laparoscopic training in South Africa has been unplanned and under-resourced. This study set out to assess the opinions of surgeons and surgical trainees with regard to the various facets of laparoscopic surgical training. Methods. A national survey was conducted, using a questionnaire distributed to surgical staff of all academic surgical centres. Multiple variables were assessed, predominantly using the following numerical scoring system: 5 – strongly agree; 4 – agree; 3 – neutral; 2 – disagree; 1 – strongly disagree. Results. There were 122 respondents: 77 trainees and 45 consultants. The majority strongly agreed that laparoscopic training is essential for local surgical registrars. Current laparoscopic training was assessed as being average. Cholecystectomy, diagnostic laparoscopy, antireflux surgery and appendicectomy were the laparoscopic procedures deemed most important in training. The average number of laparoscopic cholecystectomies respondents thought were required for competency was 24. The major hurdle to training was lack of equipment and equipment shortages, and the majority felt that laparoscopic skills facilities and laparoscopy seminars would optimally augment training. Conclusion. Surgeons and trainees in academic units recognise the importance of laparoscopic training, but feel that it is currently not optimal. Consensus exists on appropriate procedures and what the hurdles are to training in our context. This knowledge can be applied to improve laparoscopic surgical training in South Africa.
- ItemOpen AccessPancreatic pseudocysts(2006) Apostolou, C; Krige, J E J; Bornman, P CImprovements in imaging studies and a better understanding of the natural history of pancreatic fluid collections (PFCs) have allowed the different types to be clarified. Stratification of PFCs into subgroups should help in selecting from the increasing current available treatment options, which include percutaneous, endoscopic and surgical drainage. Percutaneous catheter drainage is safe and effective and should be the treatment of choice in poor-risk patients, and for infected pseudocysts related to acute pancreatitis. Endoscopic drainage should be the first management option in suitable pseudocysts related to chronic pancreatitis, if the necessary expertise is available. The high success rate and current low morbidity of elective open surgery mean that it is still the standard of management in this disease. Laparoscopic approaches are gaining favour, predominantly in drainage of collections in the lesser sac, and long-term data are awaited. The precise application of this modality will need to be critically compared with the low morbidity of mini-laparotomy, which is the current standard after non-operative treatment fails in these patients. It is essential to clearly stratify the different types of pancreatic pseudocysts, in particular with relation to acute or chronic pancreatitis, and perform a valid comparison of the different treatment modalities within groups. In this capacity a precise and transparent classification may provide valuable answers, in particular relating to optimal management according to pseudocyst type.