Browsing by Author "Boutall, Adam"

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    A Clinical Approach to Common Surgical Scenarios: A Handbook for Students and Junior Doctors
    (The Authors, 2020-01) Panierie, Eugenio; Cairncross, Lydia; Boutall, Adam; Bernon, Marc; Malherbe, Francois; Panieri, Eugenio; Malherbe, Francois
    Aimed at students and junior doctors, the purpose of this book is to provide a guide to the evaluation of common surgical problems as well as test diagnostic and troubleshooting skills when there is nobody to help or ask for advice.
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    Complications of ileostomy closure and their risk factors
    (2014) Banerjee, Deepanjali; Goldberg, Paul A; Boutall, Adam
    Previous literature pertaining to complications following ileostomy closure and possible risk factors associated with ileostomy closure have been seen derived largely from developed countries. South Africa has its own unique patient population dynamics with regards to the colorectal disease burden including the, time and age at presentation, genetic variability, access to health care facilities, financial security, varying levels of social security and differences in sociocultural health seeking behaviour patterns. It would therefore be interesting to evaluate whether the type of complications seen at a tertiary teaching hospital in South Africa are comparable to that seen worldwide. Aim: To determine the complication rate after an ileostomy closure at Groote Schuur Hospital (GSH) between January 2008 and December 2012.
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    Influence of Genetic Polymorphisms on the Age at Cancer Diagnosis in a Homogenous Lynch Syndrome Cohort of Individuals Carrying the MLH1:c.1528C>T South African Founder Variant
    (2024-09-27) Ndou, Lutricia; Chambuso, Ramadhani; Algar, Ursula; Goldberg, Paul; Boutall, Adam; Ramesar, Raj
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    Investigating the clinicopathological spectrum and associated genetics of colorectal carcinoma in young (<60 years of age) patients in the Western Cape Province
    (2025) Aldera, Alessandro; Ramesar, Rajkumar; Boutall, Adam
    The incidence of colorectal carcinoma (CRC) in young patients is rising in sub-Saharan Africa, and is set to become a major public health problem within the next decade. Despite this, there is a paucity of large-scale genomic studies in the subregion. To investigate driver genes, oncogenic signalling pathways and spectrum of pathogenic variants, we retrospectively identified 197 CRC cases over a 5 year period. Thirty-two mismatch repair deficient (dMMR) cases, without known germline variants, were investigated with amplicon-based panel next generation sequencing (NGS). Pathogenic or likely pathogenic variants were detected in the corresponding MMR gene in 14 of 18 (78%) MLH1/PMS2-deficient tumours, 5 of 8 (63%) MSH2/MSH6-deficient tumours, 1 of 4 (25%) tumours with isolated MSH6 loss, and 0 of 2 tumours with isolated PMS2 loss. Cases with a variant allele frequency suggesting a germline mutation were identified in MLH1 (eight), MSH2 (two) and MSH6 (one). NGS-based strategies for Lynch syndrome screening are advised to detect the broad spectrum of disease-causing MMR gene variants in our population. Resource constraints prohibit the rollout of universal MMR screening in sub-Saharan Africa. We sought to determine the performance of a deep learning model in our ethnically heterogeneous cohort. Our model yielded an AUROC of 0.91 (±0.02). Calibrating the classification threshold to 0.15, the overall sensitivity achieved in our cohort was optimised to 96% (95% CI 90-100) with a specificity of 60% (95% CI 52-82). This model could therefore be employed to accurately pre-screen for dMMR cases, thereby reducing the burden of downstream immunohistochemical and molecular testing in our resource limited setting. Whole exome sequencing was performed on a subset of the research cohort. Eighty-three cases were included in the analysis (77 MSS, 4 MSI, 2 POL). APC, TP53 and KRAS were among the most frequently mutated driver genes, although at a lower frequency than described in the literature. BRAF V600E mutations were absent. Although there were differences in the frequencies of mutations in the major driver genes, the frequencies of oncogenic pathway alterations were similar. FAT4 (26%) and TET2 (15%) have emerged as important novel driver genes in left-sided tumours, and potential therapeutic targets for further investigation.
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    The Incidence of Anastomotic Leaks in a South African Healthcare Setting
    (2023) Karimbocus, Mohammad; Boutall, Adam
    Introduction AL is known to be associated with increased morbidity and mortality. There are no studies reporting AL rate in sub-Saharan Africa. Methods A prospective multicentre snapshot study of 145 patients across the Cape Metro West healthcare platform was performed from 01/09/2020 to 31/12/2020. The study included all patients who had one or more intestinal anastomoses beyond the ligament of Treitz and excluded patients under 18 and patients undergoing simple appendectomies. Leaks were diagnosed clinically, radiologically or at relook laparotomy, outcomes and 30-day mortality were recorded. Results 102 males and 43 females were recruited, with a mean age of 41.9 years. 35 elective and 110 emergency procedures were performed. 120 patients had an uneventful postoperative course. 25 patients were investigated for AL and 15 leaks were confirmed. The overall leak rate was 10.3%, the leak rate for elective procedures was 8.6% and 10.9% for emergency procedures. 4 patients were diagnosed clinically, 4 were diagnosed at relaparotomy while 7 were found to have leaks on CT scans. 7 patients with AL needed a stoma, 1 needed a percutaneous drain, and 6 were treated conservatively. There were 3 deaths (overall mortality rate 2.07%), 1 in the AL group (mortality rate 6.67%), and 2 in the patients with no AL (1.54%). Conclusion This is the first study to look at AL in South Africa and it illustrates surgical practice across the entire healthcare platform. Anastomoses were performed safely in our healthcare service with a leak rate comparable to previous international studies.