Browsing by Author "Kloppers, Jacobus"

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    Open Access
    An 8-year retrospective review of Pyogenic Liver Abscesses at Groote Schuur Hospital, Cape Town, South Africa
    (2023) Govender, Nieleshen; Kloppers, Jacobus
    Pyogenic liver abscess (PLA) is the most common abdominal solid organ abscess with significant associated morbidity and mortality (2-30%). High variance in the causative organism exists therefore identifying the responsible pathogens and providing targeted therapy is needed for optimal outcomes. This study aims to describe patient variables, outcomes and the local microbiome to guide future empiric antibiotic protocols. Methods We performed a retrospective review of 121 patients with PLA from 2012 to 2020 at Groote Schuur Hospital. We analyzed patient demographics, microbiology results from cultures of PLA (bile, percutaneous aspiration or intra-operative sampling) and blood samples, empiric antibiotic regimens used, interventions and outcomes. Results The five most common organisms cultured were Escherichia coli [26 (21%)], Klebsiella pneumoniae [24 (19.8%)], Pseudomonas aeruginosa [12 (9.9%)], Anaerobic organisms Isolated [11 (9%)] and Enterobacter cloacae Complex [7 (5.1%)]. Twenty different regimens were used to treat PLA. Primary intervention (antibiotics alone, percutaneous drainage, open surgery) was successful in 72 patients (60%). Further intervention was required in 49 patients (40%). Open surgical drainage was required in 16 patients (13%). 30-day mortality was 9.1% (n=11). Biliary sepsis was the most common cause of PLA (31%). Our study showed Gentamicin [52 isolates (65%)], Ciprofloxacin [49 isolates (61%)] and Co-Amoxiclav [46 isolates (46%)] to be the most effective in covering the five most common isolates. Conclusion Optimal PLA management remains challenging with multiple combinations of empiric antibiotic regimens initiated. Local data on the topic is sparse and this research is hypotheses generating for future research to improve outcomes. Abstract word count: 250 words
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    An audit of emergency hernia operations: Surrogate of system failure or incidentalomas?
    (2020) Nkgudi, Boitumelo; Kloppers, Jacobus; Rayamajhi, Shreya
    Background: Hernia emergencies common surgery. Around 20 million groin hernia operations occur world-wide, and these form 70% of all hernia operations. Incisional hernias complicate 15- 30% of laparotomies and 20% of these present as emergencies. Watchful waiting is often applied for groin, ventral and incisional hernias in patients who are asymptomatic or those who are poor surgical candidates. The factors associated with poor outcomes include - elderly patients, multiple comorbidities, delays in presentation, those which are incarcerated or strangulated and delays in getting to theatre. Management of emergency hernias include resuscitative efforts to address life threatening problems, and thereafter performing the safest and most durable repairs. Aim: We aim to elucidate patient and health care systems factors that contribute to hernia emergency presentations and to document the mortality and morbidity of such presentations in our unit. Method: We aim to review case files of all patients above 18 years of age who had their emergency surgery for a complicated hernia. All elective cases will be excluded. Conclusion: This study will contribute to understanding emergency hernias in south Africa and will seek to improve patient care in our setting. A hernia registry has recently been established and thus we will be able to contribute to its foundation.
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    Describing the resistance patterns of necrotising fasciitis in Acute Care Surgery
    (University of Cape Town, 2020) Mabogoane, Tumiso; Kloppers, Jacobus; Rayamajhi Shreya
    Objective: This study aims to identify the microorganisms and antibiotic resistance patterns in necrotising fasciitis. Methods: This is a retrospective audit over two consecutive years (June 2015 - July 2017) of all patients who had surgery for necrotising fasciitis at an ACS unit. Results: Necrotising fasciitis accounted for 15% of all skin and soft tissue sepsis that required surgery. There were 10 male (52.6%) and nine female (47.4%) patients. The most common co-morbidity was diabetes mellitus in 10 (52.6%) patients, the compliance and control were monitored by glycosylated haemoglobin (HbA1C) in 50% of the diabetic group, with a mean of 8.98 (Range 5-12.9). Fifteen percent of cases (n=3) had a confirmed diagnosis of HIV, with a negative result in eight (42%). ICU was required in three patients two of whom were on inotropes and one patient required renal replacement therapy. Surgery was performed within 24 hours for 11 (57%) patients. The most common anatomical site for debridement was perineum in nine patients (47%). Monomicrobial infection was the most common subtype of necrotising fasciitis with methicillin sensitive staphylococcus aureus in five (26%) as the predominant microbe. Gram-negative organism Escherichia-coli was the second most common monomicrobial infection. All Gram-positive organisms were sensitive to cloxacillin and coamoxiclavulanic acid. Two gram negatives(15%) of the 13 organisms cultured were resistant to co-amoxiclavulanic acid. The 30 day mortality was 15%. Conclusion- Necrotising fasciitis is a rare but lethal infection. In our limited series, monomicrobial infection is the most common subtype. 15% of the community acquired organisms were resistant to the empiric antibiotic of choice co-amoxiclavulanic acid.
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    Describing the resistance patterns of necrotising fasciitis in acute care surgery
    (2021) Mabogoane, Tumiso B M; Rayamajhi Shreya; Kloppers, Jacobus
    Objective- This study aims to identify the microorganisms and antibiotic resistance patterns in necrotising fasciitis. Methods- This is a retrospective audit over two consecutive years (June 2015 - July 2017) of all patients who had surgery for necrotising fasciitis at an ACS unit. Results- Necrotising fasciitis accounted for 15% of all skin and soft tissue sepsis that required surgery. There were 10 male (52.6%) and nine female (47.4%) patients. The most common co-morbidity was diabetes mellitus in 10 (52.6%) patients, the compliance and control were monitored by glycosylated haemoglobin (HbA1C) in 50% of the diabetic group, with a mean of 8.98 (Range 5-12.9). Fifteen percent of cases (n=3) had a confirmed diagnosis of HIV, with a negative result in eight (42%). ICU was required in three patients two of whom were on inotropes and one patient required renal replacement therapy. Surgery was performed within 24 hours for 11 (57%) patients. The most common anatomical site for debridement was perineum in nine patients (47%). Monomicrobial infection was the most common subtype of necrotising fasciitis withmethicillin sensitive staphylococcus aureus in five (26%) as the predominant microbe. Gram-negative organism Escherichia-coli was the second most common monomicrobial infection. All Gram-positive organisms were sensitive to cloxacillin and co- amoxiclavulanic acid. Two gram negatives(15%) of the 13 organisms cultured were resistant to coamoxiclavulanic acid. The 30 day mortality was 15%. Conclusion- Necrotising fasciitis is a rare but lethal infection.In our limited series, monomicrobial infection is the most common subtype. 15% of the community acquired organisms were resistant to the empiric antibiotic of choice co-amoxiclavulanic acid. (word count= 261).
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    Risk Factors Predicting Conversion to Laparoscopic Subtotal Cholecystectomy and Post-operative Outcomes from a High-Volume Centre
    (2023) Booyse, Karien; Kloppers, Jacobus
    Background: Laparoscopic subtotal cholecystectomy (LSC) is utilized as a safe and feasible alternative for difficult cholecystectomies to avoid bile duct injury and can aid in avoiding conversion to open surgery. This study assesses the risk factors and outcomes of patients who underwent LSC. Methods: A retrospective analysis was conducted of patients undergoing LSC from September 2019 to August 2021. Relative clinical and operative factors as well as postoperative outcomes were analysed. Results: There were 631 consecutive cholecystectomies included, 53 of which required LSC. Nine (16.9%) used the reconstituting technique and 43 (81.8%) were fenestrating LSC, one procedure not specified. High BMI (26.4%) and previous endoscopic retrograde cholangiopancreatography (ERCP) (18.9%) were the most common indicators for expected difficulty. Severe inflammation (58.5%) followed by extensive adhesions (52.8%) were the leading causes for conversion to LSC. Aberrant biliary anatomy was the strongest predictor of conversion, and an emergency operation was more likely to require a LSC. The presence of a contracted gallbladder, severe inflammation, gallbladder empyema and extensive adhesions were all independently associated with LSC (all p < 0.05). Postoperative complications were recorded in 26.4% of patients. Fifteen percent of patients had postoperative bile leaks; five resolved spontaneously while three required intervention with ERCP. There were eight Clavien-Dindo Grade III complications, three (5.7%) required ERCPs and five (9.4%) required relook laparotomies. There was one mortality. Conclusions: LSC is a safe alternative that should be utilized in the management of complex gallbladder pathology. Post-operative bile leak was not a major clinical issue in our setting