Browsing by Author "Kloppers, Jacobus Christoffel"
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- ItemOpen AccessResection of biliary mucinous cystic neoplasms: Study of a single institutional cohort and a literature review(2017) Kloppers, Jacobus Christoffel; Krige, Jake E J; Jonas, EduardBackground: Biliary mucinous cystic neoplasms (BMCNs) are uncommon neoplastic septated intrahepatic cysts which are often incorrectly diagnosed and have the potential for malignant transformation. Aim: The aim of this study was to assess the outcome of surgical resection of BMCNs. Methods: Data from a departmental and faculty registered prospective liver surgery database was used to identify patients who underwent surgery at Groote Schuur and the University of Cape Town Private Academic Hospitals for BMCN from 1999 to 2015. Standard demographic variables including age and gender were documented as well as detailed preoperative imaging, location and size, operative treatment, extent of resection, histology, post-operative complications using the Clavien-Dindo classification and long-term outcome. Results: Thirteen female patients (median age 45 years) had surgery. Eleven were diagnosed by computer tomography scan after investigation of abdominal pain or a palpable mass. Two were jaundiced. One cyst was found incidentally during an elective cholecystectomy. Five cysts were located centrally in the liver. Before referral three cysts were treated inappropriately with percutaneous aspiration or drainage and two were treated with operative deroofing. Six patients had anatomical liver resections and seven patients had non anatomical liver resections of which two needed ablation of residual cyst wall. One patient needed a biliary-enteric reconstruction to treat a fistula of the left hepatic duct. Median operative time was 183 minutes (range: 130-375). No invasive carcinoma was found on histology. There was no operative mortality. One surgical site infection was treated and one patient developed an intra-abdominal collection one month post-operatively. Two patients developed recurrent BMCN after 24 months. Conclusion: BMCNs should be considered in middle aged women who have well encapsulated multilocular liver cysts. Treatment of large central BMCNs adjacent to vascular and biliary structures in particular may require technically complex liver resections and are best managed in a specialized hepato-pancreatico-biliary unit.
- ItemOpen AccessShould abdomino-perineal resection be considered when a defunctioning stoma is required for anal canal squamous cell carcinoma?(2014) Kloppers, Jacobus Christoffel; Goldberg, Paul ACombined modality treatment (CMT) is the preferred treatment for anal squamous cell carcinoma, but a small subgroup needs a defunctioning colostomy with temporary intent. The aim of this study was to evaluate the stoma closure rate of patients needing defunctioning colostomies prior to CMT for anal squamous cell carcinoma (SCC) at Groote Schuur Hospital (GSH). The key objective was to assess if abdomino-perineal resection (APR) should be offered as primary treatment modality for the subgroup of patients needing a defunctioning stoma and CMT.
- ItemOpen AccessWhat is the current practice of inguinal hernia repair at University of Cape Town affiliated hospitals?(2019) Scout, Earl; Kloppers, Jacobus ChristoffelBackground: Various inguinal hernia repair techniques exist, without one ‘single best’ option. Hernia society guidelines recommend laparoscopic repair as one of its mainstays, provided surgeons are adequately trained. The current practice for hernia repair in South Africa as well as the surgical resident exposure to laparoscopic repair training is unknown. Aim: To quantify the current practice of inguinal hernia surgery in hospitals affiliated to the University of Cape Town (UCT) and to assess trainee exposure to laparoscopic repair. Methods: All adult patients who underwent inguinal hernia repair during the 12-month study period, at the four UCT affiliated hospitals (Groote Schuur, Mitchell’s Plain, Victoria and New Somerset) were included. Collected data parameters included age, gender, primary or recurrent hernia, uni- or bilaterality, primary surgeon consultant or non-consultant, operative time, and open or laparoscopic technique used. Results: 380 patients were included. Eighty-eight (23.2%) repairs were performed laparoscopically, of which 5 (5.7%) were converted to open. Non-consultants were present at 70/88 (79.5%) cases performed laparoscopically and were primary surgeon at 15 (17%). Laparoscopic repair was performed for 63.6% of bilateral versus 19.3% of unilateral hernias, 39.3% of recurrent hernias and 45% of hernias in females. Conclusion: Inguinal hernias in our setting are predominantly repaired by open surgery. The likelihood of laparoscopic repair varies significantly depending on which hospital the patient is referred to. Non-consultants have limited exposure to performing laparoscopic hernia repairs as the primary surgeon.