Publications by authors named "N Rajaretnam"

21 Publications

The correlation between full moon and admission volume for penetrating injuries at a major trauma centre in South Africa.

S Afr J Surg 2021 Sep;59(3):94-96

Department of Surgery, University of the Witwatersrand, South Africa and Department of Surgery, University of KwaZulu-Natal, South Africa.

Background: The possible effect of full moon on admission volume of trauma centres is a well-mentioned phenomenon that has been perpetuated worldwide. We aimed to review the correlation between full moon and admission volume and to interrogate any possible relationship on admission for penetrating trauma.

Methods: A retrospective study from 2012 to 2018 at Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa.

Results: A total of 8 722 patients were admitted. Eighty-three per cent (7 242/8 722) were male and the mean age was 29 years. The total number of days during the study period was 1 953, 66 of which were 'full moon' (FM) days and 1 887 were 'non-full moon' (NFM) days. There was no significant difference between gender or age distribution. The mean number of admissions per day on FM days compared with NFM days was not significant (4.1 vs 4.5, = 0.583). A total of 3 332 patients with penetrating trauma were admitted. This constituted 42% (113/271) of admission on FM days and 38% (3 219) on NFM days, which is not statistically significant ( = 0.229). Subgroup analysis did not demonstrate any significant difference between the number of stab wounds - 28% (77/113) vs 25% (2 124/3 219) - or gunshot wounds - 13% (16/113) vs 12% (990/3 219) - between FM and NFM days.

Conclusion: The correlation between full moon and trauma admission is unfound in our setting. The perpetuating notion that 'it must be full moon tonight' is likely to be an urban myth with no scientific evidence for such a claim.
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September 2021

Trauma to the gallbladder is associated with concurrent injuries to the wider hepatobiliary system: A South African experience.

Injury 2021 Jul 30. Epub 2021 Jul 30.

Department of Surgery, University of KwaZulu Natal, Durban, South Africa.

Introduction: Gallbladder trauma is a rare injury. This study aimed to describe the significance of these injuries and the appropriate management strategies.

Methods: A retrospective study was undertaken at a major trauma centre in South Africa and included all patients diagnosed with a gallbladder injury between January 2012 and October 2020.

Results: A total of 51 cases were included (88% male, mean age: 38 years), with 44 (86%) penetrating trauma cases [28 stab wounds (SW), 16 sustained gunshot wounds (GSW)]. Of the 7 (13%) blunt trauma cases, five were involved in a motor vehicle crash, and two were injured via assault. All patients underwent laparotomy. Full-thickness gallbladder laceration or perforation was the most common type of injury (84%) and all patients with a gallbladder perforation or laceration had a cholecystectomy at index operation. Two out of 5 patients with a gallbladder contusion were managed conservatively without a cholecystectomy and the remaining three had evidence of gallbladder necrosis which were managed with cholecystectomy. Associated extrahepatic bile duct injuries occurred in 4% of cases, and 18 cases (35%) required ICU admission. The overall mortality was 8%.

Conclusion: Gallbladder injury is rare but when encountered implies a significant degree of trauma. Although cholecystectomy is usually definitive, there is an association with other occult extra-hepatic biliary tract injuries. The severity of the associated injuries usually determines patient outcomes.
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http://dx.doi.org/10.1016/j.injury.2021.07.034DOI Listing
July 2021

Use of prophylactic mesh during initial stoma creation to prevent parastomal herniation: a systematic review and meta-analysis of randomised controlled trials.

Colorectal Dis 2021 Jul 31. Epub 2021 Jul 31.

Royal Devon and Exeter Hospital, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.

Aim: Parastomal hernia (PSH) is a common complication following stoma creation. Previous reviews found mesh reinforcement during initial stoma creation beneficial in reducing PSH incidence. Since then, several multicentre randomised controlled trials (RCTs) produced widely ranging results rendering previous findings debatable. This current review assessed whether combining the latest larger multicentre RCTs would alter the previous findings.

Methods: The Cochrane Library, MEDLINE and Embase were searched from the respective dates of inception until 15 January 2021. RCTs were included if they compared mesh with no mesh during initial stoma creation in adult patients to prevent PSH. Included RCTs were summarised narratively and meta-analysed to estimate the relative risk (RR) of PSH incidence (primary analysis), peristomal complications and PSH repair (secondary analyses). Several subgroup analyses were performed, including mesh type (synthetic/biologic), surgical technique (open/laparoscopic) and mesh position (sublay/intraperitoneal).

Results: Thirteen RCTs were included in the primary meta-analysis (1070 patients); PSH incidence was reduced in patients with mesh compared with patients without mesh at maximal follow-up (RR = 0.54; 95% CI 0.39-0.77; I  = 67%; P < 0.01). The number of PSH repairs was fewer in patients who had mesh (RR = 0.63; 0.35-1.14; I  = 6%; P = 0.39), with no difference in peristomal complications (RR = 0.96; 0.55-1.70; I  = 0%; P = 0.71), comparing with no mesh. Subgroup analyses suggested that placing synthetic mesh using an open sublay technique might be more beneficial.

Conclusions: Prophylactic mesh reinforcement during initial stoma creation reduces PSH incidence and potentially its repair, without an increase in peristomal complications. However, substantial heterogeneity among included RCTs limits confidence in the results.
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http://dx.doi.org/10.1111/codi.15849DOI Listing
July 2021

Laparotomy for Abdominal Stab Wound With Combined Omental and Organ Evisceration: 10-Year Experience From a Major Trauma Centre in South Africa.

Am Surg 2021 Jul 29:31348211031855. Epub 2021 Jul 29.

Department of Surgery, University of KwaZulu Natal, Durban, South Africa.

Introduction: Combined omental and organ evisceration following anterior abdominal stab wound (SW) is uncommon and there is a paucity of literature describing the management and spectrum of injuries encountered at laparotomy.

Methods: A retrospective study was undertaken on all patients who presented with anterior abdominal SW involving combined omental and organ evisceration who underwent laparotomy over a 10-year period from January 2008 to January 2018 at a major trauma centre in South Africa.

Results: A total of 61 patients were eligible for inclusion and all underwent laparotomy: 87% male, mean age: 29 years. Ninety-two percent (56/61) had a positive laparotomy whilst 8% (5/61) underwent a negative procedure. Of the 56 positive laparotomies, 91% (51/56) were considered therapeutic and 9% (5/56) were non-therapeutic. In addition to omental evisceration, 59% (36/61) had eviscerated small bowel, 28% (17/61) had eviscerated colon and 13% (8/61) had eviscerated stomach. A total of 92 organ injuries were identified. The most commonly injured organs were small bowel, large bowel and stomach. The overall complication rate was 11%. Twelve percent (7/61) required intensive care unit admission. The mean length of hospital stay was 9 days. The overall mortality rate for all 61 patients was 2%.

Conclusions: The presence of combined omental and organ evisceration following abdominal SW mandates laparotomy. The small bowel, large bowel and stomach were the most commonly injured organs in this setting.
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http://dx.doi.org/10.1177/00031348211031855DOI Listing
July 2021

COVID-19 response by New Zealand general surgical departments in tertiary metropolitan hospitals.

ANZ J Surg 2021 07 5;91(7-8):1352-1357. Epub 2021 Jul 5.

North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand.

Background: Worldwide, coronavirus disease 2019 (COVID-19) has significantly challenged the delivery of healthcare. New Zealand (NZ) faced similar potential challenges despite being geographically isolated. Given the rapid change in the COVID-19 pandemic, hospitals in NZ were tasked with formulating their own COVID-19 responses based on the Ministry of Health's (MoH) recommendations.

Methods: This paper evaluates how six metropolitan general surgical departments in NZ had responded to COVID-19 in terms of changes made to rosters, theatres, clinics, acute admissions as well as additional measures taken to reduce the risk of staff exposure. It also explores how NZ fared in comparison with international guidelines and recommendations. Data from each centre were provided by an appointed clinician.

Results: All centres had adapted new rosters and a restructuring of teams. Handovers, multidisciplinary team meetings and educational sessions were held virtually. Different strategies were implemented to ration hospital resources and reduce the risk of staff exposure. Non-urgent operations, endoscopies and clinics were deferred with allocation of dedicated COVID-19 operating theatres. Potential COVID-19 suspects were screened prior to admission and treated separately. Various admission and imaging pathways were utilised to increase efficiency.

Conclusion: General surgical departments in NZ had implemented a comprehensive COVID-19 response but there is room to work towards a more unified national response. Our analysis shows that these centres across NZ had taken a similar approach which was aligned with international practices.
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http://dx.doi.org/10.1111/ans.17044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420382PMC
July 2021
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