The proven advantages of minimal access surgery (MAS), such as laparoscopy, are globally recognised. However, its adoption is variable in all countries irrespective of income level. One of the commonly cited barriers is lack of training. This study assesses the uptake of laparoscopy following intensive MAS training in the general surgical program at Sefako Makgatho Health Sciences University (SMU).

Inguinal hernia repairs are among the most common surgeries worldwide, with laparoscopic techniques being increasingly popular due to benefits like reduced pain, faster recovery, and better cosmetic outcomes. This study evaluated the outcomes of laparoscopic inguinal hernia repairs performed by a single surgeon in private practice.

Time from diagnosis to operative care is a quality indicator in breast cancer (BCA) care. The recommended time from diagnosis to definitive treatment in South Africa (SA) is 31 days. The primary objective of this study was to determine the time to operative care (TOC) for BCA patients attending a multidisciplinary breast clinic at a tertiary hospital in Cape Town, SA.

Penetrating neck injuries account for a significant trauma burden on the provincial healthcare system. Penetrating neck trauma ranges from obvious aerodigestive and/or vascular injuries with unstable physiology, to stable patients with subtle injuries which may cause morbid complications in the future if overlooked. The majority of the hospitals in the province have major inadequacies in terms of radiology staff and equipment, leading to a significant burden on Inkosi Albert Luthuli Central Hospital (IALCH).

Different disease entities that cause gastrointestinal (GI) obstruction have been studied in isolation; however, no description of GI obstruction in neonates and infants in South Africa could be identified. This study aims to describe the profile of GI obstruction in neonates and infants at Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2016 to December 2019.

I read with interest the survey by Nel et al. "Procedures most frequently performed by South African-trained general surgeons - implications for training and assessment". I am heartened to see the long overdue move towards workbased assessment (WBA) and procedural competency as key elements of the assessment of fitness to practise as a consultant surgeon. The survey of recently trained surgeons found that 49% of the respondents felt unprepared to undertake one or more of the 10 procedures they most frequently perform. Of these, the procedure they felt most untrained to perform was colonoscopy. Even more revealing is that those who had gone directly into private practice had a 100% expectation that they should be able to perform colonoscopy.

Hydatid disease is a zoonotic parasitic infection caused by and is not uncommonly encountered in South Africa, especially in certain endemic areas. It generally affects the liver and lungs, with primary isolated peritoneal involvement being extremely rare. We report the case of a 14-year-old female with an isolated peritoneal hydatid cyst, initially thought to be a simple ovarian cyst, with no apparent hepatic or pulmonary involvement. This case highlights the potential consideration of hydatid disease in the differential of peritoneal cystic masses, even in the absence of hepatic or pulmonary involvement, especially in patients from endemic regions.

The surgical benefits of preoperative low- or very low-calorie diets (LCDs or VLCDs) in bariatric surgery patients have been widely studied. This study aimed to observe the changes in body composition and left hepatic lobe volume (LHLV) following a two-week dietitian-led calorie-restricted diet in non-bariatric laparoscopic surgery patients, where fatty liver often complicates the surgery.

Tube thoracostomy (TT) is the standard treatment for haemothorax, but 5-30% of cases may result in retained haemothorax. Video-assisted thoracoscopy surgery (VATS) is a recognised treatment for retained haemothorax, although its timing and feasibility can be challenging in resource-limited settings with restricted theatre access. The objective was to evaluate and describe our experience with VATS at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa.

Testicular torsion (TT) is the most important cause of acute scrotum in children, which can lead to testicular loss and requires emergency surgery. Fibrotic bands around the epididymis/spermatic cord that can cause severe testicular ischemia are extremely rare. The origin of these bands is unknown. Although scrotal colour doppler ultrasonography (CDUS) has an important place in the diagnosis of TT, it may be insufficient in the diagnosis of the bands. We aimed to present two rare cases in which a band was detected surrounding the distal spermatic cord and causing testicular ischemia in patients who had no previous scrotal pathology and emergency surgery was performed considering TT.

There is a paucity of epidemiological colorectal adenocarcinoma data in sub-Saharan Africa. This deficiency coupled with the rising trends of colorectal cancer (CRC) incidence and mortality necessitated the need for an epidemiological colorectal adenocarcinoma study to be conducted in the South African setting.

We report an unusual case of complete bowel obstruction as a result of an intramural haematoma (IMH) in the ascending colon, resulting from blunt abdominal trauma. The patient presented with acute abdominal pain, nausea and vomiting, preceded by four days of constipation, obstipation and worsening abdominal distention. Symptoms were preceded by a history of sustaining a kick to the abdomen during an altercation. Explorative laparotomy was performed, revealing an obstructing ascending colon mass, where a right hemicolectomy and primary anastomosis was performed. Histology confirmed the mass to be an IMH.

Obesity complicates clinical evaluations of acute abdominal conditions like appendicitis, with excess fat limiting the accuracy of physical examinations and delaying diagnosis. This report presents a case of a 49-year-old morbidly obese female with uncontrolled diabetes who developed acute peritonitis secondary to retrocaecal appendicitis, which presented as retroperitoneal necrotising fasciitis (NF). Diagnostic delays were attributed to atypical clinical signs and limitations of ultrasound in obese patients. A computed tomography (CT) scan eventually revealed extensive retroperitoneal fluid collections, confirming the diagnosis. Surgical intervention, including appendicectomy, drainage, and debridement, was complicated by septic shock, requiring intensive care. This case highlights the diagnostic complexity of NF in high-risk patients, emphasising the role of advanced imaging modalities and diagnostic scoring systems. Improved diagnostic strategies and early imaging are crucial for managing life-threatening conditions in obese populations.

We present a case of a female patient with solitary fibrous tumour (SFT) originating in the parapharyngeal space which was successfully resected using an open transoral approach. The patient presented with a worsening airway obstruction, obstructive sleep apnoea, and dysphagia for three years. Rhinolaryngoscopy revealed a right nasopharynx and oropharynx lateral pharyngeal wall submucosal mass. Histopathological analysis was consistent with an SFT. This uncommon site of a rare tumour often presents diagnostic challenges or leads to overt misdiagnosis. We interrogated the literature in respect of the diagnostic and therapeutic approaches for this rare condition.

I would like to thank the president of the SRS and the committee for inviting me to present the annual DJ du Plessis lecture. It remains a great honour and is undoubtedly one of the highlights of a career in South African academic surgery. I have entitled my lecture "Reflections on surgical leadership". I would like to remind us all about DJ du Plessis. As time progresses the number of people in the audience who actually knew the man grows fewer and memories dim. Fortunately, there are many fine anecdotes and character sketches of Professor du Plessis which have been recorded in journals and history books. He took over a relatively new department at Wits, in 1958, which had just become embroiled in a rather unpleasant academic scandal.

Chemical burns worldwide are caused by highly concentrated acidic and alkaline substances being placed onto exposed skin surface with resultant tissue injury. These chemical substances have high toxicity and deep tissue penetrability causing significant morbidity and mortality to patients. This study describes the epidemiology and mortality of acid-related burn injuries to improve patient assessment and management strategies.

We thank Professor Thomson for his highly insightful letter to our manuscript "Procedures most frequently performed by South African-trained general surgeons - implications for training and assessment" and the opportunity it creates to further discuss this important issue. Our data shows that colonoscopy is an important procedure for general surgeons to learn and to perform competently, considering the real-life practices and expectation of general surgeons in the current healthcare system. The data also suggests that there may be enough supervised colonoscopies during training to allow for reliable workplace-based assessment of trainees' competence in performing the procedure. However, it does not tell us whether enough cases are done during training to actually achieve competence.

Minimally invasive surgery has transformed surgery. Video-assisted thoracoscopic surgery (VATS) has been used for a few specific acute indications, however there is a paucity of data describing the management of intrathoracic foreign body removal compared to open thoracotomy.

Wilkie's syndrome, also known as superior mesenteric artery (SMA) syndrome, is a rare condition characterised by the compression of the third portion of the duodenum between the abdominal aorta and the overlying SMA. Due to its rarity, the exact number of documented case reports is limited. As of recent literature, approximately 500 cases have been reported worldwide with a reported incidence of 0.013-0.3%.

This report describes a rare case of a gastric trichobezoar complicated by gastric perforation in a 14-year-old female. The patient presented with severe abdominal pain and vomiting. Computer tomography (CT) scan showed a pneumoperitoneum with a large trichobezoar in the stomach and free intra-abdominal fluid. The patient underwent an emergency laparotomy, where a perforation on the lesser curve of the stomach was detected and a large trichobezoar that was occupying the entire stomach was removed. Histology confirmed a benign gastric ulcer most likely resulting from pressure necrosis due to the bezoar.

A 55-year-old female presented with a 6-year history of a scalp mass. Clinical assessment revealed a non-toxic right thyroid nodule and 18 x 17 cm scalp mass with facial varicosities (Figure 1). A skull X-ray (Figure 2a) and brain computerised tomography (CT) scan (Figure 2b) revealed extensive erosion of the parieto-occipital bones and a lobulated mass extending within the right parietal lobe. Ultrasoundguided core biopsy of the scalp mass confirmed the clinical suspicion of metastatic follicular thyroid carcinoma. A staging CT scan demonstrated lung metastases, but no other bone metastases.