Speciality in General Surgery

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    CLINICAL PATTERN AND EARLY SURGICAL OUTCOMES OF INGUINAL HERNIA REPAIR IN ADULTS ADMITTED TO SURGICAL WARDS AT ASELLA TEACHING AND REFERRAL HOSPITAL, ASELLA, ETHIOPIA
    (2025-05-01) Bedru Mohammed
    ABSTRACT Background: Inguinal hernia is one of the most common general surgical conditions worldwide. In low- and middle-income countries, delayed presentation and limited access to elective surgical care contribute to a higher burden of complicated hernias and poorer postoperative outcomes. In Ethiopia, there is limited evidence regarding the clinical pattern and early surgical outcomes of inguinal hernia repair. Objective: To assess the clinical pattern and early surgical outcomes of inguinal hernia repair among adult patients at Asella Teaching and Referral Hospital, Ethiopia. Methods: An institutional-based cross-sectional study was conducted from July 2022 to July 2025 among adult patients who underwent inguinal hernia repair. Patient charts were retrieved using medical record numbers from operation theater logbooks and surgical ward admission registers. Data were entered into Kobo Toolbox, then coded, cleaned, and exported to the latest version of SPSS for analysis. Bivariate analysis was performed to assess associations between independent variables and postoperative outcomes. Variables with a p-value ≤ 0.25 in the bivariate analysis were entered into a multivariable logistic regression model. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (CIs) were calculated, and variables with a p-value ≤ 0.05 were considered statistically significant. Results: A total of 114 patient records were analyzed. Most patients were male (73.7%), with a median age of 47 years. The majority of hernias were primary (91.2%), and indirect (75.4). Elective repairs accounted for 88.6% of cases, while 11.4% were emergencies. Tissue repair techniques predominated, with Desarda repair performed in 68.4% of patients. Postoperative complications occurred in 16.7% of cases, with surgical site infection being the most common (4.3%). On multivariable analysis, emergency presentation (AOR = 11.9; p = 0.001) and comorbidities (AOR = 10.6; p < 0.001) were independent predictors of adverse postoperative outcomes. Conclusion: Early postoperative outcomes were generally acceptable. However, emergency presentation and comorbid conditions significantly increased the risk of complications. Optimizing comorbidities and strengthening elective surgical services may improve outcomes in our settings. Keywords: Inguinal hernia; clinical pattern; early surgical outcomes; hernia repair; Ethiopia.
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    Treatment Outcome and Its Associated Factors among Patients Admitted with Necrotizing Soft Tissue Infection to Surgery Ward of Asella Referral and Teaching Hospital, Southeast Ethiopia
    (2025-05-01) Gudeta Zewde
    Abstract Background: Necrotizing soft tissue infections are rapidly progressive, life-threatening surgical emergencies involving the fascia and subcutaneous tissues. They occur more commonly in males and are strongly associated with diabetes mellitus, immunodeficiency, obesity, malnutrition and other chronic illnesses. Despite advances in care, these infections carry high morbidity and mortality globally approaching 14–29% due to aggressive disease course. In Ethiopia, Necrotizing soft tissue infections are relatively common, especially in rural areas but data on their risk factors and outcomes remain scarce. Objective: To assess the treatment outcome and its associated factors among patients admitted to surgery ward with necrotizing soft tissue infection at Asella Referral and Teaching Hospital from January 2020 – July 2025. Methods: Institutional based cross sectional study was conducted among patients admitted with necrotizing soft tissue infection from January 2020 – July 2025. Data was extracted from patients’ medical record and registries using data extraction tools and entered in to Kobo-Toolbox then exported to SPSS Version 27 for analysis. All eligible cases that meet the inclusion criteria are included in the study during the study period. Descriptive statistics are used to describe the study variables. Bivariable logistic regression analysis is conducted to explore the crude association between each independent and dependent variable. Variables with P-value < 0.25 in the bivariable analysis are included in the multivariable logistic regression model to control for potential confounders and identify factors independently associated with treatment outcome. Adjusted odds ratio with its 95% CI at P-value <0.05 are used to report statistically significant association. Result: Out of 118 admitted patients, 96 patients fulfilled the inclusion criteria and were analyzed. Majority were males (67.7%) and rural residents (69.8%). Overall mortality was 17.7%. Nine variables were selected for inclusion in the multivariable logistic regression model. In the multivariable logistic regression analysis, abdominal site of infection involvement (AOR = 15.42; 95% CI: 1.46–162.61; p = 0.023), presence of shock (AOR = 24.57; 95% CI: 2.59–233.48; p =0.005), and acute kidney injury (AOR = 12.67; 95% CI: 1.58–101.57; p=0.017) were independently associated with poor treatment outcomes. Conclusion: The presence of septic shock at presentation and acute kidney injury significantly worsen treatment outcomes of necrotizing soft tissue infection. Early identification and referral with aggressive surgical intervention and intensive supportive care particularly for patients with abdominal involvement, shock and acute kidney injury are essential to improve treatment outcomes. Key words-Necrotizing soft tissue infection, Anemia, Acute kidney injury, Shock, Diabetes Mellitus
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    Fistula Formation and Associated Factors among Adult Patients Underwent Surgery for Perianal Abscess at Asella Teaching and Referral Hospital, Southeast Ethiopia
    (2025-05-01) Temesgen Dechassa
    Abstract Background: Fistula-in-ano is a frequent complication after surgical drainage of perianal abscess, occurring in approximately one-third to half of patients. It develops due to ongoing infection and epithelialization of the abscess tract, leading to chronic morbidity and the need for repeated surgical procedures. Identifying factors associated with fistula formation is important for improving treatment outcomes and minimizing complications. Objectives: To assess rate of Fistula formation and associated factors Among adult Patients Underwent Surgery for Perianal Abscess at Asella Teaching and Referral Hospital, Southeast Ethiopia. Methods: A retrospective cross-sectional study was conducted for patients admitted and operated with diagnosis perianal abscess at General Surgery ward from February 2020 to February 2025. Data were extracted from medical records using a structured questionnaire, entered into Kobo-Toolbox, and analyzed with SPSS v27. Simple random sampling was used to select charts. Descriptive statistics and bivariable and multivariable logistic regression were used to identify factors associated with treatment outcomes, reported as AORs with 95% CI and p<0.05. Results: A total of 120 patients with perianal abscess were included in the study,of whom the majority were young adult males and rural residents. Subcutaneous abscess was the most common type, and the overall rate of fistula formation was 33.3%. On multivariable logistic regression, duration of illness greater than 48 hours (AOR = 3.36; 95% CI: 1.20–9.36; p = 0.021) and diabetes mellitus (AOR = 16.93; 95% CI: 1.41–203.43; p = 0.026) were independently associated with increased risk of fistula formation. Conclusion: Delayed presentation and diabetes mellitus are independent predictors of fistula formation among patients with perianal abscess. Early intervention and careful management of diabetic patients are essential to reduce the risk of this complication. Keywords: Perianal abscess, Fistula in ano, Diabetes mellitus, Duration of illness, Ethiopia
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    Tube Thoracostomy Outcomes and Associated Factors among Patients Treated for Chest Injuries in Asella Referral Teaching Hospital, Asella, Ethiopia
    (2025-05-01) Abdi Lemma
    ABSTRACT Background: Chest trauma remains a leading cause of global morbidity, with tube thoracostomy serving as the definitive intervention for most thoracic injuries. In resource-limited settings, identifying clinical and procedural predictors is essential for optimizing surgical outcomes and reducing preventable morbidity. Objective: This study aimed to evaluate the clinical outcomes of tube thoracostomy and identify independent predictors of prognosis among chest trauma patients at Asella Referral Teaching Hospital. Methods: A hospital-based cross-sectional study was conducted, reviewing the medical records of patients treated with tube thoracostomy for chest injuries between 2020 and 2024. Data were analyzed using SPSS Version 26.0. Initially, the statistical analysis included bivariate screening for variables having p-value < 0.25, followed by multivariable logistic regression to isolate independent variables associated with patient outcomes. Association between variables was taken as statistically significant for the variables resulted in p-value <0.05 on multivariate logistic regression. Results: A total of 171 patients were reviewed, with a strong male predominance (80.7%) and a mean age of 42.93 years (SD=16.27). Blunt trauma was the leading mechanism of injury (81.9%). While the majority of patients (91.2%) achieved a "good" clinical outcome, the overall complication rate was 24%, primarily driven by retained hemothorax (7.9%). Multivariable analysis identified post-procedural complications (AOR = 48.9, 95% CI [5.3-455.6], p=0.001) and tube insertion performed at bedside in Emergency room (AOR=41.7, 95%CI (2.4-718.9), p=0.010), as the two most significant independent predictors of a bad outcome. Conclusion and Recommendation: Although most patients achieved favorable outcomes, prognosis is heavily influenced by the setting of the procedure and the occurrence of preventable complications. Clinical focus must prioritize standardized procedural environments and early, adequate pleural space evacuation to mitigate risks. Keywords: Tube Thoracostomy, Chest Tube, Trauma, Complications, Outcomes, Ethiopia.
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    Patter of Major Limb Amputation and Its Associated Factors among Orthopedic Patients at Asella Teaching and Referral Hospital, South East Ethiopia
    (2025-05-01) Kemal Tuke
    ABSTRACT Introduction: Amputation is a surgical procedure for the removal of a limb which is indicated when limb recovery is impossible. Major limb amputation is reported to be a major preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family. Knowledge on the pattern of major limb amputation and its associated factors are scarce in Ethiopia and absent in local area. So this study strives to fill this research gap. Objectives: To assess patterns of major limb amputation and its associated factors among orthopedic patients in Asella Teaching and Referral Hospital, Southeast Ethiopia Methods: Institutional based cross-sectional study had been conducted to review major limb amputation performed from February, 2020 to September, 2025. Data were collected from patients chart by using kobo toolbox. Then the data were exported to SPSS version 31 for statistical analysis. Bivariable and multivariable logistic regression analyses were performed to analyze factors associated with major limb amputation by considering a statistical significance level of 5%, and 95% confidence interval (CI). Results: A total of 118 patients with major limb amputation, dichotomized into lower limb and upper limb were included in the study. The majority were lower limb amputations (79.7%) from which above knee amputation was relatively the most frequently done. Factor associated with lower limb amputation analyzed by taking patients with upper limb amputation as target group. In the analysis age [AOR = 5.99; 95% CI: 1.101, 32.580], male sex [AOR = 23.11; 95% CI: 2.771, 192.638], diabetic foot ulcer [AOR = 5.066; 95% CI: 1.041, 26.855] and PVD [AOR= 20.883; 95% CI: 4.626, 94.265] showed a significant association with major lower limb amputation. Conclusions and Recommendations: In the current study lower limb amputation is the most common type. Peripheral vascular disease and diabetic foot ulcer are among factors which showed significant association with lower limb amputation. Effective prevention strategies on complications associated with diabetes mellitus i.e. diabetic foot ulcer, peripheral vascular disease and robust research efforts are critical to minimize limb amputation and its complications. Key words: Amputation, major limb amputation