Martin Brand

Workplace-based assessment (WBA) is being introduced across postgraduate training in South Africa. This study was undertaken to inform the selection of the core procedures for WBA, by determining the most frequently performed procedures in general surgery practice. These findings may also assist academic centres undertaking curriculum review to determine whether or not they are training surgeons who are competent to meet the current local needs of society. This study was a cross-sectional observational study using a self-administered survey. General surgeons who passed the final fellowship examinations of the College of Surgeons of South Africa between 2017-2022, working in fulltime specialist practice, were eligible for participation. The study included 111 surgeons of which the majority (53%) were working full time in government practice, 23% were in private practice and 24% were in a combination of both government and private practice. The 10 most frequently listed procedures were - hernia repair (95%), appendicectomy (91%), emergency laparotomy (88%), laparoscopic cholecystectomy (80%), gastroscopy (80%), colonoscopy (61%), colectomy (55%), lower limb amputation (48%), mastectomy (40%) and intestinal stoma formation (31%). Fifty-seven (51%) participants reported that they felt prepared to independently perform the full range of most frequently listed procedures. Of the 49% who reported feeling unprepared for one or more procedures on completion of training, the most frequently listed procedure was colonoscopy. This study identified a list of procedures that may be considered as core procedural activities for WBA of South African general surgery trainees.

Background: Approximately 25% of patients with colorectal cancer (CRC) will be diagnosed with CRC liver metastases (CRCLM) during the course of their disease. No data regarding CRCLM presentation, management and survival outcomeshas been published from either the private or public health care sectors in South Africa. This study aimed to address this deficit, reporting on a private sector cohort. Methods: A retrospective review of a private health care funder's database from 1 January 2008 to 31 December 2015 was performed. ICD-10 diagnosis codes were used to identify CRC and CRCLM. Procedure codes assigned to hospital admissions were used to identify the type of surgical treatment. Chemotherapy was identified by the WHO Anatomical Therapeutic Chemical classification system of medicines. Treatment patterns were assessed and five-year overall survival(OS) was calculated. Survival was estimated using the Kaplan-Meier method, and Cox proportional-hazards regression was used for between group survival comparisons. Results: Six hundred and one (601) of 3 412 patients presenting with CRC (17.6%) were diagnosed with CRCLM at presentation or during the follow-up period. Sixty patients with CRCLM (10.0%) underwent resection of the primary CRC and liver resection for metastases, 281 (46.8%) underwent CRC resection only, 180 (30%) received chemotherapy only, and 47 (7.8%) received no treatment. Five-year OS for these groups were 57.3%, 15.6%, 9.8% and 0% respectively. Conclusion: Five-year OS of the various CRCLM treatment pathways in a South African private sector population compares to results published in international series. However, a smaller proportion of patients with CRCLM underwent liver resection, compared to international studies.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of any type of selective shunt versus any type of non‐selective shunt for the prevention of oesophagogastric variceal rebleeding in people with portal hypertension.