Surgery
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Item Outcomes of open vs closed reduction with percutaneous pinning of completely displaced pediatric supracondylar fracture of humerus at Tikur Anbessa Specialized Hospital, a four-year retrospective study(Addis Ababa Uinverstiy, 2025) Tefera Belay; Birhanu Ayana; Bahiru Bezabih; Samrawit EsayasBackground: Displaced supracondylar humerus fractures (SCHF) are common pediatric injuries. While Closed Reduction and Percutaneous Pinning (CRPP) is the first line treatment, Open Reduction and Percutaneous Pinning (ORPP) is required when closed reduction fails, and when intraoperative fluoroscopic imaging is not available. The comparative functional and cosmetic outcomes of these techniques within our context is not known, leading to variation in perception of surgical practice. Objective: To compare functional and cosmetic outcomes between CRPP and ORPP for displaced SCHF (Gartland types III and IV) in children at TASH. Methods: A retrospective cohort study will be conducted, reviewing medical records of all eligible children (<16 years) treated with CRPP or ORPP for displaced SCHF at TASH between May 1, 2021, and April 30, 2025. Data on patient demographics, fracture characteristics, and operative details will be collected. Functional and cosmetic outcomes will be assessed using Flynn criteria. Complications including nerve palsy, infection, and malunion will be recorded. Statistical analysis using SPSS version 27 (t-tests, chi-square, regression) will be performed to compare outcomes between the two groups. Expected Outcomes: the study will provide crucial, localized evidence on the functional and cosmetic outcomes, and specific complications associated with CRPP and ORPP. The finding is expected to inform the development of an evidence based treatment protocol for displaced pediatric SCHF at TASH, aiming to optimize surgical decision making, improve patient outcomes and guide resource allocation.Item Knowledge, Attitude, and Practice of Nurses on the Use of Glutaraldehyde in Urology Departments at Three Hospitals, Addis Ababa, Ethiopia(Addis Ababa University, 2025-12-08) Tsiyon Nigusie; Messay Mekonnen; Habtamu AderawBackground: Glutaraldehyde is a widely used high-level disinfectant for reprocessing heat-sensitive urological instruments such as endoscopes. Although effective when used properly, improper handling or inadequate knowledge of reprocessing protocols can expose patients to healthcare-associated infections and staff to chemical hazards. Despite its widespread use in Ethiopian hospitals, there is limited data on nurses’ knowledge, attitude, and practice regarding glutaraldehyde use in urology departments. Objective: To assess the knowledge, attitude, and practice of nurses on the safe and effective use of glutaraldehyde for urological instrument reprocessing in three tertiary hospitals in Addis Ababa—Tikur Anbessa Specialized Hospital, Yekatit 12 Hospital Medical College, and Minilik II Comprehensive Specialized Hospital. Methods: A cross-sectional study conducted from September 1–30, 2025, by including all nurses working in the urology departments of the three hospitals. Data collected using a structured, self-administered questionnaire covering sociodemographic information, knowledge, attitude, and practice components. A descriptive analysis was used to report the percentages and frequencies. The mean knowledge, attitude, and practice scores were analyzed using an Independent t-test, ANOVA, and Pearson’s correlation tests. Results: A total of 42 urology department nurses participated in the survey. Half of the nurses exhibited average knowledge and only a minority (14.3%) had adequate knowledge.78.6% of nurses demonstrated a strong Positive Attitude toward safety. However, this attitude did not translate into safe practice, as 46.3% of participants demonstrated Inadequate Practice, and only 2.4% achieved an Adequate Practice score. A significant finding was the perceived lack of institutional support: 58.5% strongly disagreed that their workplace provides sufficient Personal Protective Equipment (PPE) and training. Significant difference in the mean overall kAP score is found across the nurses highest professional qualification (p=0.036) and status of nurses on receiving formal training on glutaraldehyde use (p=0.007). Additionally, a significant positive correlation between knowledge-attitude (r=0.238, p0.05), and attitude-practice (r=0.02, p>0.05) was observed. Conclusion: Despite a generally positive attitude and a portion of nurses achieving adequate knowledge, the concerning finding of inadequate practice and the strong perception of lack of resource, adequate training and written, facility-specific standard operating procedures brings a critical challenge. Urgent, interventions are needed to prevent patient infection risk and bring occupational health.Item Patterns of Associated Cardiac and Renal anomalies in Anorectal Malformation/ARM/ Patients seen at Black Line Hospital, Addis Ababa Ethiopia, November 2024 - October 2025.(Addia Ababa University, 2025-10-12) Yidnekachew Getachew; Miliard DerbewBackground: Anorectal malformations (ARM) encompass a broad spectrum of congenital anomalies affecting the distal gastrointestinal tracts like anus and rectum as well as urinary tract, and genital tract in both boys and girls. These anomalies range from minor, easily managed cases with excellent functional outcomes to complex cases that are challenging to treat, often associated with other anomalies, and have poor functional prognoses. Approximately 50% of ARM cases present with additional defects or are part of a syndrome. Methods: This study was employed as an institution-based prospective cohort design. It involves direct physical examination and by reviewing medical records of cases seen or managed at Black Lion Specialized Hospital between November 2024 and October 2025. The source population was included all children admitted during this period. The study population consist of children diagnosed with ARM. Result A total of 59 children diagnosed with anorectal malformation (ARM) were admitted to Black Lion Specialized Hospital during the study period. Of these, 35 (59.3%) were male and 24 (40.7%) were female. The age at presentation varied: 21 children (35.6%) presented within the first 24 hours of life, while the oldest patient was a 10-year-old boy with ARM and rectoperineal fistula. Regarding the types of ARM, the most common in males were rectoperineal fistula (n=12, 34.3%) and ARM without fistula (n=11, 31.4%). In females, rectovaginal fistula was the most frequent (n=13, 54.2%), followed by persistent cloaca (n=5, 20.8%). Associated congenital anomalies were common. Cardiac anomalies were present in 29 patients (49.2%), with atrial septal defect (ASD) and patent ductus arteriosus (PDA) being the most common structural heart defects. Renal anomalies were detected in 12 patients (20.3%), predominantly hydronephrosis and renal ectopia. Conclusion and recommendation: A substantial proportion of children with anorectal malformation (ARM) presented to the hospital beyond 72 hours of life, underscoring the persistent need for enhanced awareness, clear communication, training, and logistical support to primary healthcare facilities and community health workers to promote early detection, prompt referral, and timely definitive management. Additionally, this study revealed that a significant number of patients, particularly males, had ARM without an overt fistula to the urinary tract (no visible fistulous communication). Consequently, a distal colostogram should be routinely performed in all cases as a fundamental diagnostic tool to precisely define the distal rectal anatomy, confirm the level of rectal atresia, identify possible occult fistulas, and guide the optimal surgical approach during definitive corrective surgery. Also MRI can be used in selected cases to see the exact location of the rectum, identify fistulas, visualize pelvic muscles and sacral bone structures, and find associated anomalies guiding precise surgical repair for better functional outcomes.Item Prevalence of Musculoskeletal Complications among Hemophilia Patients as Seen inTikur Anbessa Specialized Hospital.(Addis Ababa Uinverstiy, 2025) Bizuayehu Amanu; Binyam DagmawBackground: Hemophilia is an X‑linked bleeding disorder caused by deficiency of factor VIII (Hemophilia A) or factor IX (Hemophilia B). Repeated bleeding into joints and muscles leads to musculoskeletal complications, accounting for 70–80% of hemorrhagic episodes. There is no local data showing musculoskeletal complications in Ethiopia. Methods: A descriptive cross‑sectional study was conducted among 149 male hemophilia patients attending Tikur Anbessa Specialized Hospital. Data were collected through structured interviews, physical examination, and review of hematology clinic records and recorded using Cobo toolbox. Statistical analysis was performed using Statisty application, with p < 0.05 considered significant. Results: Musculoskeletal complications were identified in 83.9% of patients, including hematomas (91.3%), pseudotumor (9.4%), muscle atrophy (36.2%), joint swelling (65.1%), loss of range of motion (57.0%) and joint instability (16.8%). Pain was reported by 79.9%, most commonly in the knees (80.7%), followed by elbows (34.5%) and ankles (22.7%). Statistical analysis revealed significant associations between factor level ( p< 0 .01) and treatment modality ( p<0.001) with musculoskeletal complications, while age of the patient, age at diagnosis of hemophilia, and hemophilia type were not statistically significant. Conclusion: Most of patients (83.9%) have musculoskeletal complications among hemophilia patients in Tikur Anbessa Specialized Hospital, with knees disproportionately affected. The treatment modality (p < 0.001) and factor level(p < 0.01) are significantly associated with musculoskeletal complications among hemophilia patients.Item Enhanced Recovery After Surgery Protocol as Innovative Solution for Improving Surgical Patients’ Outcome in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.(Addis Ababa University, 2025-04-19) Peniel Kenna; Girmay Medhin; Abebaw Fekadu; Tihitena NegussieIntroduction: Close to a third of the global disease burden is accounted for by surgical conditions. The 76th World Health Assembly Agenda item 13.1 highlighted urgent actions needed to enhance surgical care. With 18-25% postoperative complication rate, application of the Enhanced Recovery After Surgery (ERAS) protocol is advised. The aim of this study was to assess the effectiveness of the ERAS protocol in improving short-term and intermediate surgical patient outcomes in Low- and Middle- Income Countries (LMICs). Methodology: We conducted systematic review and meta-analysis and the protocol was registered in the PROSPERO database (CRD42024524807). A systematic search for observational studies and clinical trials was conducted in PubMed, Scopus, Cochrane, and Web of Sciences along with online trial registries and Google Scholar. Search strategy includes keywords related to “Enhanced Recovery After Surgery”, “ERAS”, “Fast-Track Surgery”, “LMICs”, and names of LMICs. Reference sections of the included studies were manually searched. Risk of bias of included studies were assessed using Cochrane risk of bias and Newcastle-Ottawa scale. Results: A total of 1332 studies were initially identified and after removing duplicates, 1243 studies remained, with 56 papers eligible for full-text review. Eight studies were identified from reference section and were added to evidence synthesis. Thirty-five studies, 23 clinical trials and 12 observational studies were included for review and 33 studies were included for meta-analysis. Eighty-four percent of the publications were from south and southeast Asia. Comparable number of participants were distributed in the intervention (3,163) and control (3,243) groups. The studies comprised mostly abdominal surgeries (n=17). Each study compared ERAS protocols with routine perioperative care. Meta-analysis indicated significant reduction of postoperative morbidity following the implementation of the ERAS protocol [(RR=0.73; 95%CI, 0.55 to 0.76) with (I^2) of 1.1% (P-value of 0.44)]. Also, significant reduction in postoperative length of hospital stay was observed when ERAS protocol was implemented [(SMD= -0.67 [95%CI -0.54 to -0.82]) with I^2 = 76.8]. There was no significant difference in postoperative mortality and readmission rate. Conclusion: Improved patient outcomes related to reduced postoperative complication rate and length of hospital stay were observed with ERAS application. The ERAS protocol appears promising in LMICs for enhancing surgical patient outcomes; Hence, we recommend its application. Although there could be ERAS implementation cost, its role in expediting patient recovery could reduce costs related to hospitalization.Item Thirty Days Posoperative Outcome After Radical Cystectomy and Associated Factors at TASH, Ethiopia.(Addis Ababa University, 2025-07) Woretaw, Anmut; Bekele, Seyefe (Ass.Prof.); Melaku, Admasu (Ass.Prof.)Background: radical cystectomy is one of the complex and technically demanding urologic surgeries. It is done usually for non-metastatic muscle invasive bladder cancer. Globally the morbidity and mortality rate is significantly high, even the advancement of operative techniques doesn’t change the outcome significantly. And, the outcome of RC is not well studied in Ethiopia including in the study area. Objectives: The objective of this study was to assess the thirty days postoperative outcome of open radical cystectomy and associated factors among patients who were operated at Tikur Anbesa Specialized Hospital. Method: Institution based cross sectional retrospective study was conducted on consequently selected patients who were operated in Tikur Anbesa Specialized Hospital from September 2020 to May 2025. Data was collected using Kobotoolbox from the patients’ medical records. Then exported to Excel and exported to SPSS version 25 after cleaned. Subsequently descriptive analysis and binary logistic regression was done. Association between independent and outcome variables studied using multivariable logistic regression. Variable with p –value <0.05 was used to declare the level of significance. Result: A total of 35 cases were analyzed the average age was 55.54 years. Male sex accounts for 74.3%. ONB was done in 25.7% whereas the rest was IC. 45.7% of the operated patients were with smooth post-operative course others developed minor and major complications. Pre and post-operative biopsy showed 32 cases were urothelial cancer whereas 3 cases were non-urothelial cancer.in 22 cases post-operative biopsy was found and marginal status define. Of these 22 cases 68.2% was margin positive. There were about 4 deaths early post operatively due to surgical causes. Multivariable regression analysis showed serum albumin level <3g/dl was associated with post-operative complication with p-value of 0.019 and adjusted odds ratio of 14.54. Conclusion: The 30 day mortality and morbidity rate were 11.4% and 54.3% respectively. Serum albumin <3g/dl was associated with post-operative complication.Item Analysis of clinical presentation of prostatic cancer patients at TASH: Two-year retrospective cross-sectional study(Addis Ababa University, 2025-07) Muluneh,Sewunet; Melaku,Admassu(Ass.Prof.)INTRODUCTION: Prostate cancer is second most diagnosed cancer exceeded by lung cancer only across globe and it is fifth leading cause of cancer associated mortality. It is number one cause of cancer death in men in 48 countries which includes many countries in sub-Saharan Africa. In Ethiopia, it was the third most diagnosed cancer and eighth cause of cancer death in 2013 in both sexes. In Ethiopia, in 2019 and 2020, it was second leading cancer in incidence in males with reported new cases of 2,570 & 2,720 respectively. OBJECTIVE: The study describes clinical presentation of prostatic cancer patients seen at outpatient department of Urology unit of TASH from 31st December,2023 to 1st January ,2025 GC. METHODS: The study was two-year cross-sectional descriptive study on prostatic cancer patients seen at Urology unit of TASH, Addis Ababa, Ethiopia from 31st December, 2023 to 1st January, 2025 GC. The questionnaires were used extract data of study population from patients’ chart by data collectors to collect the necessary information and phone call was used to get additional information from patients. Data collected with kobo toolbox, entered to spreadsheet and analysed by SPSS version 26. The findings of the study were summarized with Descriptive statistics and results presented in the form of text, table, and chart. Pearson chi-square test, Bi variable and multi variable logistic regression analysis used to explore association between different variables. Significant associations were declared at P-value <0.05 on multi variable logistic regression analysis. Results: 98.4% of the patients were symptomatic at time of diagnosis with 97.7% having LUTS and 33. 9% having metastatic symptoms. 24.4% have locally advanced cancer and 34.2% have metastatic prostate cancer. The ISUP grade group 4 and 5 account for 97% of cases, PIRADS 4 and 5 account for 67.5% of cases and mean PSA at time of diagnosis was 285ng/ml. Conclusion: 98.4% of the patients were symptomatic at time of diagnosis. Majority of patients were diagnosed with advanced of stage prostate cancer with higher Gleason's score, higher PIRADS score and high PSA at time of diagnosis. On multimodal regression analysis, Gleason’s score has significant association with PIRADS score and digital rectal examination finding. TNM staging has significant association with residential area, educational status, presence of symptoms at presentation, PIRADS score and digital rectal examination in the study. Work plan and budget: The study was conducted from March, 2025 GC to May, 2025GC with total budget of 47,491.4 Ethiopian birr.Item Prevalence and Associated Risk Factors of Early Local Complications After Total Laryngectomy in Laryngeal Carcinoma Patients at Tikur Anbessa Hospital and Yekatit 12 Hospital Medical College: a Retrospective Study Over 5 Years.(Addis Ababa University, 2025-02) Zelalem, Welelew; Bogale, Mesele (Ass. Prof); Arusi, Mohammedsefa (Ass. Prof)Background: Laryngeal carcinoma is the most common site of malignancy in the head and neck worldwide. Total laryngectomy is the standard surgical treatment for management of locally advanced laryngeal and hypopharyngeal cancers. Complications after total laryngectomy have significant impact on morbidity and health care cost, leading to prolonged hospitalization, further operations, permanent sequelae, and sometimes a fatal outcome. Studies from various countries report that the prevalence of early postoperative complications after laryngectomy ranges from 9% to 25%. In Ethiopia, the prevalence and risk factors of early local complications in total laryngetomy patients is not yet studied. Objective: To determine the prevalence and associated factors of early local complications in laryngeal cancer patient who had total laryngectomy at Tikur Anbesa Hospital and Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2025. Methods: A retrospective study design was conducted to determine the magnitude of early local complication and associated risk factors in laryngeal cancer patients for whom total laryngectomy was done at Tikur Anbesa Hospital and Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia from January 1 to 30 2025. All patients with a diagnosis of laryngeal cancer for who total laryngectomy was done at Tikur Anbesa Hospital and Yekatit 12 Hospital Medical College from January 2019 to December 2024 were included. Data were collected using a structured checklist questionnaire by using Kobo tool box was imported to SPSS for analysis and interpretation. Descriptive statistics was used to describe baseline patient characteristics. To identify the independent effects of the factors logistic regression analysis was employed and those variables with a p value <0.05 was considered as a significant predictor factor for early local laryngectomy complications. Result: A total of 43 patients met the inclusion criteria and were enrolled in the study. The mean age 58.52 years (SD = 12.21, range: 30–82 years). There were 41 males and 2 females with a ratio of 21 to 1. All patients 100% presented with voice change. A large majority of patients 93.0% reported shortness of breath while throat pain/discomfort and stridor present in 88.4% percent of patients each and the least was neck swelling in 16.3 %. The majority of patients 83.7 % were diagnosed at TNM Stage IV with smaller proportion 16.3 % were at Stage III disease. Nodal stage of the disease shows 74.42% N0, 13.95%, N1 and 11.63 % N2. Only smaller proportion (4.7%) had partial pharyngectomy. Preoperative tracheostomy was done in 79.1% of patients. The most commonly used neopharynx maturation was the vertical method (41.9%). Pharyngocutaneous fistula was observed in 20.9% of cases. Wound infection, bleeding and hematoma, mortality rate, chyle leak reported in 34.9%, 11.6%, 4.7%and 2.3% of cases respectively. Conclusion: This study highlights that wound infection is the most prevalent postoperative complication following total laryngectomy, affecting nearly one-third of patients. Given the high prevalence of wound infections and pharyngocutaneous fistulas, enhanced perioperative care, strict infection control measures, and optimized surgical techniques are essential to improve patient outcomes. Further prospective studies are recommended to better understand the risk factors and develop targeted interventions to reduce postoperative complications in laryngeal cancer patients undergoing total laryngectomy in Ethiopia.Item Research done on patient and/or parent satisfaction among patients underwent hypospadias surgery at TASH and DMCSH; Three years cross sectional, prospective study; Ethiopia, 2022(Addis Ababa University, 2023) Misgea,Abdureuf; Temesgen,Fisseha(MD)Introduction Hypospadias is one of the most common congenital anomalies in boys, occurring in 1 in 150 to 300 live births (Elliott et al., 2011; Springer et al., 2015) followed by Down’s Syndrome, Cleft Lip and Spinal bifida. Surgeon perspective of outcome assessment is vital; but it will not be complete without patient input. In spite of what surgeons may determine a successful repair, parental and patient perception of their outcomes may differ (Lorenzo et al., 2014; Mureau et al., 1996). Longitudinal studies following hypospadias repair are still rare and the real impact in adolescence and adult life remains uncertain. This may be due to lack of condition specific validated patient-related outcome (PRO) measures and objective tools to evaluate young people and families The study was done determine the Parent reported outcome of hypospadias repair in our institution and to identify the effects of factors on post-operative PRO. Objective The objective of study was to assess patient and/or parent satisfaction among patients underwent hypospadias surgery for three years in TASH and DMCSH; 2022 Methodology The study was conducted in TASH and DMCSH for children with hypospadias operated during January, 2019 – December, 2021. Data was collected in four major stages as chart retrieval, address identification, phone communication and data analysis. The study design was hospital based cross sectional descriptive. Result and Discussion Potential variables identified for confound of association for post hypospadias surgery satisfaction includes age, location, type of hypospadias, type of first procedure, and total number of procedure. Bivariate and multinomial logistic regression was done with above variables showed that there is strong association of satisfaction level with localities from Addis Abeba (P=0.02, 95% CI) Our study revealed that locality or address, type of hypospadias, and repeated procedures all shares major contribution in reducing our patients and parents level of satisfaction after hypospadias surgery. We are also showed that it is possible to assess post-operative PRO and post-operative follow up by the use of mobile phones with consistency of operating team and strong network connection. Conclusion and Recommendation Parental and /or patient related outcome assessment and satisfaction level has paramount importance than surgeon oriented outcome assessment. We can use phone calls for post hypospadias surgery satisfaction assessment without much difficulty.Item The pattern of clinicopathologic presentation of gall bladder cancer patients managed at Tikur Anbessa specialized hospital from April 1, 2018, to March 31, 2023, Addis Ababa, Ethiopia: a retrospective cross-sectional study.(Addis Ababa University, 2023-06) Dagne,Andualem; Nigussie,Shimelis(Ass.Prof.)Background: Gallbladder cancer (GBC) is a rare tumor with a very poor prognosis. It is often incidentally found during routine cholecystectomy for gall stone or diagnosed at the advanced clinical stage at the time of presentation. In Ethiopia, no published data assessed the clinicopathologic presentation and the management approach of patients with gall bladder cancer. Objective: The main objective of this study was to assess the pattern of clinicopathologic presentation of gallbladder cancer patients managed at Tikur Anbessa Specialized Hospital from April 1, 2018, to March 31, 2023, in Addis Ababa, Ethiopia. Methods: Facility based retrospective cross-sectional study was conducted on the pattern of clinicopathologic presentation of gallbladder cancer patients managed at Tikur Anbessa Specialized Hospital from April 1, 2018, to March 31, 2023, in Addis Ababa, Ethiopia. Secondary data were extracted from patients’ clinical charts and recorded to a pre-tested checklist. Data was entered into epidata version 3.1 and exported to SPSS version 26 for descriptive analysis using frequency tables, mean, median and standard deviations. Result: During the study period a total 70 gallbladder cancer cases were studied. The mean age at presentation was 56.5 ± 12.2 years and most of the patients were females with a 1.9:1 F: M ratio. The Most (82.9%) common presenting feature was abdominal pain with a median duration of symptoms of 3months (IQR 5.7 months). About 12.8% of patients were found incidentally. Close to half (47.2%) of the patients were having metastasis, with liver involvement accounting for 63.6% and non-regional nodes for 30.3% of metastasis. The remaining 31.4% were resectable and 21.4% of patients were locally unresectable. GB mass lesion is the most frequent imaging feature while gallstones were detected in 50% of cases. Surgical exploration was performed in 35.7% of patients, the rest majority were managed with supportive care (35.7%) and palliative chemotherapy (18.6%). Adenocarcinoma was the commonest histologic type identified (94.4%). Conclusion: - The prevalence of concomitant gallstones in this study was low compared to other studies. Most of the patients were having either locally advanced or metastatic gall bladder cancer. It requires a high index of suspicion and appropriate imaging in middle age individuals and above who presented with persistent abdominal pain to diagnose gall bladder cancer at the early curative stageItem Perioperative outcomes and associated factors of patients with hepatic resection, in Central Ethiopia: a multicenter prospective cohort study.(Addis Ababa University, 2023-06) Dagne,Andualem; Abdurahman,Zeki(Ass.Prof.)Introduction: As a relatively recent experience practiced only in a few tertiary centers across Ethiopia, the perioperative outcome of patients with hepatic resection is barely known. The main objective of this study is to assess perioperative outcomes and associated factors among patients treated with hepatic resections from July 1, 2022 – June 30, 2023, at tertiary hospitals in Addis Ababa, Ethiopia. Methods: It is multi-center prospective cohort study. Data were collected regarding demographics, comorbidities, the extent of resection, intraoperative findings, perioperative morbidity, and mortality. Data was entered into epidata version 3.1 and exported to SPSS version 26 for descriptive analysis and statistical analyses using binary logistic regression. Result: A total of 76 patients underwent hepatic resection, there were 44 females and 32 males. One-third (32.9%) of these patients had underlying liver disease. The main indication was primary hepatic cancer in 65.8% with HCC in 55.3%. The majority (82.9%) of patients had anatomic-based hepatic resections. Major hepatectomy was performed in 34.2% of patients. The mean duration of surgery was 3.2±1.23 hr., the length of hospital stay was 6.04 ± 3.35 days while the median blood loss was 800ml (IQR 500-1000 ml), and 40.8% of the patients required transfusions. Overall 30- day mortality and morbidity were 3.9% and 32.9% respectively. Morbidity was higher in patients requiring blood transfusion (p=0.008) and malignant disease indications (p= 0.071) although not statistically significant. Conclusion: The perioperative morbidity and mortality of hepatic resection are consistent with the other published literatures. The requirement for blood transfusion and malignant disease indications were associated with higher morbidity.Item Peridictive Accuracy of Absent Color Flow on Doppler Ultrasound in the Operative Finding of Intussusception at Tikur Anbessa Specialized Hospital,Ethiopia(Addis Ababa University, 2023-10) Brhanu,Freselam; Gossaye,Abay(Ass.Prof.)Background: Intussusception is a common paediatric surgical emergency condition which has contributed a significant burden on morbidity, mortality, and emergency surgical health care. Despite ultrasound serving a great deal as an accurate tool in diagnosing intussusception, evidences on the diagnostic accuracy of absent colour flow with the intraoperative finding are limited. The aim of the study was to assess the diagnostic accuracy of absent flow on colour Doppler Ultrasound study with intraoperative findings of Intussusception Methods: Hospital based retrospective crossectional study was used. The medical record number of patients operated in the past 5 years, from September 2017-December 2022, with the preoperative diagnosis of intussusception, was traced and their charts were retrieved. The data was collected with standardised questionnaire. The data was cleaned, entered and analyzed using SPSS version 25. Diagnostic accuracy of absent color flow to predict gangrenous and viable bowel was measured using Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Uni-variate analysis was performed to test factors associated with gangrenous intussusception. A binary logistic regression mode was used to identify independent risk factors. Results of logistic regression reported as adjusted odds rations (OR) with 90% confidence intervals. Results: During this crossectional study, data from 121 patients were collected. The median age was 9 months (±IQR 9) with male predominance (70.2%). The most common complaints were vomiting (93.4%), non-bloody Diarrhea (78.5%), abdominal pain (89.3%), fever (29.7%), abdominal distension (14%) and, bloody diarrhea (8.3%). while the commonest physical findings were currant jelly stool detected at the time of DRE (62.8%), palpable abdominal mass (45.5%), abdominal distension (41.3%). Classic triads were present in 35.5% of the patients. The postoperative complication rate was 20.7% and mortality rate was 2.5%. Conclusion: In our setting Color Doppler US had Sensitivity of 46.8%, Specificity of 84.3%, PPV of 66.67% and NPV of 70.2% in predicting whether or not an intussuscepted bowel is gangrenous.Item Treatment Outcome of Hydrocephalus among patients with Dandy Walker Malformation managed with ETV at Zewditu Memorial Hospital, from January 2021- May 2023 Addis Ababa, Ethiopia.(Addis Ababa University, 2023-11) Hailu,Bereket; Zewdie,Kibruyisfaw( Ass.Prof.); Bizuneh,Yemisirach( Ass.Prof.)Background: Dandy-Walker complex (DWC) is a term coined to describe a continuum of posterior fossa anomalies categorizing spectrum of cystic malformation posterior fossa depending on extent of involvement and severity. DWS has been reported to occur in 1 of 25,000 to 30,000 newborns, with the majority of patients presenting in the first year most of them present with hydrocephalus (70–90%). There are different treatment modalities to treat hydrocephalus in Dandy-walker Malformation patients endoscopic Third ventriculostomy being one of them. In our country Ethiopia, ETV has also been applicable for the treatment of the hydrocephalus in those patients with DWM lately. Despite its applicability in the management of Hydrocephalus its outcome hasn’t been properly assessed. This research aims at assessing the treatment outcomes of ETV. Objectives: To assess the treatment outcomes of Hydrocephalus among patients with DWM who are treated with ETV at Zewditu Memorial Hospital. Methods: Retrospectively collected data in 33 children with confirmed Dandy-Walker Malformation patients who have undergone ETV was conducted at Zewditu Memorial Hospital from January 2021 to May 2023. The Data collected was analyzed using SPSS. Frequency distribution will be used to describe the characteristics of the patients. Data analysis was performed using chi-squared tests and survival analysis by Kaplan-Meier tests to assess the treatment outcomes and survival probability. Result: The median age at surgery was 7 months and 84.7% of the patients were less than 1 year. There was slight Male predominance than females 1.75:1. ETV was successfully done in 22(66.7%) of the patients with improvement in their initial presenting clinical sign & symptoms. The 6-month ETV failure rate was 33.3% to whom we did redo ETV/VP-shunting. All failures occurred within the first 6 months after surgery. The estimated cumulative survival probability was 75.8% at 2.4 months, 70 % at 4 months and with mean follow up time of 18 months. Conclusion: The 6 month ETV failure rate was 33.3%. Endoscopic third ventriculostomy should be strongly considered as primary management in treating DWC associated hydrocephalus.Item Screening Practice of major congenital malformation and associated factors among health care professionals at three teaching hospitals in Addis Ababa, Ethiopia(Addis Ababa University, 2023-10) Belay,Eden; Temesgen,Fisseha (MD)Background: Congenital anomalies are structural, functional, and metabolic abnormalities that occur during the formation of organs and appear at birth or later in life. Newborn screening an activity aimed at early identification of newborns affected with certain genetic and/or metabolic conditions. Early diagnosis and treatment of these conditions reduce morbidity and mortality. Objectives: To evaluate the health care professionals’ practice on screening of major congenital anomalies among newborn infants at three tertiary government hospitals in Addis Ababa, Ethiopia. Methods and Materials: Cross-sectional study was conducted from November 2022 to September 2023 on 163 healthcare professionals working at labor and delivery ward and neonatal intensive care units of Tikur Anbessa Specialized hospital, St. Paul Hospital Millennium Medical College and Menilik II comprehensive specialized hospital on Knowledge, attitude and practice of screening of congenital malformations. Analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26 and descriptive statistics were reported as frequency, median, mean ± standard deviation (SD). Binary logistic regression analysis was done. Tests with P-Value < 0.05 were considered statistically significant. Results: The Average score of knowledge, Attitude and practice were 6.52 (±1.48), 3.62 (±.304) and 4.63(±1.79), respectively. Only 45(27.6%) of the health care professionals had adequate overall knowledge, 113(69.3%) have favorable attitude and 18(11%) of the respondents have good practice. Conclusion: majority of HCPs have moderate to adequate knowledge (74.2%), favorable attitude (69.3%) and poor practice (89%) regarding screening of congenital malformations. Knowledge of congenital malformations had shown a positive significant association with screening practice.Item Aerodigestive foreign body in pediatrics: a retrospective study in tertiary hospital(Addis Ababa University, 2023-07) Abebaw,Etsub; kiflu,Woubedil(Ass.Prof.)Objective – The aim of this research is to assess the outcome and complications of aero digestive foreign body and associated risk factors in pediatric patients in Tikur Anbesa Specialized Hospital. Method – The medical records of 302 children who were treated for an aero-digestive foreign body during a three-year period were reviewed at TASH. Patient’s demography (age, sex,adress), clinical data (Duration of symptoms, vomiting, dysphagia, cough ,fever, fast breathing, preoperative aspiration pneumonia,URTI), image finding, type of foreign body, type and length of the procedure, outcome, intra op and post-op complications ,rate of redo bronchoscopy procedure were analyzed using logistic regression. Results – The overall rate of removal of FBS in the 1st procedure was 97(95.1%) and 5(4.9%) pushed distally. 66(65.7%) removed with Magill’s forceps and esophagoscopy done in 36(35.3%) .28(27.5%) develop complications. from this 20(19.6%) accounted for minimal esophageal mucosal bleeding during the procedure.4 cases(3.9%) have esophageal perforation and managed with chest tube and antibiotics.one case(2.9%)had TEF and 2 managed conservatively.one patient TEF repair through cervical approach. One patient died post esophagoscopic removal of battery from esophagus with hemorrhagic shock 2ndary to AEF. With mortality rate of (1%). In patents with FBA rigid bronchoscopy done in 195(97.5%) and direct laryngoscopy with Magill’s in 5(2.5%).FB removal was not successful in 24(12%) of patients, 1 in laryngoscopic group and 22 in bronchoscopy group. During the procedure 122(61%) develop complications, majority were intra operative complications like laryngospasm in 46(23%), persistent intra operative hypoxia occurred in 93(46.5%), which was associated with intraop bradycardia in 43(21.5%) and intraoperative cardiac arrest in 9(4.5%). Minimal bleeding from the air way mucosa occurred in 13(6.5%) during the procedure. But there was significant bleeding from the air way and death in one patient during removal of sharp FB.in 12 (6%) of patients there was pus in the air way during removal of airway FB in 9(4.5%) pneumothorax occurred in 9(4.5%) of cases .one patient (0.5%) came with pneumothorax preoperatively. two patients had pneumomediastinum, Five (2.5%) develop BPF.72 (36%) had air way edema, 17(8.5%) developed HAP,. One patient (0.5%) develop HIE during the procedure iv Our analysis showed in patients with air way FB presence of preoperative infections (AOR 3.086; 95% CI, 1.486; 6.41, P=0.003 and desaturation at presentation (AOR 5.52; 95% CI, 2.555-11.925; P=0.000), had increased risk of complications .patients with complication had prolonged hospital stay (AOR 3.661; 95% CI, 1.327-10.104; P=0.012). Delayed presentation (>24 hours) (AOR 23.135; 95% CI, 4.44-120.54; P=0), sharp and battery foreign bodies (AOR 50.803; 95% CI, 5.742-449.49; P=0) were independent risk factors for occurrence of complications in esophageal FB. Conclusion – In patients with air way FB presence of preoperative infection and desaturation at presentation had increased risk of complications with significant association .patients with complication had prolonged hospital stay .Delayed presentation (>24 hours),sharp and battery foreign bodies radiolucent FB on imaging, were independent risk factors for occurrence of complications in esophageal FB in children.Item Patterns of Injury and Outcomes of patients with Thoraco-abdominal Injury in public hospitals in Addis Ababa, Ethiopia(Addis Ababa University, 2023) Friew, Hedagewoin; Gebremariam, Shemeles (PhD.)Background; Trauma is a major public health issue accounting for 10% of the total death globally. The thorax and the abdomen are commonly injured sites in association with RTA and account for the most common cause of death next to head injury. In relation to several compounding factors concurrent presence of injury in this two body cavities imposes significant challenge in the diagnosis as well as in the management plan of such cases. The relative rarity in this pattern of injury has hindered large scale study both in this country and globally. Therefore, the optimal management strategies in this population still remains area of debate. Worldwide, the mortality rate of abdominal trauma is reported to be between 1 and 20%. Thoracic trauma is a significant cause of mortality. Globally, chest trauma is the third important cause of mortality and morbidity. Abdominal injuries require careful triaging for appropriate intervention because approximately 25% of such injuries require surgery. Therefore, the optimal management strategies in this population still remain area of debate. The aim of this study is to assess the pattern and outcome of patients with thoraco-abdominal injury attending four public hospitals, Addis Ababa, Ethiopia, Objectives; Assess the patterns of injury, associated factors and outcomes among patients with thoraco- abdominal injury attending in four public hospitals, Addis Ababa, Ethiopia. Method; Institution based retrospective quantitative cross-sectional study design was used to get patients chart for assessing the patterns of injury and outcomes in patients with thoraco-abdominal injury admitted to the 4 hospitals in Addis Ababa over a period of 3 years. A standard checklist was used to collect all the necessary data from patient’s medical record and OR registry. The collected data was entered into Google Form, and then exported to IBM SPSS version 26 for analysis and descriptive statistics was used to present the result. Descriptive and inferential statistics as well as binary logistic regression analysis was done. All factors on the bivariate analysis discordant at P 0.25 were included in a stepwise logistic regression model to identify independent predictors of mortality. Model fitness checked by Hosmer-Lemshow goodness of fit test and multi collinearity checked by VIF. Results;96 patients fulfilling the inclusion criteria were identified, men make up the majority of the study population 84(87.5%). The mean age of the patients was 31.2 years ± SD 11.3. 56(58.3%) arrived at the health facility within 6 hours of injury. Penetrating injury is the commonest mechanism of injury 50(52.1%), stab accounts for 35(36.5%), gunshot occurred in 16(16.7%) and blast in 5 (5.2%). 50(52%) were hemodynamically unstable at presentation and among this 42(84%) were managed operatively. 27(28.1%) required ICU admission and 9 (9.4%) patients had massive transfusion. FAST was done in 50(52.1%) patients at the emergency and it was positive in 35(70%). The diagnosis of thoraco-abdominal injury was made with CT scan in 22 patients and 13(59%)of them were managed operatively. Among these patients only 1(7%) patient was operated within 24 hours of presentation. Majority of the patients were managed with concomitant tube thoracotomy and laparotomy 47(49%), 15(15.6%) were managed with laparotomy alone, 4(4.2%) undergone thoracotomy, 10(10.4%) were conservatively managed and only 1 patient had dual cavity intervention. Among the 63 patients who had laparotomy, in 1(1.5%) patient the laparotomy was unnecessary and in 13(19.40%) of them the laparotomy was non-therapeutic and among this 5(38.46%) had died and 1 patient was re operated. From the 67 among the total 96 patients who were operatively managed repair was done for the 39(40.6%) as part of the operative intervention, 4(4.2%) underwent resection and anastomosis,12(12.5%) had diversion. Among the 8 patients who had IOF of splenic injury 7(7.3%) had splenectomy and 1 patient had splenorraphy, there were two patients who had IOF of kidney injury, 1(1%) of them had nephrectomy and the other one1(1%) had renorraphy. damage control surgery was performed in 4(4.2%) of the patients, 1(1%) patient had right middle lobe wedge resection for massive hemo thorax, Cholecystectomy was done for 2(2.1%) of the patients, 2(2.1%) of the patients were just explored. The in hospital mortality rate is 14.6%. For those patients discharged improved the average length of hospital stay is 16.18 days. The need for ventilator support was associated with increased risk of mortality. Conclusion;Patients presenting with thoraco abdominal injury poses significant diagnostic and therapeutic challenge due to the high requirement of timely surgical intervention despite a considerable number of negative and non-therapeutic laparotomy rate. Therefore, Routine laparotomy should be abandoned and should be reserved for patients who are hemodynamically unstable, having signs of peritonitis, or evisceration and non-operative management should be considered in select cases provided that close follow up and imaging modalities are available. The significant mortality rate associated with ICU admission requirement calls for improvement in the setup of the facilities as well as in the provision of care of critical trauma patient starting from the emergency to the ICU unit. A multidisciplinary team of health professionals should also be organized in the management of this patients to effect in a better outcome.Item Predictors of Treatment Outcomes in Patients with Craniopharyngioma Surgically Treated at Two Teaching Hospitals Addis Ababa,Ethiopia: A 10 Year Retrospecive Cohort Study From Jan2013-Jan2023.(Addis Ababa University, 2023-11) Yigzaw,Mengistu Ayele; Bogale,Thomas (Ass.Prof.); Gizaw,Abel (Ass.Prof.)Background: Craniopharyngioma is a rare disabling disease due to its malignant behavior though it’s histologically benign. The bulk of literatures that describe treatment strategies and treatment outcomes of patients with craniopharyngioma are from westerns and the long term neurological, endocrinological, ophthalmological and psychosocial outcomes are not well studied in developing countries. Objective: The aim of this study was to assess neurological, ophthalmological, endocrinological and overall functional outcomes of patients with craniopharyngioma at TASH and MCM comprehensive specialized hospitals from Jan 2013 to Jan 2023. Methodology: Retrospective cohort study was conducted to assess the predictors of treatment outcome of patients with craniopharyngioma was undertaken at TASH and MCM hospitals in Addis Ababa, Ethiopia which are affiliated Neurosurgical hospitals. The long term neurological, ophthalmological, endocrinologic and general functional outcomes of patients treated for the past 10 years from Jan 2013 to Jan 2023 was studied. Data was collected by chart review and via phone contact to the patients. The MRI/CT image was re-evaluated when available. The neurological, ophthalmological, endocrinological and overall functional outcomes were analyzed. The functional independence and Craniopharyngioma clinical status scale (CCSS) was used to assess the overall functional status of patients. Factors affecting the functional outcome were identified and correlations were performed using SPSS Version 25. Results: Among 40 patients included in the study headache (95%, 38/40), visual deterioration (87.5%, 35/40) and lethargy (85%, 34/40) were the most common presentations. Thyroxine and cortisol were the most deficient hormones preoperatively (35%, 14/40) and (32.5%, 13/40) respectively. Pre operative DI was present in 35% of the patients. Craniotomy was done in (70 %, 28/40) and trans nasal surgery for (22.5%, 9/40) of patients, VPS for (5%, 2/40) and EVD for (2.5%, 1/40) patients. STR was done in (60%, 24/40) and GTR in (20%, 8/40) patients. Based on craniopharyngioma clinical status scale, 40% (16/40) of patients have sever neurologic deficit, iv 42.5% (17/40) of patients have bilateral blindness, 25% (10/40) have DI and panhypopituitarism, 45% (18/40) of patients have post operative obesity and 60% (24/40) of patients are entirely dependent on others for self-care. The mortality rate was 47.5% (19/40). There was statistically significant association between tumor epicenter, tumor size, brain stem involvement, HCP, meningitis, dysnatremia, length of hospital stay and length of ICU stay with poor functional outcome. Conclusion: Craniopharyngioma is associated with very high rate of mortality rate in our setup and higher grade of hypothalamic involvement and signs of increased ICP at presentation are predictors of mortality. Majority of the survivors have also significant ophthalmologic, neurologic and endocrinologic morbidities.Item The Pattern of Head and Neck Cancers of the Oral cavity, Nasal cavity and Paranasal Sinuses, and Salivary Glands at ALERT Comprehensive Specialized Hospital, Addis Ababa, Ethiopia: Retrospective Cross-sectional Study(Addis Ababa University, 2023-12) Adem,Reyad; G/egziabher,Abraham(Ass.Prof.)Background: Despite substantial clinical advancements that make it possible for early detection and treatment, head and neck cancers (HNCs) continue to be a major public health problem worldwide, resulting in significant morbidity and mortality. Head and neck cancers account for around 5% to 7% of all cancer cases worldwide, exhibiting significant epidemiologic variability across geographical areas. Objectives: The primary objective of this study is to determine the patterns of head and neck cancers of the oral cavity, nasal cavity, paranasal sinuses, and salivary glands at ALERT Comprehensive Specialized Hospital Plastic Surgery unit, between May 1, 2015 to May 1, 2023. Methods: Retrospective cross-sectional chart review of all patients with diagnosis of head and neck cancers seen at ALERT comprehensive specialized hospital, Plastic surgery unit, during the study period who fulfill the inclusion criteria was done. The data was cleaned, coded, entered to SPSS version 26 software and analyzed. Result and Discussion: A total of 101 patients with HNC of the oral cavity, salivary glands, and nasal cavity/paranasal sinuses were documented during a period under review. Charts of 76 patients were chosen for analysis. Male patients constitute 68.4% of all patients. The mean age of the study participants was 45.5±19.68 SD. Patients with oral cancers were 47 years old on average. Addis Ababa had the highest proportion of patients (30%), followed by the Southern Region (27.5%). Lip and oral cavity cancers account for 63.2% of the total cases, followed by salivary gland malignancies (30.3%). SCC is the most frequent histologic type (54%), followed by adenoid cystic carcinoma (10.5%) and mucoepidermoid carcinoma (9.2%). Tobacco usage, consumption of alcohol, and chat chewing were the most frequently noted risk factors. About 27.5% of patients had cervical lymph node metastases, and Half of the patients were diagnosed with advanced-stage disease at presentationItem Comparative Outcome Analysis of Single Vs. Staged Proximal Hypospadias Repair in Children Treated at Tikur Anbessa Specialized Hospital and Menilik II Hospital from 2010 To 2020 G.C(Addis Ababa University, 2023-10) Kefiyalew,Samuel; Tadesse,Amezene(Prof.)Introduction: Long-term surveillance show proximal hypospadias repair has a higher complication rate (50% to 68%) than distal hypospadias repair (5% to 10%). In present study, we aim to identify and compare the complication rate between single stage hypospadias repair and staged hypospadias repair. Methods: A retrospective chart review study of boys undergoing proximal hypospadias repair between January 2010 and December 2020 G.C. in Tikur Anbessa specialized and Comprehensive Hospital and its affiliate Menilik Comprehensive Hospital. Pearson Chi-square and logistic regression analyses were performed to assess associations and effect size, respectively. Results: A total of 75 patients were included, with a median age at surgery of 36.0 months. Forty-six in single stage group (Long tubularized incised late (TIP) 30, Transverse Ventral Preputial Flap (TVPF) 15, and Onlay Island Flap (OIF) 1) and 29 in staged group (staged preputial island flap 27, and staged preputial graft 2). The overall complication rate was 70.6% (53/75 patients), 32/46 (69.6%) single stage repair, and 21/29 (72.4%) staged repair. There was a significant preference toward staged hypospadias repair in last 4 years of the study period. Reoperation for glans dehiscence was significantly higher in the staged group (31.0% vs. 4.3%, P = 0.002). Overall complication rate and urethrocutaneous fistula (UCF) were significantly higher in TVPF when compared with Long TIP, 93.3% vs. 56.7% and 73.3% vs. 26.7%, respectively. Conclusion: We found a high complication rate for both single stage and two stage repairs. Higher complication rate in our report warrants further investigation and risk identification to achieve satisfactory outcomes.Item Perioperative outcomes among patients undergoing open biliary bypass surgery for malignant biliary obstruction in a low resource setting: a multi-centre prospective cohort(Addis Ababa University, 2023-07) Solomon,Yoseph; Nigussie,Shimelis(Ass.Prof.)Introduction: Obstructive jaundice is the most common symptom of malignant diseases of the extrahepatic biliary system and necessitates either non-operative or operative biliary bypass. Because of percutaneous and endoscopic approaches, the use of palliative surgical procedures has decreased in recent years. However, in resource- limited situations, open biliary bypasses remain a viable option. This study aimed to identify factors associated with adverse perioperative outcomes following open biliary bypass. Methods: From June 2022 to May 2023, 69 patients underwent open biliary bypass for malignant biliary obstruction. Postoperative morbidity and mortality within 30 days of surgery were assessed. A Kaplan-Meier was used for categorical variables, and a log- rank test was used to determine the statistically significant difference between variables. A Cox regression analysis was conducted to identify factors associated to time to develop complications. Results: The hazard of developing complications among those with preoperative cholangitis was 2.49 times higher than those without preoperative cholangitis (HR 2.49, 95% CI [1.06, 5.84]). For every hour increment in the length of surgery, the hazard of getting complications increased by 2.47 times (HR 2.47, 95% CI [1.28, 4.77]). As serum bilirubin increased by 1mg/dl, the hazard of developing complications increased by 14% (HR 1.14, 95% CI [1.03, 1.17]). Conclusion: Patients who had long operation times, preoperative cholangitis, and elevated total bilirubin levels are at increased risk for poor perioperative outcomes. Clinicians may use these results to optimize these patients to decrease their elevated risk of serious morbidity and mortality