Abstract
This study presents a pioneer experience with laparoscopic operations in a General Surgical unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Consecutive patients who had laparoscopic operations from April through December 2008 were prospectively studied. Following clinical diagnosis, initial diagnostic laparoscopy was undertaken in all patients, followed by therapeutic open or laparoscopic procedures. All procedures were done under general anaesthesia. Duration of operation and outcome including complications were recorded. In all, there were 12 patients (8 males, 4 females), aged 15 to 50 years. Eight patients had clinical diagnoses of acute appendicitis, one each had undetermined right lower abdominal pain suspected ectopic gestation, adhesive intestinal obstruction and metastatic liver disease. The first 4 patients with inflammed appendix confirmed at laparoscopy had open appendicectomy. Of the next cohort of 5 patients, laparoscopic appendicectomy was completed in four but converted to open procedure in one. Normal findings were noted in the lady with suspected ectopic gestation. Laparoscopic adhesiolysis was done for adhesive intestinal obstruction while a laparoscopic liver biopsy was done for the patient with metastatic liver disease. Operative time ranged from 55-105 minutes with marked reduction in operation time as confidence and experience grew. No intraoperative complication was observed but one patient had superficial port site infection postoperatively. We conclude that with good patient selection and some improvisation, laparoscopic general surgical operations are feasible with acceptable outcome even in a poor resource setting.
Keywords: Laparascopic surgery, appendicectomy; metastatic, intraoperative
Résumé
Cette étude présente les premières expériences avec les opérations laparoscopiques a l’unité générale de chirurgie du complexe Hospitalier Universitaire d’Obafemi Awolowo, Ile-Ife , Nigeria. Des patients consécutifs qui ont eu des opérations laparoscopiques d’Avril a Décembre 2008 étaient prospectivement étudiés. Suivant des diagnostiques cliniques, le diagnostique de laparoscopie était initialement fat sur tous les patients, suivie par des procédures laparoscopiques. Toutes les procédures étaient faite sous anesthésie générale. La durée de l’opération, le résultat de même que les complications étaient notées. Il y’avait en tout 12 patients (8 males,4 femelles) âgés de 15 - 50 ans. Huit patients étaient diagnostiques ayant une appendicite sévère, chacun ressentait une douleur indéterminée sous l’abdomen droit suspecte d’être une gestation ectopique, l’abdomen adhésive de l’ intestine et le mal de foie. Les 4 premiers patients avec l’inflammation de l’appendice confirmé a laparoscopie avaient une appendicectomie ouverte. Dans la cohorte suivant de 5 patients, l’appendicectomie laparoscopiques était complète chez 4 mais nécessitait une procédure ouverte.
Correspondence: Dr. Adewale O. Adisa, Department of Surgery, Obafemi Awolowo University, Ile Ife 220005, Nigeria. E-mail wadisc@yahoo.com
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