A Five-Year Review of Laparoscopic Gynaecological Surgeries in a Private-Owned Teaching Hospital, in Nigeria.

BACKGROUND: Laparoscopic surgery is associated with shorter hospital stay and less post-operative morbidity. Cost, expertise and availability of equipment, however remain limitations to the range of surgeries available in low resource settings. OBJECTIVES: To determine the indications, the patient characteristics and the surgical outcomes of laparoscopic gynaecological surgeries in a Nigerian private tertiary level hospital. METHODS: This retrospective observational study included all gynaecologic laparoscopy procedures done between August 2016 and July 2021, at the Babcock University Teaching Hospital (BUTH). Data were extracted from the hospital records with the use of a proforma designed for this purpose and were analyzed using the SPSS version 21.0. RESULTS: Laparoscopy accounted for 13.5% of gynaecological surgeries. They were majorly in nulliparous women (67.6%) of reproductive age (mean 33.9±10.2 years and median of 32 years). The commonest indication was secondary infertility (27.3%) and operative procedures were more commonly done (59.0%). The mean duration of surgery was 94.8±52.4 min and conversion to laparotomy rate was 8.6%. Operative procedures lasted longer (113.9±58.1 min) and accounted for most conversions, 10/12 (83.3%). Intraoperative complication rate was 2.2% and they were mostly (66.7%) entry related. The mean duration of hospitalization was 2.2± 1.6 days. CONCLUSION: The prevalence and indications for laparoscopic surgeries were similar to findings from other parts of Nigeria. Operative procedures were however more commonly done. In spite of the sustained increase in procedure rates, a steady decline in the duration of surgery, conversion and complication rates occurred. Private hospitals may have potential for uninterrupted progression of laparoscopic gynaecocologic surgeries in Nigeria.

CONTEXTE: La chirurgie laparoscopique est associée à un séjour hospitalier et moins de morbidité postopératoire. Coût, expertise et la disponibilité de l'équipement restent cependant des limites à la gamme de chirurgies disponibles dans des contextes à faibles ressources. OBJECTIFS: Pour déterminer les indications, le patient et résultats chirurgicaux de la chirurgies gynécologiques par laparascopie dans un hôpital privé nigérian de niveau tertiaire. MÉTHODES: Cette étude observationnelle rétrospective comprenait les procédures de laparoscopie gynécologique effectuées entre août 2016 et juillet 2021, au Babcock University Teaching Hospital (BUTH). Les données ont été extraites des dossiers de l'hôpital à l'aide d'un proforma conçu à cet effet et a été analysé à l'aide de version 21.0 du SPSS. RÉSULTATS: La laparoscopie représentait 13.5 % des gynécologues Chirurgies. Ils étaient principalement chez les femmes nullipares (67.6%) âge de reproduction (moyenne 33.9±10.2 ans et médiane de 32 ans). L'indication la plus courante était l'infertilité secondaire (27.3%) etles procédures opératoires étaient plus couramment effectuées (59.0 %). La durée moyenne de la chirurgie était de 94.8±52.4 min et la conversion en laparotomie était de 8.6 %. Les procédures opératoires ont duré plus longtemps (113.9±58.1 min) et représentait la plupart des conversions, 10/12 (83.3 %). Le taux de complicationsintra opérative était de 2.2 % et ils étaient principalement (66.7 %) apparenté. La durée moyenne de l'hospitalisation était de 2.2 ± 1.6 jour. CONCLUSION: La prévalence et les indications pour les chirurgies par laparoscopie étaient similaires aux résultats d'autres régions du Nigéria. Les procédures opératoires étaient cependant plus courantes. Malgré tout de l'augmentation soutenue des taux d'intervention, une baisse constante de la durée de la chirurgie, la conversion et les taux de complications sont survenus. Les hôpitaux privés peuvent avoir un potentiel de progression interrompue des chirurgies gynécologiques laparoscopiques au Nigeria. Mots-clés: Audit, endoscopie, laparoscopie, hôpital privé.

Seat-Belt Syndrome as managed in Babcock University Teaching Hospital. A Case Report and Literature Review.

BACKGROUND: This paper is a case report of a 54 year old woman that presented in our casualty with just "seat belt sign" following a road traffic injury. At laparotomy, she was found to have sustained disastrous internal/visceral injuries with torrential intraperitoneal haemorrhage from the surface of the liver caused by the seat belt. Frantic attempts at haemostasis were proving difficult and time wasting. The lacerated liver surface was then generously packed with absorbent abdominal mops which were left in-situ for 48hrs. A second-look operation 48 hrs later revealed satisfactory haemostasis of the bleeding surface of the left lobe of the liver OBJECTIVE: This paper is to highlight the wisdom in using "Damage Control" techniques to save a patient's life in an unsuspecting torrential bleed during laparotomy - especially in seatbelt injuries. DESCRIPTION: "Damage Control" implies doing the minimum, in the quickest time possible, to keep patient alive and coming back when patient is stable to deal with the pathology. RESULT: After 48hrs, a re-laparotomy was performed on the patient and it was found that complete haemostasis had been achieved. The packs were removed and abdomen closed in a single layer. The patient remained well till discharge after two weeks of hospitalisation and has remained well on follow up. CONCLUSION: Seatbelts, although protective, can lead to complex injury patterns. Early detection and prompt management of the injuries is key to survival.

Inversion appendicectomy.

OBJECTIVES: (i) To emphasise that incidental appendicectomy has indications and, to highlight this indications. (ii) To teach that, even when indicated, this procedure should not convert a clean surgical wound into a clean contaminated or even less optimal wound. (iii) To recommend that if an incidental appendicectomy is to achieve (ii) above, inversion appendicectomy is the better option to choose. (iv) To prove that inversion appendicectomy is fast, easy and achieves a similar result as the more popular excision appendicectomy. PATIENTS AND METHODS: This study was carried out in the paediatric surgical unit of Korle-Bu Teaching Hospital Accra, Ghana - between March 2003 and May 2004. PATIENT SELECTION: Fifteen patients qualified for enrollment into this study. These were (i) Those who had clear cut indications for incidental appendicectomy, and had it done as an inversion appendicectomy. (ii) Cases of incidental appendicectomy. METHODS: Eleven of these cases were done for intussusceptions and four for malrotation. Only wounds that qualified as clean surgical wounds were included in this study. There was no age or sex discrimination. RESULTS: Follow up on these patients did not reveal any complications. CONCLUSION: Incidental appemdicectomy has well-defined indications. When indicated in clean wound, inversion appendicectomy is the procedure of choice.

Dicephalic-dipus: a case report.

Bipagous conjoined twins are rare with an incidence of 1 in 50,000 to 1 in 100,000 births, but rarer still are heteropagous dicephalic dipus with an incidence of 0.1-0.2 per 10,000 births. No more than 4 sets of such surviving twins-sharing an undivided torso and two legs have been recorded in history consequently, the usual recommendation is for termination of pregnancy following prenatal diagnosis since historically, postnatal survival is unlikely. We present a case of dicephalic-dipus seen in our institution.