Early Experience with Laparoscopic Surgical Practice in Ondo State, South Western Nigeria.

BACKGROUND: Laparoscopic surgery is a relatively new and expanding field of surgical therapy in Ondo state. This is a multi-centre study cataloguing the work of the authors in Ondo State, Nigeria. AIM: To determine the indications, operative findings, and interventions at Laparoscopy in our resource challenged settings. PATIENTS AND METHODS: Medical records of all patients who had laparoscopic procedure at the Federal Medical Centre, Owo, Ondo State Specialist hospital, Okitipupa, University of Medical Sciences Teaching Hospital, Ondo, George and Martins Medical Centre, Ore and Mishmael Hospitals and Clinics, Akure from December, 2009 to December, 2018 were reviewed. Data on patient's age, gender, indications for surgery, duration of hospital stay, outcome of surgery were analyzed. Challenges and adaptations were also noted. RESULTS: One hundred and eighty-one (181) laparoscopic procedures were done, but only 152 had complete records for review. The median age was 35.5 years (mean = 33.7±11.4years; age range of 8 month -72 years). There were more males 88(57.9%) than females, 64(42.1%). Laparoscopy was purely diagnostic (n=28,18.4%), therapeutic (n=118, 77.6%) or both (n=6, 3.9%). Cholecystectomy (n=76, 50%) and appendicectomy (n=37, 24.3%) were the two most common procedures done. In the paediatric patients, patent processus vaginalis (hernia), cryptorchidism and indeterminate sex (gender) were common indication. Challenges encountered were power failure (n=3, 2%), equipment failure (n=4, 2.6%) and difficult dissection (n=4, 2.6%). The mean duration of surgery was 96.96(±25) minutes (diagnostic), 150 (±57.6) minutes (therapeutic); while the mean duration of hospital stay was one day (diagnostic) and 2.3(±1.7) days for therapeutic interventions. CONCLUSION: Laparoscopic service is achievable with adequate motivation, males appear to benefit more in our setting, and the service transcends all aged groups.

Congenital giant hydroureteric cistern in a duplex system of an infant.

Duplex collecting system is a congenital genitourinary anomaly commonly found incidentally. Our experience with a duplex system associated with giant hydroureter presenting as mobile abdominal swelling that was noticed from birth, constipation, and failure to thrive is described. Ultrasound and IVU did not assist in making the diagnosis, while a barium enema suggested a colonic duplication. Congenital giant hydroureter should be considered as a differential diagnosis in infants with cystic abdominal swelling. A preserved renal moiety attributed to a dilated ureteric cistern was a unique theory in this case.

Outcome of management of complicated extragonadal teratoma in a resource poor setting.

BACKGROUND: Extragonadal teratomas (EXGTs) are ubiquitous in the human body; hence, they have varied presentation. In underdeveloped areas presentation and management are affected by socio-economic, cultural and health facilities factors. The aim of this study was to review the outcome of management of complicated EXGT in a tertiary health centre. MATERIALS AND METHODS: A review data of paediatric patients with EXGT was done between January 1999 and December 2012. Variables reviewed were bio-data, mode of presentation and site of tumour, comorbidity, treatments and outcome. The data was analysed with Statistical Package for Social Sciences (SPSS (R)) version 16.0. RESULTS: There were 21 complicated EXGT (77.8%) among 27 children, age ranges from 4 days to 16 years (median = 2 years). Male:Female ratio of 1:2. The complications per region of the body at presentation were cervical 4 (66.7%), mediastinal 2 (100%), abdominal 3 (75%) and sacrococcygeal 12 (75%). The complications were respiratory distress 6, intestinal obstruction 5, faecal incontinence 2, bladder outlet obstruction 3, malignant transformation 5, ruptured sacrococcygeal teratoma 2, ulcerated tumour 2, anaemia 3 and malnutrition 3. There were 5 (23.8%) progressive disease post-excision outside our facility. Excision biopsy was successful in 19 (85%) patients two of which had neoadjuvant cytotoxic therapy. Overall mortality was 5 (23.8%) (septicaemia, anaemia, respiratory distress, renal failure) and post-excision mortality was 11.8% (endotracheal tube blockage and progressive disease). CONCLUSION: Delay presentation (due to local belief, ignorance and poverty) malnutrition, sepsis, malignant transformation characterised presentation of children in this study and the lack of paediatric intensive care unit facility and intensivists compromised survival of children with EXGT.