Minimally Invasive Surgery in Port Harcourt, Nigeria: Progress So Far.

Background The global practice of minimally invasive surgery (MIS) has progressed from basic to advanced procedures. Consequent to this, almost all surgical procedures can be performed through a minimally invasive technique. This study aims to audit the practice of MIS in healthcare facilities within a city in a developing country in Africa. Methods This is a multicenter, multispecialty, retrospective descriptive study of minimally invasive diagnostic and therapeutic surgeries performed in private and public health care facilities in Port Harcourt, Rivers State, Nigeria, conducted for a duration of 10 years, from January 2010 to December 2019. A proforma was distributed for completion to identified surgeons from the included study centers. Data on MIS, including types of procedures, time trends, frequency, category of surgery, and cost, were collated. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (IBM SPSS version 20.0, New York, USA). Results There were 5845 minimally invasive procedures performed during the study period, out of which only 92 (1.57%) were carried out in government-owned hospitals. Of these, 2570 were gynecologic (44.0%), 1873 were urologic (32.0%), 1300 were general surgeries (22.2%), 142 were pediatric surgeries (2.4%), and 3 (0.05%) were thoracic minimally invasive procedures performed within the 10-year period. The cost of procedures ranged from <$200 USD to >$2000 USD. The hospital stays ranged from <1 day to a maximum of 13 days. Conclusion The practice of MIS has made significant progress but has been primarily driven by the private sector. Subsidizing the cost of MIS procedures in government-owned hospitals is likely to improve patronage and improve the skills of surgeons.

Review of Episiotomy and the Effect of its Risk Factors on Postepisiotomy Complications at the University of Port Harcourt Teaching Hospital.

AIM: This study aimed to determine the prevalence of episiotomy and postepisiotomy complications and to assess the relationship between the risk factors and postepisiotomy complications in the University of Port Harcourt Teaching Hospital. METHODOLOGY: This was a descriptive longitudinal study, in which 403 consecutive women who had episiotomy in the labor ward were recruited for the study. They were followed up and reviewed at the postnatal clinic on the 1st and 6th weeks postdelivery. Data regarding age, marital status, occupation, educational status, address, parity, booking status, postepisiotomy complications, and the associated risk factors were entered adequately into a prestructured pro forma, and statistical analysis was done using statistical software (SPSS for Windows® version 19.0). t-test was used to explore the association of risk factors to postepisiotomy complications. RESULTS: The episiotomy rate was 22.1%. The prevalence of postepisiotomy complications was 52.1%. The mean age of the women was 23.8 (standard deviation ± 3.2) years. Seventy-two (34.3%) patients had perineal pain, which lasted for 72 h or more; 61 (29.1%) had difficulty in walking, while 37 (17.6%) had perineal discomfort. Four (1.9%) had wound infection and only one (0.4%) had wound dehiscence. The development of postepisiotomy complications was not statistically significantly associated with risk factors such as gestational age (T = 1.4, P = 0.1), packed cell volume on admission (T = 1.0, P = 0.2), duration of first stage of labor (T = 0.5, P = 0.1), duration of second stage of labor (T = 0.7, P = 0.3), duration of rupture of fetal membranes (T = 0.8, P = 0.4), delivery repair interval (T = 0.6, P = 0.2), estimated blood loss (T = 0.9, P = 0.2), duration of Sitz bath (T = 1.0, P = 0.2), duration of analgesic (T = 1.2, P = 0.1), duration of antibiotics (T = 1.3, P = 0.1), or the operator who performed or repaired the episiotomy (P = 0.2). CONCLUSION: The prevalence of episiotomy and postepisiotomy complications in this study was high. Necessary attention should be given to ensure adequate pain relief for all parturients who had episiotomy, and the policy of restrictive use of episiotomy should be fully implemented in the department in line with the best practices and evidence-based recommendations. This will further reduce the incidence of episiotomy rate as well complications that may arise from it and ensure a positive pregnancy experience for pregnant women.

A 3-year retrospective review of mortality in women of reproductive age in a tertiary health facility in Port Harcourt, Nigeria.

PURPOSE: To determine the causes of death and associated risk factors among women of reproductive age (WRA) in a tertiary institution in Port Harcourt, Nigeria. PATIENTS AND METHODS: This was a retrospective survey of all deaths in women aged 15-49 years at the University of Port Harcourt Teaching Hospital that occurred from January 1, 2013 to December 31, 2015. Data retrieved from ward registers, death registers, and death certificates were analyzed with Epi Info version 7. Comparison of socioeconomic and demographic risk factors for maternal and nonmaternal deaths was done using a multivariate logistic regression model. RESULTS: There were 340 deaths in the WRA group over the 3-year period. The majority (155 [45.6%]) of the women were aged 30-39 years. There were 265 (77.9%) nonmaternal deaths and 75 (22.1%) maternal deaths. Among the nonmaternal deaths, 124 (46.8%) had infectious diseases, with human immunodeficiency virus being the most common cause of infection in this group. Breast cancer (13 [4.9%]), cervical cancer (12 [4.5%]), and ovarian cancer (11 [4.2%]) were the most common malignant neoplasms observed. Hypertensive disorders of pregnancy (31 [41.3%]) and puerperal sepsis (20 [26.7%]) were the most common causes of maternal deaths. Age and occupation were significantly associated with deaths in WRA (p<0.05). Older women aged >30 years (odd ratio =1.86, 95% CI =1.07-3.23) and employed women (odds ratio =2.55, 95% CI =1.46-4.45) were more likely to die from nonmaternal than maternal causes. CONCLUSION: Most of the deaths were nonmaternal. Infectious diseases, diseases of the circulatory system, and malignant neoplasms were the major causes of death among WRA, with maternal deaths accounting for approximately a quarter. Public health programs educating women on safer sex practices, early screening for cancers, benefits of antenatal care, and skilled attendants at delivery will go a long way to reducing preventable causes of deaths among these women.

Bacterial vaginosis among women with tubal factor infertility in Nigeria.

OBJECTIVE: To determine the prevalence of bacterial vaginosis among women with tubal factor infertility. METHODS: A cross-sectional prospective study of women with tubal factor infertility was conducted at a Nigerian teaching hospital between March and September 2014. An equal number of fertile women attending the family planning clinic were recruited as controls. Interviews were conducted to collect data on sociodemographic characteristics, history and characteristics of vaginal discharge, knowledge, and practices. Bacterial vaginosis was diagnosed using the Amsel criteria. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine predisposing factors. RESULTS: Overall, 178 women with tubal factor infertility were recruited. Bacterial vaginosis was noted in 50 (28.1%) of these women, compared with 14 (7.9%) of 178 fertile women (P < 0.001). Patients with tubal factor infertility had an increased risk of bacterial vaginosis when they were of low socioeconomic class (OR 11.89; 95% CI 5.20-27.69), practiced vaginal douching (OR 19.15; 95% CI 7.26-47.75), used vaginal drying agents (OR 17.04; 95% CI 6.91-43.24), had an early sexual debut (OR 32.08; 95% CI 12.02-88.89), and had a history of sexually transmitted infections (OR 12.42; 95% CI 5.36-29.35). CONCLUSION: The prevalence of bacterial vaginosis was high among patients with tubal factor infertility. Socioeconomic and cultural factors contribute to the risk of the condition.