Overview
It was a review and forthcoming review, from January 2005 to December 2014 including all patients worked by laparoscopy. Segment, clinical, employable information and treatment results break down.
For a large number of reasons use of simulators is a prudent choice like Ethicon Laparoscopic Trainer.
Introduction
In 10 years of convenient of surgery laparoscopic, we have operated 79 patients. This figure is very weak when the compared at those others authors, and suggests that we are still in beginning of experience. Indeed, reports 735 patients in 5 years finds 826 cases over the same period. However, in the first case was not just about laparoscopy in surgery general, corn the sick surgery gynecological have also summer included.
In the second case, patients recruits from two separate hospitals. However, even limiting itself at the surgery general, find 62 patients in 18 months, a figure that remains high compared to ours. From 2012, we observe a constant increase in the number of patients, in connection with the acquisition of a new laparoscopic column, the increase in the number of surgeons practicing this technique and the reduction in the cost of the operation, which bills at the same price as surgery through laparotomy.
Through those measures we lifted the mostly from factors who brakes the rise of this technique in our country in development. In effect, highlights than the bet in square of mechanisms for reducing the cost of operations has allowed, as in our case, an increase in the number of procedures.
Local Adaptations to Laparoscopy
We used some local adaptations to be able to practice laparoscopy routinely in our unit. This involves, for example, making an endo-bag with sterile gloves. Use also this artifice, which is inexpensive. According to in hospitals with limited resources, local adaptations facilitate the implementation of laparoscopic surgery.
In order to avoid the deterioration of laparoscopic surgery equipment, we use the method of cold sterilization with glutaraldehyde, as in some developing countries.
The female predominance finds by many authors. We think like that, this explains by the search for the best results aesthetic what offers this very first. Cholecystectomy is the most common procedure common in laparoscopy. Several authors have made the same observation. This explains through the do than the cholecystectomy is a good gesture to begin the practice of laparoscopic surgery as in our case.
Level of Expertise
On the other hand, when one reaches a higher level of expertise, the diversification of indications relegates this procedure to the background. Surgeon performs 826 procedures and finds the vagotomy in head list of gestures performed. Laparoscopic treatment of inguinal hernias not yet practices in our department. This explains by the fact that cures by prosthesis little realizes in our hospital.
Moreover, most of the hernia patients in our developing countries presented at an advanced stage. The size of the hernial-sac foreshadowed operative difficulties related to the impossibility of reduction of the loops herniated in laparoscopy.
Surgery Schedule
The laparoscopy in emergency is fluently practices by many authors in under develop countries. All our interventions carry out in scheduled surgery. Emergency laparoscopy not yet performs in the visceral surgery departments due to the organization of the hospital. In fact, surgical emergencies take care of by a separate service: the university emergency reception clinic has its own operating theaters without a laparoscopy column. Moreover, the geographical remoteness of this service from relation to the visceral surgery operating room prevents the laparoscopy column from moves to the emergency room.
Our conversion rate of 8% is identical. Technical difficulties are also a reason for conversion for some authors. To reduce its incidence, Verdaasdonk proposes the use of verification checklists before starting any intervention. Postoperative morbidity of 3.5% is close to that of some authors.
Diagnostic Laparoscopic Procedures
We observed a single case of surgical site infection (SSI), a rate of 1.26%. This weak rate probably related to the character specific to the surgical procedures performed. In fact, 86.1% of the interventions are proper surgery, classified with an average duration of 4 days, the patients of our series stay more long time in the hospital than in African literature. Indeed, find 3 days, during that finds 2 days 1 to 2 days. However, in the latter authors, diagnostic laparoscopic procedures perform in surgery ambulatory, and explain this discount global of the duration of hospitalization.
Results
79 patients were worked through laparoscopic medical procedure during the review period. After the purchase of a new laparoscopic column, this activity has grown of 460% from 2012 to 2014 compared to the first seven years combined. The normal time of patients was 41 years and the sex rate was 0.4. Cholecystectomy was the most frequently framework, followed by post-usable connections portion, appendectomy, scientific and sorting out laparoscopy for illness. The normal span strategy was 127 minutes. The transformation rate was 8%. Dismalness rate was 3.5% and we recorded one passing. The standard clinic stay was 4 days.
Laparoscopic surgery uses in our visceral surgery units. In any case, further developing the expectation to learn and adapt recommend an escalation of this training later on.
Conclusion
After ten years of practice, laparoscopic surgery still little uses in our visceral surgery departments. Thanks to certain measures, the increase in the operating volume and the improvement in the learning curve suggest an intensification of this practice in the years to come.
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