Introduction
The laparoscopic route has now become the route of choice in surgery. It is a technique increasingly used. We report the results of ten years of practice of laparoscopy in the surgery department A of the National Hospital.
For a large number of reasons use of simulators is a prudent choice like Laparoscopic Needle Driver.
Retrospective Study Methods
This was a retrospective study carried out over a period of 10 years from January 1, 2006 to December 31, 2015 in the general surgery department A of the National Hospital. Included in this study were all the records of patients admitted to the department who had undergone laparoscopic surgery.
Video Endoscopic Abdominal Surgical Techniques
Laparoscopy a generic term for all video endoscopic abdominal surgical techniques is part of the current trend in so-called minimally invasive surgery. Laparoscopy or laparoscopy was born in the 1940s gynecological surgeon, laparoscopy was then for diagnostic purposes only. It is since this date and especially from the middle of the seventies, that laparoscopy has developed in gynecology to become therapeutic. In visceral and digestive surgery, it was from the mid-1980s that this technique flourished to extend to other surgical specialties. The indication of laparoscopy in our countries hampers by the difficulties of acquiring the equipment, of training medical and paramedical personnel in its use and maintenance. The practice of laparoscopy began in Niger in 2004 with the realization of a cholecystectomy.
Patients and Methods
This was a descriptive retrospective study carried out over a period of 10 years from January 1, 2006 to December 31, 2015. Included in the study all patients admit to the general surgery department A of the National Hospital and having benefited from laparoscopic surgery. Not included in our study patients admits outside our study period, and those operated by an approach, other than the laparoscopy.
Results
During the study period, 20,640 patient’s admitts to general surgery and 447 had undergone laparoscopic surgery, a frequency of 2.16%.
The female sex predominated with 317 cases, i.e. a proportion of 70.92% and the male sex 130 cases (29.05%) with a sex ratio of 0.41. The age group most affected is that of 30 to 44 years (192 cases or 42.95%). The average age was 35.28 years with extremes ranging from 12 years to 77 years? Eighty-two
(82) Patients were less than 18 years old, i.e. 18.34%. For the mode of admission, 81.3% of patients refers from other health centers against 13.2% of patients who came on their own and 5.5% admits urgently. More than nine tenths (9/10) of the patients had no history of surgery, against only 7.60% (34 cases) who had a history of laparotomy. For the medical history, 85 patients or 19.01% were sickle cell disease.
Pain in the right hypochondrium was the main reason for consultation with 68.23% (305 cases). Sexual ambiguity represented 1.11% (5 cases) and 1.78% (8 cases) of the workforce had consulted for infertility. (Table I).
Treatments
More than half of the patients treat for benign biliary pathologies (gallstones), i.e. 63.75% (285 cases). Laparoscopy performs for diagnostic purposes in 14.54%. Gynecological pathologies represented 11.18% (50 cases) of these indications (table II).
Simple cholelithiasis accounted for 40.26% (180 cases) followed by acute cholecystitis in 23.48% (105 cases). Treatments of colorectal cancers in 11 cases, i.e. 2.46%.
Table III: Distribution of patients according to intraoperative diagnosis
The majority of patients were classified as ASA I (96.64% or 432 cases). More than half of the patients had benefited from a cholecystectomy, i.e. 58.02% (271 cases) and 13.49% (63 cases) treats for tubal and adnexal surgery (table IV).
Laparotomy
The conversion rate to laparotomy was 6%, or 27 cases. The most important cause of conversion was the inflammatory state of the gallbladder with 3.13% (14 cases) of the rate of conversion. The average operative ti me was 62 minutes with extremes ranging from 50 to 180 minutes? The results of the histological examination of 83.89% of the patient are reports.
Postoperative complications were 2.90% (13 cases) including 6 cases of biliary leakage postoperatively, i.e. 1.34%. The causes of the bile leaks were in 4 cases, due to wounds of the bile ducts observed during the operation and in 2 cases they were due to the clamping of the unrecognized bile duct during the intervention.
More than half of the patients, or 52.10%, had a hospital stay ≤ 48 hours. The average duration of hospitalization was 2.5 days with extremes ranging from 2 to 10 days. The majority of operated patients, ie 99.35% of the workforce, discharges with a favorable outcome. We noted 3 cases of postoperative death in the short and medium term, including 1 case for hemodynamic instability linked to poor general condition (coelio exploratory for cancer), 1 case for acute cholangitis and 1 case for post-transfusion hemolysis in a sickle cell patient.
Conclusion
Laparoscopy is feasible in our environment. It is a minimally invasive procedure with low morbidity and mortality. However, we must extend our indications to other pathologies.
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