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Coelioscopy
surgery or laparoscopy is a “minimally invasive” and specialized technique for
performing surgery with numerous advantages to classical or traditional “open”
surgery. As such, to assess the place of laparoscopy in the state hospitals of
Cameroon, we carried out a descriptive retrospective survey of 11 years of
practice (2006-2016) in the general hospitals of Yaoundé and Douala as well as
the gyneco-obstetric and pediatric hospital of Douala. Data were collected from
the registers of patient medical files and surgical reports. Collected data
were analyzed with Sphinx Déclic Version 5. Khi2 was the statistical test used.
Results obtained reveals that 31.5% of laparoscopy was practiced within a
sample of 709 cases. Most concerned with this laparoscopy were women with 94.4%
compared to men with just 5.6%. The mean age of the sample size was 33.85 years
with extremes at 8 years and 74 years respectively. Gynecological laparoscopy
predominated with 89.6%, followed by digestive laparoscopy with 9.7%. We noted
equally throughout this study the conversion of laparoscopy to tradition “open”
surgery in 5.2% of the cases, motivated by important adhesions in the abdomen.
Keywords: Laparoscopy, Cameroon, Surgery
INTRODUCTION
Laparoscopy is a type of surgical procedure
that allows a surgeon to access the inside of the abdomen and pelvis without
having to make large incisions in the skin. The development of laparoscopic
surgery was clearly a gradual evolution and not a revolution. Since the
beginning of laparoscopy under the protection of the French gynecologist Raoul
Palmer in 1955, it has witnessed important evolutions regarding materials,
diagnosis and therapeutic domains [1]. As such, with the development of new
surgical materials, laparoscopy has become a gold standard in the cure of
certain surgical pathologies. In fact, laparoscopic surgery has much less
discomfort and requires less pain medicine. Patients are able to get up and
walk around sooner and get back to their regular activities earlier. They are
also less likely to develop wound infections and because patients are able to
get out of bed sooner they are less likely to develop blot clots or pneumonia.
After the incisions have healed the scars are almost invisible so patients do not
have to feel self-conscious at the beach or pool. As a result, approximately
80% of gynecologic surgery is practiced by coelioscopy [2]. The transfer of
technology to developing countries concerning laparoscopy is still nowadays
limited due to insufficient investment in technical equipment’s, limited human
resources and know-how. In Cameroon, this technic has been introduced for the
first time in April 1992 at the general hospital of Yaoundé. A study carried
out after 5 years of practice in Yaoundé showed that 735 surgeries were
practiced with laparoscopy [3]. Today, less review concerning this subject is
found written in our local literature; hence, we decided to evaluate the place
of this surgical technic in our hospitals here in Cameroon and notably its
frequency and complications.
OBJECTIVES
General objective
Establish an assessment of the practice of laparoscopic surgery in
Cameroon.
Specific objectives
·
Determine the socio demographic
characteristics of concerned patients
·
Determine the frequency of laparoscopic
surgery
·
Identify the surgical indications of
this practice
·
Describe the principal complications
METHODOLOGY
Type and study
period
Descriptive retrospective study going from
January 1st 2006 to December 31st 2016, either a period
of 11 years of practice.
Data collection
duration
Data were collected within a period of 4
months going from April 1st 2017 to July 31st 2017.
Place of study
This study was carried out at the
gyneco-obstetric hospitals of Yaoundé and Douala and at the general hospitals
of Yaoundé and Douala.
Population source
Surgical patients of the concerned hospitals.
Population size
Concerns the population of all the patients
who when through a laparoscopic surgery during procedure.
Inclusion criterion
All laparoscopic surgery in the concerned
hospitals with or without conversion to traditional surgery.
Non-inclusion
criterion
Laparoscopic surgeries of other sources non-identified
and traditional surgery.
Sampling
We went through an exhaustive sampling
procedure recruiting all laparoscopic cases without any distinction and a total
of 709 patients were enrolled.
Data collection
Data were collected from registers and the
different variables concerned were mainly the socio demographic
characteristics, preoperative diagnosis, laparoscopic technic of procedure and
complications.
Materials for data
collection
We used: patients medical files, registers of
hospitalization, registers of surgical reports and individual survey files.
Data analysis
Data analysis was made possible by the means
of Microsoft Office 2013. The different variables in accordance with the study
objectives were taken into account and analyzed by the software sphinx déclic
version 5. Khi2 was the statistical test used.
RESULTS
The analysis of data permitted us to obtain
the following results:
The evolution of coelioscopy surgery between
2006 to 2016.
The Figure
1 shows that laparoscopy have evolved by jerks and jumps between 2006 and
2014. And from 2014 to 2016, it observed a net progression as the number of
surgery increased from 48 in 2014 to 230 in 2016.
Age distribution
We note that, the age group of 30 years to 39
years was the most represented age group with a rate of 58%. The mean age of
the sample size was 33.85 years with extremes at 8 years and 74 years,
respectively (Table 1).
Patient’s
distribution following sex
Almost all the patients were of the female
sex with 94.40% (Figure 2).
Distribution of
patients following the type of surgery
The Figure
3 below shows that laparoscopy is mainly practiced in gynecology with a
percentage practice of 89%.
Evolution of the
different types of surgery within years
Coelioscopic surgery in gynecology is the
most practiced among the other laparoscopic technics in others surgical domains
(Table 2).
Incidents
and accidents
We have registered 04 cases of hemorrhage
during surgery, 02 uterine perforations, 01 intestine lesion and 01 bladder
lesion. We equally registered 03 cases of gas escape and one trocar defect
during surgery. Globally 5% of the laparoscopies were converted to traditional
surgery (Table 3).
DISCUSSION
Among 4426 laparotomies carried out within
the period of 2006 to 2016, 1381 laparoscopies were practiced thus 31.2%. This
result is slightly less than that reported by Tchuente et al. [4] in Yaoundé
who obtained 39.1%. This may also be as a result of the size of the population
studied because we focused only on state general hospitals.
Age
The youngest age sample of this study was 8
years and the oldest 74 years with a means age of 33.85 years. The most
represented age group was that of 30 to 40 years with 58%. Similar results were
obtained in Douala with Belley priso et al. [5] and Nana et al. [6] in Yaoundé
which are respectively 32 and 32.7 years. Mboudou et al. [7] in Yaoundé
obtained a mean age of 31.7 ± 5.4 years with extremes at 6 and 47 years.
Sex
The sample study regrouped 94.4% female and
5.6% male. The high representation of women in this study may be as a result of
the great number of gynecological pathologies and preferences for laparoscopy
for surgeries.
Type of surgery
Throughout the study, gynecological surgery
predominated with 89.6%, followed by digestive surgery with 9.7% and then
stating cancer with 0.7%. Results are similar to those of Fe Togola [8] in
Bamako who obtained 67.9% practice in gynecology followed by 29.6% practice in
digestive surgery. This high rate of gynecologic pathology in this study may be
explained by the fact that gynecologic laparoscopy is one of the most ancient
technic.
Conversion and
motifs
During the course of this study, 5.2% conversion
was observed either 37 cases. Among this number were 4 digestive cases and 33
gynecologic cases. Our results look greater than those of Tcheunte et al. [4]
who obtained 2.46% conversion from laparoscopy to traditional laparotomy. On
the other hand, Sokol et al. [9] obtained 6.3% conversion which is closer to
our results. Numerous pelvic adhesions were recorded and were for the most the
first reason of conversion with a rate of 41.7% followed by enormous myoma
which represented 22.2% and lastly hemorrhages with 13.9%. These tendencies
were reported by Coulibaly in 2007 [10].
Perioperative
accidents
We recorded 2 perioperative accidents during
this study period. It has been reported 4 vascular sections during appendectomy
and 2 during extra uterine pregnancy cure. The only case of vascular section in
hemorrhages following the section of the lombo-ovarian section is reported by
Tcheunte et al. [4]. Two uterine perforations, one intestinal and bladder
lesion concords with the three cases of organ lesions reported by Tcheunte et
al. [4].
Per operative
incidents
Five per operative incidents were recorded in
this study, either 0.7%. The incidents were CO2 escape in three cases and
trocar defect in one case. We obtained more incidents than Fosto in Bamako who
obtained 0.2% [11].
Post-operative
follow up
Post-operative complications in this study
was of the order of 4.52%, much less than that of Tcheunte and al. [4] who
obtained 8.3% but a little bit greater than that of Mboudou et al. [7] which is
3.9%. Suppuration of the site of incision was observed in five cases either a
rate of 0.7% which is above the values in the other literatures which varies
between 0.18% to 0.5% [12-14]. Three cases of peritonitis post-surgery due to organ
lesion was recorded and a case of incisional hernia either a rate of 0.14%.
This result is similar to that of Tcheunte et al. [4]. One case of death due to
peritonitis was registered corresponding to 0.14% in this study.
Hospitalization and
post-surgery stay
Study reports 86.3% a hospitalization period
of 72 hours with and average stay period of 3.19 days. This result is similar
to that of Koumare in 2007 [15]. As for post-surgery stay period, the mean of
this study is 1.16 days. Bendinelli in 2002 [16] on the other hand obtained 3.7
days in average. Meanwhile Raiga et al. in Cameroon [17] and Henrion in France
[18] obtained, respectively, 3 days and 2.84 days. The longest stay period was
21 days after surgery.
CONCLUSION
The objective of this design study was to
assess the activities of laparoscopic surgery in state general hospitals of
Cameroon. It results that, the frequency of laparoscopy was of the order of
31.2% within study period of 2006 to 2016. Gynecologic laparoscopy was the most
practiced with a frequency of 89.6%. Several morbidities were recorded and
dominated by post-surgical procedures related to digestive troubles and
infections with respectively 2.12% and 0.85%. At last, laparoscopy is a reality
in Cameroon hospitals and proven its efficiency with a mortality rate of 0.14%
within 11 years of practice even though still not really practiced. Its
practice may be valorized and encouraged by the engagement of public
authorities.
CONFLICTS OF
INTEREST
Authors declare no conflicts of interest.
AUTHOR’S
CONTRIBUTION
Ngaroua and Joseph Eloundou Ngah: conception
and planification of the study, supervision.
Aminatou Soufianou, Djibrilla Yaouba and
Dah’Ngwa Dieudonné participated to the literature review and writing of this
work.
SPONSORSHIP
Declared none.
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