Incidence and outcomes of cases of caesarean scar ectopic pregnancy in a tertiary referral centre

Background. Caesarean scar ectopic pregnancy (CSEP) is a rare condition in which the implantation of the gestational sac takes place within the uterine scar of a previous caesarean section (CS). If the pregnancy continues within the uterus, the risk of placenta accrete or uterine rupture is increased.Objective. To investigate four treatment methods, based on each patient's clinical presentation, gestational age of the pregnancy and haemodynamic stability, for the management of CSEP.Methods. CSEP cases (N=30) were diagnosed by ultrasound at the Shatby Maternity University Hospital, Egypt. Various treatment modalities, based on gestational age, were employed to treat the patients. Treatments included suction curettage (n=12), embryo reduction with local methotrexate injection (n=12), laparoscopic excision (n=3) and excision through laparotomy (n=3). Serum levels of beta-human chorionic gonadotrophin (ß-hCG) were measured at diagnosis and weekly following treatment until the levels returned to non-pregnant values.Results. There was a significant positive correlation between gestational age in weeks and the CSEP management strategy employed. ß-hCG levels decreased from before treatment to the end of the follow-up period 3 weeks later.No cases required a hysterectomy, and no maternal complications were reported in this study.Conclusion. The appropriate CSEP management strategy varies according to gestational age. Suction and embryo reduction with local methotrexate injection offers an effective, safe and minimally invasive surgical treatment to remove ectopic pregnancy tissue. Closely monitored follow-up of patients, including serial measurement of ß-hCG levels and ultrasonographic examinations, is recommended after CSEP management

Laparoscopy in gastro- intestinal tumors

Background: Cancer is a major public health problem worldwide. Many studies have shown that the completion of adjuvant chemotherapy improves the survival rate. Objectives: The aim of the current study was to discuss the efficacy and role of diagnostic and therapeutic laparoscopy as a new trend in managing gastrointestinal tumors. Patients and Methods: This prospective study included a total of 50 patients, whom had gastro-intestinal tumor diagnosed by tissue biopsy and histopathology attending at General Surgery Department, Sayed Galaal Al-Azhar University Hospital. The hospital statistically significant data for the included 50 patients, pre and post diagnostic laparoscopy and surgical intervention were collected and analyzed. Results: A significant percentage of intra-abdominal cancers prove to be inoperable because of metastatic or locally advanced disease despite a preoperative workup suggesting a potentially resectable disease. Conclusion: It could be concluded that diagnostic laparoscopy is accurate staging tool for gastro intestinal tumors as staging method prior to surgery that can change plan to start neoadjuvant chemotherapy (CTR) instead of surgery. Laparoscopic surgery shows also short post- operative patient stay at hospital and early start of CTR

Comparative clinical study between preoperative oral administration of paracetamol, celecoxib and pregabalin on postoperative pain in gynecological laparoscope

Background: Since the introduction of laparoscopic surgeries, postoperative pain has been generally reduced. However, it can still peak, especially during the early postoperative period and becomes the main cause of overnight hospital stay and prolonged convalescence after this day-case surgical procedure. Thus, optimizing postoperative pain relief, not only to sub-serve reduction of its intensity but to also enhance the recovery and shorten length of stay became the broader target of multimodal pain control regimens nowadays. That is why; searching for a drug that would be effective in reducing pain, safe from major adverse effects and can meanwhile possess an opioid-sparing potentiality would be a merit so as to improve the success rate of ambulatory day-care surgeries. Objective: To study the analgesic effects of preemptive single oral dose of paracetamol, celecoxib and pregabalin in patients undergoing gynecological laparoscope. Method: Preoperative evaluation, preparation and premedication was assessment, and routine laboratory investigations was done. Postoperative pain, Level of Sedation was measured. Results: There was statistical significant difference between the three groups regarding VAS. There was statistical significant difference between the three groups regarding the total pethidine consumption. Regarding postoperative level of sedation, blood glucose there was no statistical significant difference between the three groups. Conclusion: Oral pregabalin in a dose of 150 mg 2 hour before surgery, is significantly attenuating pain intensity and total meperidine consumption during the first 6 hours postoperatively

A modified open primary laparoscopic surgery port placement through umbilical tube

Background:A safe, reliable technique for primary trocar introduction is important for laparoscopic surgery. In resource-constrained settings where there is paucity of needed equipment and cost is prohibitive, a method utilizing fewer instruments will be useful.Aim:This study aims to describe a method of primary trocar introduction that utilizes any available port.Methods:A supra- or infra-umbilical incision is made into an everted tubular umbilicus. The linear alba is incised and the resultant opening bluntly developed, after which any available port is inserted using the trocar as a guide. The trocar is withdrawn while the sleeve is pushed in.Results:One hundred and three successful insertions were affected in 107 patients with age range of 1­75 years, with no significant gas leaks.Conclusion:This modified open approach is a simple and reliable way of primary port insertion. Access is gained easily in different age groups and umbilicus types

The first series of laparoscopic radical cystectomies done in South Africa

Background: Radical cystectomy (RC) with extended lymphadenectomy and urinary diversion remains the standard of care for muscle-invasive urothelial carcinoma. Laparoscopic radical cystectomies (LRC) have been performed at Groote Schuur Hospital (GSH) since 2009. We aimed to audit our data regarding complications and oncological outcome and compare it to data obtained from patients undergoing open radical cystectomy (ORC) by the same surgeon since 2007.Methods: All adult patients who underwent open and laparoscopic RC from 2007 to 2013 have been included in the study. Data on demographics, operative time, intraoperative blood loss, postoperative complications, margin positivity, and lymph nodes was obtained retrospectively by means of folder review.Results: Thirty (30) patients who underwent LRC and 32 who underwent ORC were included in the study. Participants undergoing ORC experienced shorter operative duration (301 minutes versus 382 minutes; p-value < 0.0001), increased blood loss (1376 ml versus 779ml; p-value = 0.0023) and transfusion requirement (2 units versus 0; p-value = 0.071) in contrast to LRC. Postoperative complications were more prevalent in the ORC arm compared to the LRC arm (61% versus 43%). Patients with a past medical history were at higher risk of experiencing postoperative complications (p-value = 0.04; Risk Ratio: 1.6). Margin positivity was comparable between the two arms. A higher number of nodes was sampled by the laparoscopic technique in this study (overall p-value = 0.07).Conclusion: Laparoscopic RC is associated with longer operative times, decreased blood loss, and equivalent oncological outcomes when compared to ORC. Laparoscopic RC is a feasible option in our setting

A randomised trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy

Background. Ruptured ectopic pregnancy (REP) is a common gynaecological emergency in resource-poor settings, where laparotomy is the standard treatment despite laparoscopic surgery being regarded as the optimal treatment. There is a lack of prospective randomised data comparing laparoscopic surgery with laparotomy in the surgical management of women with REP.Objective. To compare operative laparoscopy with laparotomy in women with REP.Methods. This was a randomised parallel study. One hundred and forty women with suspected REP were randomised to undergo operative laparoscopy or laparotomy. The outcome measures were operating time, hospital stay, pain scores and analgesic requirements, blood transfusion, time to return to work, and time to full recovery.Results. Operating time was significantly longer in the laparoscopy group (67.3 v. 30.5 minutes, p<0.001). Duration of hospital stay, pain scores and need for analgesia were significantly less in the laparoscopy group. Women in this group returned to work 8 days earlier and their time to full recovery was significantly shorter compared with those in the laparotomy group. Significantly more women undergoing laparotomy required blood transfusion than women in the laparoscopy group. In the latter group, 14.5% of women required blood transfusion compared with 26.5% in the laparotomy group (p=0.01). Conclusion. Operative laparoscopy in women treated for REP is feasible in a resource-poor setting and is associated with significantly less morbidity and a quicker return to economic activity

Gastrectomie longitudinale calibrée ou sleeve gastrectomie : expérience abidjanaise

Introduction : Le but de ce travail a été d'évaluer et d'analyser les 29 premiers cas de sleeve gastrectomie à Abidjan. Patients et Méthodes : Nous avons évalué le dossier des patients opérés pour obésité morbide dans 03 cliniques privées d'Abidjan par l'équipe du Pr N'Guessan Alexandre de 2009 à 2014. Ont été inclus tous les patients ayant bénéficié d'une sleeve gastrectomie laparoscopique pour obésité morbide. Résultats : 29 patients ont été opérés ; 28 femmes et 1 homme avec un âge moyen de 34 ans. L'indice de masse corporelle (BMI) compris entre 35 et 49 Kg/m2 avec des comorbidités. La procédure laparoscopique a été possible dans tous les cas sans conversion. La durée opératoire moyenne était de 3h. Les patients étaient exéat dans 70% des cas au 2ème jour post opératoire après un contrôle au bleu de méthylène. Quatre (4) complications (1 abcès sous phrénique, 1 occlusion du grêle, 1 sténose gastrique et 1 fistule digestive) ont nécessité une reprise opératoire. La mortalité opératoire était de 6.89%. environ 92,85% des patients avaient une perte d'excès de poids supérieure à 50% sur 4 ans, avec une amélioration des comorbidités. Conclusion : La sleeve gastrectomie est une technique réalisable dans nos conditions de travail. Elle nécessite une bonne sélection des patients, une équipe multidisciplinaire

Early experience with laparoscopic management of nonpalpable undescended testes

Background: Nonpalpable undescended testes (NPT) constitute 20%­30% of undescended testes, and its management has been a challenge both in diagnosis and treatment. Worldwide, laparoscopy is the current gold standard of management. In Nigeria, the management of NPT has largely been by open surgery with consequent high morbidity. In Nigeria, the trend is changing from a largely open management with its attendant high morbidity, to laparoscopic management which is the current worldwide gold standard of care. Aim: This study aims to classify the laparoscopic features of NPT and determine the outcome of managed cases in our center. Methodology: Prospective data were collected from consecutive patients who had laparoscopy for NPT at the Paediatric Surgical Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from June 2014 to July 2016. Results: A total of 15 patients with 23 testes were treated. There were eight patients with bilateral NPT; four had left and the remaining three right NPT. The age ranged from 1.2 to 29 years with a median of 5 years. Eleven out of the 22 internal inguinal rings were open. The position of the testes was canalicular (2), peeping (2), low abdominal (6), high abdominal (6), blind-ended vas (1), absent vas and vessels (5). No further intervention was needed for the six agenetic/atrophic testes. Standard open orchiopexy was done for the two canalicular testes. Eight testes were brought down by one stage laparoscopic orchiopexy while four were brought down by staged laparoscopic Fowler-Stephens procedure. Laparoscopic orchiectomy was done in two patients (a grossly dysmorphic testes [nubbin] and a high abdominal testis in a 29-year-old). Orchiopexy was successful in 11 out of 15 fixed testes. Of the unsuccessful ones, three testes were atrophic (volume less than what it was initially) while two were high scrotal (one testes has both complications). There was no conversion to open abdominal surgery. All patients were discharged within 24 h of surgery.Conclusion: Laparoscopy provides for a better management of NPT by combining diagnosis and intervention in the same sitting with a good success rate and minimal postoperative morbidity

Clomiphene resistant polycystic ovarian syndrome: Analysis of outcomes following laparoscopic ovarian drilling in infertile women in Ilorin, North-central, Nigeria

Background: Laparoscopic ovarian drilling (LOD) is one-off treatment modality for clomiphene citrate (CC)-resistant polycystic ovarian syndrome (PCOS) avoiding the need of medical therapy and its attendant complications. Aims and Objectives: This study aimed at determining the efficacy of LOD in women with anovulatory infertility secondary to CC-resistant PCOS and factors influencing reproductive outcomes. Materials and Methods: A cross-sectional study of infertile women who underwent LOD on account of CC-resistant PCOS between January 2012 and December 2015 at a tertiary institution. Results: Patients aged 24­38 years (29.7 ± 3.6 years) and their body mass index (BMI) ranges from 20 to 35 (26.3 ± 4.3). The majority (90.5%) were nulliparous. Most (61.3%) had primary infertility. Their duration of infertility ranges from 1 to 13 years (4.3 ± 2.7) and ovarian volume ranges from 10 to 24 cm3 (mean, right ovary = 15.2 ± 3.2; left ovary = 16.3 ± 3.2). The number of drills per ovary ranged from 4 to 14 (mean, right ovary = 7.4 ± 2.1; left ovary = 7.3 ± 2.1) and the luteinizing hormone/follicle stimulating hormone (LH)/FSH ratio ranges from 2 to 6 (3.2 ± 1.4). All achieved spontaneous resumption of menses and ovulation with mean durations of 4.0 ± 1.8 days and 5.3 ± 3.2 weeks, respectively. Eighty-three (60.6%) clinical pregnancies were recorded, of which 68 (49.6%) resulted to live births (61 singletons and 7 twin births) and 14 (10.2%) early first trimester miscarriages. The mean time interval from LOD to pregnancy was 4.4 ± 1.1 months. There was a significant association between BMI, duration of infertility, FSH/LH ratio, and pregnancy outcomes (P < 0.05). Conclusion: LOD is the most preferred treatment modality for CC-resistant PCOS as it resulted in higher pregnancy rate

Early experience with laparoscopic surgery in children in Ile-Ife, Nigeria

Background: Laparoscopy is not yet routinely employed in many Paediatric Surgical Units in Nigeria despite the advantages it offers. This study describes the preliminary experience with laparoscopic procedures in a single centre. Patients and Methods: A retrospective analysis of all children who had laparoscopic surgery between January 2009 and December 2013 at the Paediatric Surgical Unit of Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife was carried out. Their sociodemographic, preoperative and intraoperative data along with postoperative records were subjected to descriptive analysis. Results: Eleven (44%) diagnostic and 14 (56%) therapeutic procedures were performed on 25 children whose age ranged from 5 months to 15 years (Median: 84 months, Mean: 103 ± 64.1 months), including eight (32%) females and 17 (68%) males. Indications included acute appendicitis in 12 (48%), intra-abdominal masses in six (24%), three (12%) disorders of sexual differentiation, two (8%) ventriculoperitoneal shunt malfunctions and impalpable undescended testes in two (8%) children. The procedures lasted 15-90 minutes (Mean = 54 (±21.6) minutes). Conversion rate was 17% for two patients who had ruptured retrocaecal appendices. No intra operative complications were recorded while three (12%) patients had superficial port site infections post-operatively. All diagnostic (11) and two therapeutic procedures were done as day case surgery. The mean duration of hospital stay was 3.1 (±3.3) days for those who had appendectomies. Conclusion: Laparoscopic surgery in children is safe and feasible in our hospital. We advocate increased use of laparoscopy in paediatric surgical practice in Nigeria and similar developing settings

Analytical Retrospect of the First Successful Thoraco-laparoplasty for Congenital Diaphragmatic Hernia in a 1-day Old Newborn in Rwanda: A case review

Successful diaphragmatic surgeries with abdominal approaches have been reported nowadays in most developed and fully equipped surgical centers. Few reports exist in developing countries due to the rarity of the disease; and insufficiency of well-equipped centers for its accurate diagnosis and management. The following analytical retrospect describes a 1-day old newborn with congenital diaphragmatic hernia (CDH) received after 24hours of life and treated successfully at King Faisal Hospital Rwanda (KFH); with hernioplasty through a thoraco-abdominal approach. The newborn recovered perfectly well after surgery without complications. The discussion; herein; extends on the rationale and new practical concepts in the combination of both medical and surgical therapies; highlights some updated anticipatory preoperative and postoperative measures for a better overall outcome on such major and complex disease

Bilan d'activite coelioscopique dans un hopital secondaire. cas de l'hopital general d'Ayame (Cote d'Ivoire)

Objectif. Etablir le bilan de l'activite colioscopique a l'Hopital General d'Ayame Methode. Il s'agissait d'une etude retrospective et descriptive qui s'etait realisee a l'hopital general d'Ayame et qui concernait tous les actes coelioscopiques effectues dans le service de gynecologie et d'obstetrique du 02 janvier 2013 au 30 juin 2014. Nous avions etudie les caracteristiques socio-demographiques des patientes; les indications; les actes operatoires (diagnostiques et therapeutiques) et la morbidite postoperatoire. Resultats. Il a ete realise 45 interventions percoelioscopiques; soit 21% de l'activite chirurgicale gynecologique de l'hopital. Les patientes avaient un age moyen de 33;1 ans avec des extremes de 24 et 44 ans. Il s'agissait en majorite de nulligestes et primigestes (66%); de nullipares (71%); de cadres et de niveau scolaire superieur (48;8%); residant a Abidjan (66;6%) et vivant maritalement (75%). L'infertilite et la seconde consultation post-myomectomie etaient les indications avec respectivement 67% (30 cas) et 33% (15 cas). Les constatations per operatoires pour infertilite etaient dominees par les adherences periannexielles; les kystes ovariens et les obstructions tubaires avec des frequences respectives de 33%; 27% et 23%. L'adhesiolyse et la kystectomie representaient les actes chirurgicaux les plus realises dans des proportions respectives de 53;3% (24 cas) et 13;3% (6 cas). Dans tous les cas de seconde consultation postmyomectomie; nous avions note des adherences parmi lesquelles predominaient les type II (60%). Aucune complication operatoire n'avait ete observee. Conclusion : la colioscopie est realisable en dehors des structures sanitaires de niveau tertiaire. Une mise a niveau du personnel pourrait ameliorer sa pratique

Modern Management of Colorectal Cancer

Colorectal cancer affects approximately 1:20 of the population and in South Africa is largely managed by general surgeons. Management of this disease has undergone very significant changes over the last two decades. Until very recently; only two academic general surgery departments included a specialist colorectal unit; and this remains so in the majority of our universities. This has resulted in a generation of surgical graduates who are unfamiliar with; and unskilled in current best management practices for this disease. Rectal cancer is particular challenging and attracts extremely high morbidity and mortality; with poor oncological outcomes. Repeatedly; outcome has been shown to be worse in the hands of generalists; rather than specialist colorectal surgeons; of whom there are very few in the country. This review presents the most important advances of the last 20 years and highlights current controversies and frontiers

Experience with Diagnostic Laparoscopy for Gynecological Indications

Context: Diagnostic laparoscopy is an endoscopy procedure; which has become indispensable in the evaluation of the female reproductive organs especially in infertility. Aim: Experience with conversion to open laparotomy is presented and ways of averting this complication are discussed. Settings and Design: A retrospective study was performed. Materials and Methods: All the 1654 diagnostic laparoscopies performed at a private fertility center over a 10-year period (January 2000 to December 2009) were analyzed for indications; cases of conversion to open laparotomy; and measures taken to prevent this complication. Statistical Analysis Used: Simple percentage method was used. Results: Infertility was the commonest indication for 1627 (98.4) procedures; while primary amenorrhoea and chronic pelvic pain were responsible for 20 (1.2) and 7 (0.4) procedures; respectively. There was no mortality in this series. There was conversion to open laparotomy due to hemorrhage in only 2 (0.12) procedures and this happened at the first year of practice. Conclusions: The low rate of conversion was attributed to the surgeons experience; proper patient selection; and the use of Palmers point for insufflation in some patients with previous pelvic surgeries and use of supraumbilical access in patients with pelvic masses. Diagnostic laparoscopy for gynecological indications is safe and wider application of this modern technology is recommended for our practice

Laparoscopic Myomectomy for Infertile Patients with Intramural Fibroids: a Retrospective Study at a Tertiary Endoscopic Centre

Background: The safety of laparoscopic myomectomy has been questioned especially in the case of intramural fibroids. Objectives: To assess the safety of a laparoscopic myomectomy for intramural fibroids and study the subsequent effect on fertility Methods and Settings: A retrospective study of a tertiary endoscopic centre specialising in laparoscopic myomectomy. Results: 87 Patients were studied and there were no major complications. The conversion rate from laparoscopy to laparotomy was 3/87 (3.4) due to multiple fibroids. There was one case of uterine perforation during hysteroscopy. The overall pregnancy rate was 29/64 (45) with a spontaneous pregnancy rate of 18/29 (62). Conclusions: Laparoscopic myomectomy can be regarded as a safe alternative to abdominal myomectomy in the hands of the experienced surgeon resulting in good subsequent pregnancy rates

Laparoscopic General Surgery - The Journey So Far

Background: Laparoscopic surgery has evolved in a relatively short time to become a popular and integral part of the surgical armamentarium. An overview of developments which have taken place since its inception is presented. Methods: The PubMed database was searched for all eng language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. Conclusion: Laparoscopic surgery has developed rapidly; initially from a basically diagnostic procedure to a therapeutic one which is currently challenging time-honoured traditional methods of surgery. Technological advancements and enthusiasm as well as the desire for scar less surgery appear to be poised to push even further the frontiers of this discipline

Laparoscopic Repair of Penetrating Injury of the Diaphragm: an Experience from a District Hospital

In this study we review our experience in using laparoscopy as a diagnostic and therapeutic tool in dealing with penetrating diaphragmatic injuries due to stab wounds and look at the feasibility of using this procedure in other similar institutions. Thirty patients; all of whom were males 20-30 years of age; presented to the surgical emergency unit of our hospital with upper abdominal and lower chest wall stab wounds between 01-05-1998 and 30-11-2006. Diagnosis of the diaphragm injury was either obvious with omentum herniating through the chest wall; or occult with confirmation of the injury at laparoscopy. All patients underwent diagnostic laparoscopy; which resulted in identification and efficient treatment of eight patients with diaphragmatic injury; and thereby laparotomy was avoided. The procedure converted to open surgery in one patient because of a small left-sided colonic tear. Laparoscopy is an efficient tool for the diagnosis and management of diaphragmatic injuries. It should be used routinely instead of exploratory laparotomy in haemodynamically stable patients with penetrating lower chest injuries

Laparoscopy-assisted appendectomy via the patent umbilical ring (umbilical hernia): a case report

Umbilical hernia aswell as acute appendicitis are two of the most common problems seen by paediatric surgeons; although rarely simultaneously. When detected the operative approach is adjusted. We perform the a laparoscopically assisted appendectomy trough through the an excised umbilical hernia sac opening. The operative technique is presented. The most important advantages are single general anesthesia for the two surgical procedures and the use of present openingpatent umbilical ring as an access to inflamed appendix; what is the essence of a minimally invasive surgery;. Evaluating the results of the appendectomy superior cosmetic end result; minimal scaring and lower stress index are the advantages in comparisoncompared to the conventional open surgery. Shorter procedure and reduced costs are the advantages in comparison to the three port laparoscopic appendectomy. Efficacy and safety are the same as in single umbilical hernia repair