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

Laparoscopic varicocelectomy versus modified Palomo's Operation

A total number of 40 patients with varicocele grade 2 to 3 were subjected to this study. They were divided into two groups randomly, each containing 20 patients. The first group was operated upon using the midified Plamo's operation. This group consisted of 6 patients with bilateral varicoceles, 12 with left ones and two cases with right ones. The second group underwent laparoscopic varicocelectomy. It consisted of 8 patients with bilateral varicoceles and 12 cases with left varicocele. There was no difference noticed between the two groups as regards the improvement in semen analysis postoperatively. But in the second group the postoperative morbidity, pain and hospital stay were markedly reduced, as the feasibility of bilateral ligation through the same incisions was safe for the patient. Laparoscopic varicocelectomy has ability to visualize the testicular artery and veins very clearly, due to the magnification of the field and hence the accidental ligature of the artery was not present. The collateral veins were more amenable to ligation using the laparoscopic technique in addition to the proper ligation of their spermatic veins as near as possible from the internal ring below any collateral. Hence 2 cases of recurrence were noticed in their postoperative follow up of the first group but none in the second group. However, laparoscopic varicocelectomy takes a little bit more operative time