Early Experience with Laparoscopic Surgical Practice in Ondo State, South Western Nigeria.

BACKGROUND: Laparoscopic surgery is a relatively new and expanding field of surgical therapy in Ondo state. This is a multi-centre study cataloguing the work of the authors in Ondo State, Nigeria. AIM: To determine the indications, operative findings, and interventions at Laparoscopy in our resource challenged settings. PATIENTS AND METHODS: Medical records of all patients who had laparoscopic procedure at the Federal Medical Centre, Owo, Ondo State Specialist hospital, Okitipupa, University of Medical Sciences Teaching Hospital, Ondo, George and Martins Medical Centre, Ore and Mishmael Hospitals and Clinics, Akure from December, 2009 to December, 2018 were reviewed. Data on patient's age, gender, indications for surgery, duration of hospital stay, outcome of surgery were analyzed. Challenges and adaptations were also noted. RESULTS: One hundred and eighty-one (181) laparoscopic procedures were done, but only 152 had complete records for review. The median age was 35.5 years (mean = 33.7±11.4years; age range of 8 month -72 years). There were more males 88(57.9%) than females, 64(42.1%). Laparoscopy was purely diagnostic (n=28,18.4%), therapeutic (n=118, 77.6%) or both (n=6, 3.9%). Cholecystectomy (n=76, 50%) and appendicectomy (n=37, 24.3%) were the two most common procedures done. In the paediatric patients, patent processus vaginalis (hernia), cryptorchidism and indeterminate sex (gender) were common indication. Challenges encountered were power failure (n=3, 2%), equipment failure (n=4, 2.6%) and difficult dissection (n=4, 2.6%). The mean duration of surgery was 96.96(±25) minutes (diagnostic), 150 (±57.6) minutes (therapeutic); while the mean duration of hospital stay was one day (diagnostic) and 2.3(±1.7) days for therapeutic interventions. CONCLUSION: Laparoscopic service is achievable with adequate motivation, males appear to benefit more in our setting, and the service transcends all aged groups.

Single versus two layer suturing for wound closure after inguinal hernia repair.

OBJECTIVE: Method of skin-subcutaneous closure after inguinal herniorrhaphy affects the operation time and immediate outcome of the wound. The study was aimed to assess the effects of a single layer closure of the skin and subcutaneous wound of inguinal herniorrhaphy, in contrast to the conventional two layer closure. DESIGN: Prospective randomized controlled trials. SETTING: Obafemi Awolowo University Teaching Hospital Ile-Ife, Osun State, Nigeria. PATIENTS AND METHOD: All adult patients attending surgical out patient clinic with uncomplicated inguinal hernia and had surgery, after randomization into two groups from June 2000 Dec 2005 were included in the study. One group had one layer - closure i.e. closure of skin and subcutaneous tissues together at once while the second group had two layer closure i.e. closure of skin and subcutaneous tissues separately. Duration of operation and complications were documented for comparison. RESULTS: One hundred and eighty wounds were studied in 160 patients; the extra wounds being from bilateral inguinal hernias. There were 93 wounds in group one (two layer closure) and 87 wounds in group two (one layer closure. There was no significant difference between healing of wounds and appearance of scars in both groups. The single layer closure group was, however, apparently quicker. (P= 0.006). CONCLUSION: The immediate outcome of the wound in both groups was similar. The medical personnel time was saved by closing the wound in single layer.

Priapism in southwestern Nigeria.

OBJECTIVES: To determine the aetiology, pattern of presentation, treatment regimen and outcome of management of priapism in our environment and to compare our findings with previous studies in this country and elsewhere. DESIGN: A 10-year retrospective study from January 1991 to December 2000. SETTING: Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. PATIENTS AND METHODS: Hospital records of 16 patients managed for priapism over 10 years (January 1991 to December 2000) were analysed. Information extracted included the age, occupation, duration of symptoms, precipitating factors, past medical history, haemoglobin genotype, drug and social history, physical findings, treatment regimen, outcome of treatment, complications and duration of follow up. Eighteen patients were treated for priapism during the period but only sixteen case files available for analysis were reviewed in this study. RESULTS: The mean age of the 16 patients under review was 20.4 years (range: 2.5-38 years). Thirteen patients (81%) were single and 10 (62.5%) were students. All the patients presented late with pain and woody hard penis with mean duration of eight days (range; 7 hrs-30 days). Eleven patients (68.7%) had previous episodes of priapism. Fourteen patients (87.5%) had sickle cell disease (SCD) and two (12.5%) were psychiatric patients on oral chlorpromazine. Associated medical conditions include urinary tract infection, malaria, acute urinary retention, bone pain crises and acute psychosis. All the patients received initial conservative management. Six patients had needle aspiration with irrigation plus injection of 2 ml of adrenaline solution (1 ml 1/1000 adrenaline in 200 ml saline) in both corpora cavernosa. One (16.7%) out of the six patients achieved full detumescence with normal erection. The remaining five patients later had cavernotomy with full detumescence and normal erection in three (60%) and weak erection in two (40%). Eight patients had Cavernosa-glandular shunt, full detumescence and normal erection was achieved in five patients (62.5%) while three (37.5%) became impotent. Two of the three patients with impotence presented with the longest duration of symptoms (14 and 30 days respectively), while the third patient reported earlier after five days, but he had suffered more than six (>6) previous attacks of priapism. Duration of hospital stay was 3-10 days and the average duration of follow up was 80.7 weeks. CONCLUSION: Sickle cell disease account for 87.5% of priapism in our community. Late presentation and previous episodes of priapism, which are common features in most of these patients, are associated with poor prognosis with higher risk of impotence. Conservative management and aspiration with intracavernous adrenaline therapy appears ineffective in late case. However, good results obtained with surgery indicate that late presentation should not be a deterrent to surgical intervention. Surgeries in form of cavernotomy or cavernosa-glandular shunt, when carefully done, are effective and safe.