Prospective, randomized clinical trial of laparoscopic totally extraperitoneal inguinal hernia repair using conventional versus custom-made (mosquito) mesh performed in Cameroon: a short-term outcomes.

BACKGROUND: Adverse economic conditions often prevent the widespread implementation of modern surgical techniques in third world countries such as in Sub-Sahara Africa. AIM OF THE STUDY: To demonstrate that a modern technique (laparoscopic totally extraperitoneal inguinal hernioplasty [TEP]) can safely be performed at significantly lower cost using inexpensive mesh material. SETTINGS: Douala University Hospital Gynecology, Obstetrics and Pediatrics and two affiliated centers, Ayos Regional Hospital and Edéa Regional Hospital in Cameroon. PATIENTS AND METHODS: Prospective randomized controlled trial (RCT) of consecutive adult patients presenting with primary inguinal hernia treated by TEP, comparing implantation of sterilized mosquito mesh (MM) with conventional polypropylene mesh (CM). Primary endpoints were peroperative, early and midterm postoperative complications and hernia recurrence at 30 months. RESULTS: Sixty-two patients (48 males) were randomized to MM (n = 32) or CM (n = 30). Groups were similar in age distribution and occupational features. Peroperative and early outcomes differed in terms of conversion rate (2/32 MM) due to external (electrical power supply) factors and mesh removal for early obstruction (1/30 CM). No outcome differences, including no recurrences, were noted after a median follow-up of 21 months. CONCLUSION: In this RCT with medium-term follow-up, TEP performed with MM appears not inferior to CM.

First steps of laparoscopic surgery in a sub-Saharan African setting: a nine-month review at the Douala Gynaeco-Obstetric and Pediatric Hospital (Cameroon).

OBJECTIVES: To describe the first laparoscopic surgeries in a tertiary hospital in Cameroon. METHODS: We carried out a descriptive study at the Douala Gynaeco-Obstetric and Pediatric Hospital (DGOPH). We examined the files of the 45 patients who underwent laparoscopic surgery from November 1, 2015 to July 31, 2016. Descriptive statistics were computed for patients' characteristics and surgical parameters. RESULTS: Mean (SD) age was 36.8(11.9) years. Women made up 86.7% of the sample. Twelve patients (26.7%) had a previous laparotomy. Cash deposit (86.7%) was the main mode of payment. Thirty-two (71.1%) laparoscopies were gynaeco-obstetrical (GO) and 13 (28.9%) were digestive. Main indications were infertility (59.4%) and chronic cholecystitis (30.8%) for GO and digestive laparoscopies respectively. Mean (SD) durations were 89.1(57.5) and 55.5(41.0) minutes for digestive and GO laparoscopies respectively. Mean (SD) costs were 1065.4 (406.1) and 934.2 (657.0) USD for digestive and GO laparoscopies respectively. Mean (SD) lengths of hospital stays were 5.5 (2.5) and 5.5 (2.5) days for digestive and GO laparoscopies respectively. Local staff carried out all GO laparoscopies while foreign (Belgian) experts did digestive cases. Only one (2.2%) complication (colic perforation) was registered. CONCLUSION: The beginnings of laparoscopy at the DGOPH were successful thanks to strong local leadership and Belgian technical assistance.

Successful medical treatment of a hepatic pregnancy: a case report.

BACKGROUND: Hepatic pregnancy is a rare form of abdominal pregnancy, often documented only as case reports. CASE PRESENTATION: We report here the case of a 24-year-old African woman, gravida 4 para 3, presenting with right upper quadrant pains and metrorrhagia after amenorrhea of 8 weeks 5 days. Elements in favor of the diagnosis of hepatic pregnancy were her clinical presentation, the kinetics of ß-human chorionic gonadotropin titers, and the presence of a sub-hepatic mass on ultrasound. We successfully treated this patient with intramuscular methotrexate only. CONCLUSIONS: The interest of this case resides in the rarity of this condition and the therapeutic approach used. Clinicians should raise their index of suspicion for hepatic pregnancy when faced with females of reproductive age with such a clinical presentation.

[How do Cameroonian women experience their first gynecological examination? How can the procedure be modified to improve this experience?]. / Le vécu du premier examen gynécologique en milieu africain : cas du Cameroun Quels ajustements apporter à son déroulement pour un meilleur vécu ?

UNLABELLED: The gynecological examination is a key element in the diagnosis of the most genitourinary disorders. Improving how women experience the first gynecological examination (FGE) should have a significant impact on their perception of this examination and on their general feeling about it afterwards. OBJECTIVE: The aim of our study was to describe the general feeling of Cameroonian women towards the FGE and to identify the factors associated with negative feelings. METHODOLOGY: In this one-month survey study, we asked patients to complete a questionnaire about how they had experienced the FGE. The answers have been analyzed and the factors influencing the way they experience this examination determined. RESULTS: At the end of the FGE, 41.5% of the women had negative feelings, and 38.6% reported that the examination had been painful. The average age of women who experienced pain was younger than that of those who did not [19.4 vs 20.39 years, P = 0.029], as was that of women with negative feelings lower [19.41 vs 20.43 years, P = 0.024]. A negative experience was significantly associated with a painful examination [P≤0.001], an examiner not specialized in gynecology [P = 0.04], lack of information [P = 0.001], and lack of a separate room to undress [P = 0.038]. The rate of subsequent refusals of a gynecological examination was higher among women with a negative first experience [56.2% vs. 35.9%, P = 0.008]. CONCLUSION: The FGE is experienced by Cameroonian women as very difficult. Their feelings at the end of this examination significantly influences their behavior towards gynecological examinations in general.

[Impact of excessive weight gain during pregnancy on maternal and fetal outcome at the Yaoundé Women's and Children's Hospital (Cameroon)]. / Impact du gain pondéral excessif pendant la grossesse sur l'issue maternofœtale à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé (Cameroun).

UNLABELLED: Excessive weight gain (EWG) during pregnancy can cause maternal and fetal complications. It has not yet been studied in our social environment, however. OBJECTIVES: Our study aimed to describe maternal and fetal outcome in women gaining excessive weight during pregnancy in Cameroon. METHODOLOGY: This cross-sectional descriptive study took place over a two-month period. Women were interviewed after delivery and grouped in two categories: those who did and did not have EWG during pregnancy. The complications due to EWG were analyzed. RESULTS: The frequency of EWG in pregnancy was 35.5%. The incidence of high blood pressure was 9.8% for patients with EWG, and 6% for those with normal weight gains (P = 0.301). The mean birth weight of the babies of women with EWG was 3,433 g, significantly higher than the 3,103.7 g (P = 0.001) of the babies in the other group. Patients with EWG had significantly fewer babies with low birth weight (P<0.05) and significantly more with macrosomia (P<0.01). The cesarean rate was higher, but not significantly so, for women with EWG (23.2% vs 16.1%, P = 0.187); this was the case as well for postpartum hemorrhage and (1- and 5-min) Apgar scores as well. CONCLUSION: EWG is associated with a higher incidence of macrosomia, but does not significantly increase the rate of cesarean births or modify the Apgar scores.

[Risk factors and prognosis of emergency cesarean delivery at the Yaoundé Women's and Children's Hospital, Cameroon]. / Facteurs de risque et pronostic des césariennes d'urgence à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé (Cameroun).

OBJECTIVE: To identify the risk factors for emergency cesarean deliveries and assess the effects of the emergency situation on maternal and fetal prognosis. METHODS: This retrospective cohort study compared emergency and elective cesarean deliveries performed at the Yaoundé Women's and Children's Hospital in Cameroon, analyzing socioeconomic variables, the indications for surgery, and complications for mother and child. RESULTS: Risk factors predisposing to emergency cesareans were: age <20 years, not having a salaried job, unmarried status, no university-level education, referral from other health facilities, primiparity, prenatal care in a health center or in a district hospital, prenatal care by a nurse, and preadmission rupture of membranes. Emergency cesareans increased the mothers risk of general anesthesia, unavailability of standard preoperative work-up during surgery, infection, and a longer hospital stay. Babies born by emergency cesarean delivery had a higher risk of admission to the neonatology unit, neonatal asphyxia, neonatal infection, preterm birth, and perinatal death. CONCLUSION: In our setting, lack of reproductive experience (primiparity), low socioeconomic level, poor prenatal care, and preadmission rupture of membranes were risk factors for emergency cesarean deliveries. The emergency situation exposes mother and child to a significant risk of morbidity and mortality.

[Diagnosis and treatment of breast cancer in Cameroon: a series of 65 cases]. / Diagnostic et traitement du cancer de sein au Cameroun: a propos de 65 cas.

AIM: The objective was to describe the clinical and therapeutic aspects of breast cancer at the Yaounde Gynaeco-Obstetric and Pediatric Hospital, which is a referral centre for gynecological malignancies. METHODS: It was a retrospective descriptive study over a period of four years, from June 1st 2003 to May 31st 2007. RESULTS: Sixty five patients were identified during the study period. The mean age and parity were respectively 42.9 ±13.6 years and 3.9 ± 2.1. The mean age of onset of the first menses was 14.0 ± 1.5 years. Most patients were under 50 (72.3%) and had given birth at least once (89.2%). Non menopausal period (75.4%) and breastfeeding (76.9%) were frequently found. The patients consulted 9.2 ± 3.4 months after the onset of symptoms, with 78.5% of cases arriving at a local advanced clinical stage. Ductal carcinoma accounted for 75.4% of histological types, SBR grades 1 and 2 being the most frequent (89.2%). Chemotherapy (69.2% of the cases) and surgery (67.7% of the cases) often radical (three out of four) were the main treatment modalities used. CONCLUSION: In Yaounde, breast cancer is often a ductal carcinoma of high histological grade, attacking the quarantine non menopausal woman, who gave birth and breastfed at least once, diagnosed with a local clinical advanced disease. Chemotherapy and surgery are the main therapeutic options implemented.

BUT: Il s'agissait de décrire les aspects cliniques et thérapeutiques du cancer du sein à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé qui est un centre de référence pour la prise en charge des cancers gynécologiques. MATÉRIEL ET MÉTHODES: C'était une étude descriptive rétrospective sur une période de 4 ans allant du 1er Juin 2003 au 31 Mai 2007. RÉSULTATS: Soixante-cinq malades ont été colligées pendant la période de l'étude. L'âge et la parité moyennes étaient respectivement de 42,9 ±13,6 ans et 3,9 ± 2,1. L'âge moyen de survenue des ménarches était de 14,0 ± 1,5 ans. La plupart des patientes avait moins de 50 ans (72,3%) et avait accouché au moins une fois (89,2%). La période non ménopausique (75,4%) et l'allaitement au sein (76,9%) étaient fréquemment retrouvés. Le délai moyen de consultation était de 9,2 ± 3,4 mois, avec 78,5% des cas arrivant à un stade clinique local avancé. Le carcinome canalaire représentait 75,4% des types histologiques, les grades histologiques SBR 2 et 3 étant les plus fréquents (89,2%). La chimiothérapie (69,2% des cas) et la chirurgie (67,7% des cas) souvent radicale ( trois fois sur quatre) étaient les principales modalités thérapeutiques utilisées. CONCLUSION: A Yaoundé, le cancer du sein est souvent un carcinome canalaire de haut grade histologique, intéressant la quarantenaire non ménopausée, ayant accouché et allaité au sein, et consultant à un stade local avancé. Il est souvent pris en charge par chimiothérapie et par chirurgie.

Conservative treatment of ectopic pregnancy in a sub-Saharan African setting.

In the sub-Saharan African setting, laparotomy for salpingectomy is the common method of treatment for ectopic pregnancy (EP). The objective of this retrospective study was to find out how common EP is treated conservatively in the Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon. Of the 281 patient files analysed, 126 patients (44.8%) were treated conservatively and successfully for EP. Of these, 86 (68.2%) had received conservative surgical treatment while 40 (31.8%) had non-surgical treatment. Salpingostomy was the conservative surgery for 79.1% of the cases. According to the publications available for the sub-Saharan setting, the rate of conservative management of EP at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon is high. We recommend that this rate should be improved so that, eventually, the conservative treatment methods of EP become routine.