Local adaptations aid establishment of laparoscopic surgery in a semiurban Nigerian hospital.
BACKGROUND
Establishing and sustaining the routine practice of laparoscopy in resource-limited settings is extremely challenging. We present our experience implementing laparoscopic surgery at the Obafemi Awolowo University Teaching Hospital in Western Nigeria and the associated modifications that were necessary for success.


METHODS
We reviewed all laparoscopic cases performed at our institution from January 2009 through December 2011. Operating surgeons were trained locally. Laparoscopic equipment and instrumentation was procured by both local and foreign sources.


RESULTS
One hundred eighty-one procedures were performed in 175 patients whose ages ranged between 18 and 72 years. The procedures included cholecystectomies (n = 48, 24.5 %), appendectomies (n = 36, 20 %), diagnostic laparoscopies for staging and biopsy of intra-abdominal masses (n = 53, 30.9 %), adhesiolyses (n = 18, 11.6 %), hernia repairs (n = 6, 3.2 %), colorectal surgeries (n = 2, 1.3 %), and others (n = 18, 8.4 %). Diagnostic procedures were performed as day cases. Duration of stay for hospital admissions was 1-3 days. There were four conversions to open operation due to technical difficulties with equipment. No deaths were recorded. Local adaptation techniques facilitated cost reduction. Overall, there was improvement in the acceptance of the laparoscopic procedures among our patients and coworkers.


CONCLUSIONS
Our local institution has successfully adopted laparoscopic techniques to treat surgical diseases. Specific improvisations have helped establish and sustain this technology. We advocate similar local adaptations to increase the use of laparoscopic surgery in hospitals located in limited resource settings.
Department of Surgery, Obafemi Awolowo University, Ile-Ife 220005, Nigeria. wadisc@yahoo.com
Adewale O
AO
Adisa
Oladejo O
OO
Lawal
OlukaYode A
OA
Arowolo
Olusegun I
OI
Alatise
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006757:Hospital Units / Q000458:organization & administration*; D006786:Hospitals, Urban; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D055815:Young Adult