Page 19 - Journal of Laparoscopic Surgery - WALS Journal

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10.5005/jp-journals-10033-1263
Laparoscopic Appendicectomy in Gombe
ORIGINAL ARTICLE

Our Experience in Laparoscopic Appendicectomy in

Federal Teaching Hospital in Gombe

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1 Nuhu Musa Mshelia, SK Obiano, MI Guduf, YS Gital, S Khalifa
ABSTRACT INTRODUCTION
Background: Federal Medical Centre, Gombe is one of the Laparoscopic appendicectomy has recently been intro-
tertiary hospitals located in the northeast of Nigeria. It serves duced in Nigeria. Although the speed is slow, quite a
as a referral center to neighboring states and also gives
secondary care to the immediate environment. The institution number of procedures have been performed as reported
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has evolved in providing minimal access surgery services in in Ekwunife et al. Until recently all appendicectomy
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appendicectomies, cholecystectomies, diagnostic laparoscopy, procedures were open. Semm, a gynecologist, was
endourology, etc. We present our experience in laparoscopic the first to remove the appendix in 1983 and Schreiber

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appendicectomies.
removed an inflamed appendix in 1987. The acceptance
Objective: To share our experience in general surgery unit in of the use of laparoscopy to treat appendicitis has been
laparoscopic surgery. slow. This may be attributed to its longer operating time,
Materials and methods: One-year review (May 2013 to increased cost, and observation made on higher rate of
February 2014) of patients who underwent laparoscopic intra-abdominal abscesses. More laparoscopic appendi-
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appendicectomy was made. Recruitment for the procedure cectomies are being performed than open appendicecto-
was done from patients who presented at the Emergency 5
Department (ED) or at the Surgical Outpatient Department mies in Australia. The trend is toward a single-incision
(SOPD). All patients who had complications and previous laparoscopic surgery using the umbilicus to perform
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abdominal surgeries or had cardiopulmonary disease were procedures. Navarra et al started the single incision
excluded. Patients were counseled and written consent for method to perform cholecystectomy in 1997 and since
conversion to open surgery was obtained.
then many other surgeries like appendicectomy, among
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Results: Twenty patients who had laparoscopic appendicectomy others, are being done with success.
were reviewed. All had successful surgery; there was no Patients who will benefit from a laparoscopic appen-
conversion to open. Mean operative time was 34.2 minutes;
mean recovery period was 181 minutes (3 hours), mean pain dicectomy are as follows:
perception was 2.55 (mild pain), mean hospital stay was • Patients with acute or chronic right lower abdominal
22 hours. They were followed up at the SOPD and none of pain with doubtful diagnosis of acute appendicitis. A
them had port site wound infection or clinical evidence of other diagnostic laparoscopy is done.
complications. • Patients with vague lower abdominal pain suspected to
Conclusion: Laparoscopic appendicectomy is a favorable be appendicitis in immune-compromised individuals.
option in the treatment of uncomplicated appendicitis. Early • Obese patients in whom larger wound is needed to
recovery, reduced pain, and reduced hospital stay are the
outcomes observed. perform appendicectomy.
• Young females where it may be difficult to differentiate
Keywords: Experience, Federal Teaching Hospital, General other pathology of the pelvis from appendicitis.
surgery unit, Gombe, Laparoscopy.
How to cite this article: Mshelia NM, Obiano SK, Guduf MI, MATERIALS AND METHODS
Gital YS, Khalifa S. Our Experience in Laparoscopic
Appendicectomy in a Federal Teaching Hospital in Gombe. A total of 20 patients had laparoscopic appendicectomy
World J Lap Surg 2016;9(1):17-21. within the period of review, 8 males and 12 females. They
Source of support: Nil were counseled on the procedure and written consent
Conflict of interest: None was obtained including the option of converting to open
appendicectomy. Under general anesthesia, with the
patient intubated and fully relaxed in supine position,
1 Consultant, Chief Consultant Surgeon, 3,4 Consultant the surgical team is shown in their position (Fig. 1).
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Surgeon, Registrar Female patients may be placed in lithotomy position
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1-5 Department of Surgery, Federal Teaching Hospital, Gombe for uterine manipulation when the need arises. Formal
Nigeria pneumoperitoneum was achieved. First, laparoscopic
Corresponding Author: Nuhu Musa Mshelia, Consultant visualization was carried out and then placement of
Department of Surgery, Federal Teaching Hospital, Gombe, Nigeria second and third ports under vision in the left lower
Phone: +08038045093, e-mail: mshelianuhu@yahoo.com
and right upper quadrants (Figs 2 to 4) for dissection
World Journal of Laparoscopic Surgery, January-April 2016;9(1):17-21 17