Page 24 - WJOLS - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Is Laparoscopic Cholecystectomy Safe in Gombe, Nigeria?

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Emmanuel L Mba , Nuhu M Mshelia , Sunday K Obiano 3
AbstrAct
Aim: This study compares the outcome of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) in terms of the duration of surgery,
the length of hospital stay, the postoperative analgesia, and the postoperative complications, in order to determine the safety of LC in our center.
Materials and methods: This is a retrospective study. All patients who had cholecystectomy in Federal Teaching Hospital, Gombe, Nigeria,
between January 2012 and December 2016 were studied. Their relevant data were obtained from the records and analyzed using SPSS version
20.0. t test was employed and a p value of <0.05 was considered to be significant.
Results: A total of 26 patients had cholecystectomy during the period—four of them were excluded, three had additional procedures while
one had incomplete records. The female-to-male ratio was 1.2:1 and the mean age was 39 years. The indications for surgery were symptomatic
gallstones in all patients except in one, which was for an acalculous cholecystitis. Fifteen (68%) patients had LC while seven (32%) had OC. The
mean age for LC was 38 years and for OC it was 41 years. The mean duration of procedure was 73 (±17.4) minutes for LC and 92 (±28.0) minutes
for OC. This was not statistically significant (p value = 0.066). The mean length of hospital stay for LC was 5.8 (±5.5) days and 10 (±8.5) days for

OC, and was equally not statistically significant (p value = 0.433). There was no difference in postoperative analgesia, no surgical site infection

or mortality recorded.
Conclusion: LC is very safe and has a good outcome in our environment despite our challenges.
Clinical significance: LC is still nascent and has not been studied in our environment. This study affirms the safety of this procedure, but fails
to establish its superiority over OC.
Keywords: Cholecystectomy, Gombe, Laparoscopic, Nigeria, Open.
World Journal of Laparoscopic Surgery (2018): 10.5005/jp-journals-10033-1355

IntroductIon 1–3 Department of Surgery, Federal Teaching Hospital, Gombe, Nigeria
Cholecystectomy is the surgical removal of a diseased gallbladder Corresponding Author: Emmanuel L Mba, Department of Surgery,
and may be either LC or OC. LC is the gold standard and has Federal Teaching Hospital, Gombe, Nigeria, Phone: +2348063924442,
revolutionized the treatment of gallbladder, since its introduction e-mail: dremmamba@yahoo.com
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in 1987 by Mouret Philippe. The advantages include reduced How to cite this article: Mba EL, Mshelia NM, et al. Is Laparoscopic

postoperative pain, rapid recovery, shorter hospital stay, early Cholecystectomy Safe in Gombe, Nigeria? World J Lap Surg
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return to work, and better cosmetic outcome. In the developed 2018;11(3):132–134.
countries, LC is the procedure mostly performed and OC is often Source of support: Nil

performed as a result of conversion from LC. This is not the case Conflict of interest: None

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in the developing countries, where OC is mostly performed.
In Nigeria, LC is still nascent and not widely available. High cost,
unstable power supply, lack of awareness, and inadequate expertise LC was done under general anesthesia using a four-port
are some of the reasons. Despite the drawbacks, many centers system. Pneumoperitoneum was achieved with CO . A 10 mm
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in Nigeria have good outcome. Laparoscopic surgeries in our umbilical port for the camera was inserted and a 10 mm port at
center were initially done by the Department of Obstetric and the epigastrium under direct vision. The other two 5 mm ports at
Gynaecology for diagnostic purposes, until 2012, when therapeutic the right hypochondrial and iliac fossae were also inserted under
procedures were started with the assistance of a visiting general direct vision. Clips were applied on the cystic duct and artery after
surgeon. We now have a trained general surgeon who does most dissection around the Calot’s triangle. The gallbladder was retrieved
of the laparoscopic procedures. via the epigastric port and sometimes, the bile was suctioned or the
The aim of this study is to compare the outcome of LC and OC incision increased to help deliver the gallbladder. The OC was done
in terms of the duration of surgery, the length of hospital stay, the conventionally under general anesthesia via the right subcostal
postoperative analgesia, and the postoperative complications, in incision. All patients received paracetamol and pentazocine
order to determine the safety of LC in our center. injections postoperatively.
MAterIAls And Methods
results
This is a retrospective study. All patients who had cholecystectomy
in Federal Teaching Hospital, Gombe, Nigeria, between January A total of 26 patients had cholecystectomy during the study period.
2012 and December 2016 were studied. Their relevant data were Four of them were excluded, three had additional procedures while
obtained from the records and analyzed using SPSS version 20.0. one had incomplete records. Out of the 22 patients, 12 (54.5%)
t test was employed and a p value of <0.05 was considered to be were females and 10 (45.5%) were males, with a female-to-male
significant. ratio of 1.2:1. The age range was 18–70 years and the mean age

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