Experience with gynaecological laparoscopy in a tertiary hospital, North-West Nigeria

Abstract

Background: Laparoscopy provides excellent visualization of the pelvic structures and often permits the diagnosis of gynaecological disorders and performance of pelvic surgeries without laparotomy. It has become an invaluable tool in both diagnostic and operative gynaecological procedures. It is a cost effective procedure.
Objective: The objectives of this study were to determine the rate, indications, findings and complications of diagnostic laparoscopy at Usmanu Danfodio University Teaching Hospital, Sokoto.
Methodology: This was a five-year retrospective review of all cases that underwwent diagnostic laparoscopy from 1st October, 2008 to 31st October, 2013. All the case notes of patients that had diagnostic laparoscopy during the stated period were retrieved and analyzed.
Results: A total of 975 gynaecological surgeries were carried out in the department within the study period, out of which 7.4% were diagnostic laparoscopies. Of these case notes 82% were available for analysis. The ages of the women ranged 14-42years with a mean age of 29.8 ± 6.2years. The most common procedure carried out was laparoscopy and dye test (69.5%), followed by laparoscopy alone (23.7%). Infertility (primary and secondary) was the major indication (72.9%) then, primary amenorrhoea in 11.9% of patients. Findings at laparoscopy were bilateral tubal blockage in 39%, hypoplastic uterus in 6.8%, absent uterus and ovaries in 3.4%, bilateral hydrosalpinx in 5.1%, dense pelvic adhesions 6.8%, peri-hepatic adhesions in 8.5% and moderate pelvic adhesion in 20.3% of cases. All the procedures were performed under general anaesthesia. The complications included upper abdominal pain 8.5%, abdominal discomfort from residual pneumoperitoneum 5.1%, difficult insufflation 3.4% and wound sepsis 3.4%. The mean duration of hospital stay was 1.9 ±0.9days, making our laparoscopy, therefore, not completely an outpatient procedure.
Conclusion: Diagnostic laparoscopy is a relatively safe procedure with minimal complications when performed by skilled personnel. The rate of 7.4% found in this study together with its most common indication is similar to the reports from other centres.

Keywords: Complications, diagnostic, indications, infertility, rate, surgeries