Impact of Introduction of Laparoscopic Surgery On Management of Unresolved Intraabdominal Malignancies in a Semi-urban Nigerian Hospital

Adewale O Adisa, MBChB FWACS FMCSNig DMAS, Oladejo O Lawal, MBBS FMCSNig FWACS. Obafemi Awolowo University, Ile-Ife, Nigeria

 Introduction: With limited access to modern imaging techniques, intra-abdominal malignancies often pose diagnostic challenges to surgeons in poor resource settings. This article describes initial experience with laparoscopic surgery for advanced intra-abdominal malignancies in a Nigerian hospital.
Methods and procedures: A prospective study was carried out from January 2009 through December 2010. Patients preoperative, intraoperative and postoperative data were recorded and evaluated.
Results: Thirty-six patients with previously unresolved intra-abdominal tumours were studied. Fifteen (41.7%) had masses detected by Computerized Tomography (CT) without a clear diagnosis while 21(58.3%) could not afford the CT scan. On diagnostic laparoscopy, 12(33.3%) had ascites. Anatomic diagnosis were made and tissue biopsies taken in all patients leading to histopathological diagnoses such as abdominal tuberculosis, lymphoma, pancreatic carcinoma, hepatic malignancies, carcinoid tumour, and Kaposi’s sarcoma in an HIV positive patient. One operation was converted to open due to significant bleeding from hepatic biopsy site. No mortality was recorded. With local adaptation and improvisations, the local cost of the procedure was about 30% the cost of abdominal CT scan in our setting.
Conclusion: Laparoscopic surgery provided an affordable and safe aid for clinical and histopathologic diagnosis for patients in a resource limited setting.

Key words: Laparoscopic surgery, intra-abdominal malignancies, Nigeria.

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