Limitations and challenges of laparoscopic surgery in a low-income country: example of the Gaston Berger Teaching Hospital of Saint-Louis (Senegal)

Abstract

Introduction: Despite the advances in minimally invasive surgery in developed countries, laparoscopy remains less used in low-resource settings. Our aim is to describe our first experience in laparoscopic surgery at the Saint-Louis Hospital (Senegal). Methods: This is a descriptive cross-sectional study over the period from November 1, 2018, to June 31, 2020. We included patients operated on by laparoscopy. The parameters studied were age, sex, indications, operative time, reasons, conversion rate, intraoperative difficulties, hospital stay, and postoperative complications. Results: We operated on 83 patients. The mean age was 33.3 years (range, 11–74 years). There were 37 men (44.5%) and 46 women (55.5%). The procedures included appendectomy (49.3%), cholecystectomy (18.1%), exploration of infertility (10.8%), exploratory laparoscopy (7%), and transabdominal preperitoneal (TAPP) for inguinal hernia repair (5.1%). The conversion rate was 9.6% (n = 8). The mean operative time was 81 min (range, 20–210 min). The average length of hospital stay was 2.7 days (range, 1–8 days). The mortality rate was 2.4% (n = 2). Conclusion: Laparoscopy has a real benefit even in a low-resource context. To develop minimally invasive surgery, emphasis must be placed on training the medical team and improving equipment.