A 5-year audit of diagnostic gynaecologic laparoscopy under conscious sedation at the university college hospital, Ibadan

Abstract

Introduction: Diagnostic laparoscopy affords smaller incisions, shorter recovery time, and fewer complications. In developing countries, access is limited by cost, infrastructural deficit, and expertise. In a bid to reduce cost at our center, conscious sedation for diagnostic laparoscopy was introduced as far back as 1980. We present here a 5-year audit of our outpatient diagnostic laparoscopy highlighting the various indications, findings, and complications observed. Methodology: A retrospective review of case files of patients who had diagnostic gynecological laparoscopy between 1st January 2011 and 31st December 2015. The retrieved case files had data extracted and analysed using the Statistical Package for Social Sciences version 20 (Chicago IL USA). Data was presented as simple percentages using tables and figures. Results: During the period, 1,329 outpatient gynecological procedures were performed with 207 diagnostic gynecologic laparoscopies (15.6%). Only 187 case notes were retrieved (retrieval rate of 90%). The mean age was 33.04 (±5.2) years, 84.5% (158) had post-secondary education, and 69.0% (129) were nulliparous. Majority, 131 (70.0%), had laparoscopy and dye test, 26 (14.0%) had laparoscopy alone, and 30 (16.0%) had a combination of laparoscopy, dye test, and hysteroscopy. The commonest indications were secondary infertility (51.9%), primary infertility (24.1%), and chronic pelvic pain (11.2%). Common findings at laparoscopy were pelvic adhesions (53.5%), uterine fibroids (35.1%), and bilateral tubal blockage (30.3%). Normal findings were reported in only 19 patients (10.3%). Conclusion: Diagnostic laparoscopy under conscious sedation is cost-effective and safe. It has very minimal complications when performed by skilled personnel. It is thus recommended for low resource settings with the view to avail low income patients the opportunity for endoscopic evaluation.