[en] [en] BACKGROUND: Laparoscopic surgery is the gold standard for many abdominal surgeries. Laparoscopic programs in low- and middle-income countries (LMICs) and in sub-Saharan Africa face many constraints, although its use is safe, feasible, and clinically beneficial. The authors assessed patient-reported outcomes and the experience of patients operated on at the University Teaching Hospital of Kigali (CHUK).
METHODS: This is a retrospective cross-sectional study combining medical data from medical files and information collected from telephone calls to 288 patients who underwent laparoscopic cholecystectomy at CHUK from January 2015 to December 2020.
RESULTS: Among 446 laparoscopic surgeries performed at CHUK over 6 years, cholecystectomies accounted for 64.6 % of cases (288/446). Postoperative complications and mortality after laparoscopic cholecystectomy were low, respectively 1.7 % and 0.7 %, while the median length of stay was 3 days. About 74 % of surveyed patients had never heard of laparoscopic surgery prior to their procedure. Knowledge of laparoscopic surgery was associated with patient education level (p < 0.001). Half of patients had not been involved in the choice of the surgical technique. Overall satisfaction was over 95 % and >90 % of patients consider laparoscopic surgery as the best surgical approach in Rwanda, and for this reason they declared to be ready to promote this new technology despite its higher cost. However, patients reported some weaknesses and made recommendations for improving public awareness of laparoscopy and its benefits, patient-provider relationships, training of surgical workforce, laparoscopic equipment, and infrastructure.
CONCLUSION: Laparoscopic cholecystectomy can be performed with a low rate of postoperative complications in a resource-limited setting like Rwanda. Patient satisfaction was high, but efforts should be made to improve public awareness of laparoscopic surgery, improve surgical capacity, laparoscopic equipment, and infrastructure.
Disciplines :
Surgery
Author, co-author :
Nyundo, Martin ; Université de Liège - ULiège > Faculté de Médecine > Form. doct. sc. méd. (paysage) ; Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Rwanda
Kayondo, King; Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
Gasakure, Miguel; Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Rwanda
Urimubabo, Jean Christian; Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Rwanda
Houben, Jean Jacques; Department of Abdominal Surgery, ERASME Hospital, Université Libre de Bruxelles, Belgium
Limgba, Augustin; Department of Abdominal Surgery, King Faisal Hospital, Kigali, Rwanda
Nifasha, Antoine; Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Rwanda
Gashegu, Julien; Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Rwanda ; Clinical Anatomy Department, University of Rwanda, Rwanda
Detry, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation
Language :
English
Title :
Patient-reported outcome, perception and satisfaction after laparoscopic cholecystectomy in Kigali, Rwanda.
ARES - Académie de Recherche et d'Enseignement Supérieur WBI - Wallonie-Bruxelles International
Funding text :
The authors wish to extend their appreciation and gratitude to Académie de Recherche et d'Enseignement Supérieur (ARES), Wallonia, Belgium, for the financial support.This research was partly funded by the Académie de Recherche et d'Enseignement Supérieur (ARES), Wallonie-Bruxelles International , through Belgian cooperation under the ARES Projet de Formation Sud (PFS) 2018 – Rwanda.
Mayol, J., Garcia-Aguilar, J., Ortiz-Oshiro, E., Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 21:5 (1997), 529–533.
Rosenbaum, A.J., Maine, R.G., Improving access to laparoscopy in low-resource settings. Ann Glob Health, 85(1), 2019, 114.
Manning, R.G., Aziz, A.Q., Should laparoscopic cholecystectomy be practiced in the developing world? The experience of the first training program in Afghanistan. Ann Surg 249:5 (2009), 794–798.
Adisa, A.O., Lawal, O.O., Arowolo, O.A., et al. Local adaptations aid establishment of laparoscopic surgery in a semiurban Nigerian hospital. Surg Endosc 27:2 (2013), 390–393.
Asbun, H.J., Berguer, R., Altamirano, R., et al. Successfully establishing laparoscopic surgery programs in developing countries: clinical results and lessons learned. Surg Endosc 10:10 (1996), 1000–1003.
Brekalo, Z., Innocenti, P., Ðuzel, G., et al. Ten years of laparoscopic cholecystectomy: a comparison between a developed and a less developed country. Wien Klin Wochenschr 119:23–24 (2007), 722–728.
Ball, C., Maclean, A., Kirkpatrick, A., et al. Hepatic vein injury during laparoscopic cholecystectomy: the unappreciated proximity of the middle hepatic vein to the gallbladder bed. J Gastrointest Surg 10:8 (2006), 1151–1155.
Bendinelli, C., Leal, T., Moncade, F., et al. Endoscopic surgery in Senegal. Surg Endosc 16:10 (2002), 1488–1492.
Alfa-Wali, M., Osaghae, S., Practice, training and safety of laparoscopic surgery in low and middle-income countries. World J Gastrointest Surg 9:1 (2017), 13–18.
Senthilnathan, P., Srivatsan Gurumurthy, S., Gul, S.I., Sabnis, S., et al. Long-term results of laparoscopic pancreaticoduodenectomy for pancreatic and periampullary cancer—experience of 130 cases from a tertiary-care center in South India. J Laparoendosc Adv Surg Tech 25:4 (2015), 295–300.
Chao, T.E., Mandigo, M., Opoku-Anane, J., Maine, R., Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies. Surg Endosc 30:1 (2016 Jan), 1–10.
Kane, M.G., Krejs, G.J., Complications of diagnostic laparoscopy in Dallas: a 7-year prospective study. Gastrointest Endosc 30:4 (1984), 237–240.
Petroze, R.T., Nzayisenga, A., Rusanganwa, V., et al. Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. Br J Surg 99:3 (2012), 436–443.
Lau, W.Y., Leow, C.K., Li, A.K.C., History of endoscopic and laparoscopic surgery. World J Surg 21:4 (1997), 444–453.
Afuwape, O.O., Akute, O.O., The challenges and solutions of laparoscopic surgical practice in the developing countries. Niger Postgrad Med J 18:3 (2011), 197–199.
Robertson, F., Mutabazi, Z., Kyamanywa, P., et al. Laparoscopy in Rwanda: a national assessment of utilization, demands, and perceived challenges. World J Surg 43:2 (2019), 339–345.
Bolliger, M., Kroehnert, J.A., Molineus, F., et al. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur Surg 50:6 (2018), 256–261.
Dixon, E., Vollmer, C.M., May, G.R., Management of benign biliary stenosis and injury: a comprehensive guide. 2015, Springer, Cham.
Vollmer, C.M., Callery, M.P., Biliary injury following laparoscopic cholecystectomy: why still a problem?. Gastroenterology 133:3 (2007), 1039–1041.
Khan, M.H., Howard, T.J., Fogel, E.L., et al. Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center. Gastrointest Endosc 65:2 (2007), 247–252.
Cuschieri, A., Lezoche, E., Morino, M., et al. E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13:10 (1999), 952–957.
Bishoff, J.T., Allaf, M.E., Kirkels, W., et al. Laparoscopic bowel injury: incidence and clinical presentation. J Urol 161:3 (1999), 887–890.
Thurley, P.D., Dhingsa, R., Laparoscopic cholecystectomy: postoperative imaging. Am J Roentgenol 191:3 (2008), 794–801.
Saber, A., Hokkam, E.N., Operative outcome and patient satisfaction in early and delayed laparoscopic cholecystectomy for acute cholecystitis. Minim Invasive Surg 2014 (2014), 1–4.
Choy, I., Kitto, S., Adu-Aryee, N., Okrainec, A., Barriers to the uptake of laparoscopic surgery in a lower-middle-income country. Surg Endosc 27:11 (2013), 4009–40015.
Naude, A.M., Heyns, C.F., Matin, S.F., Laparoscopic urology training in South Africa. J Endourol 19:10 (2005), 1180–1184.
