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IntroductionThe advent of laparoscopy has significantly reduced the morbidity associated with the majority of abdominal surgeries. In Senegal, the first studies evaluating this technique were published in the 1980s. The objective of this systematic review is to assess the evolution of laparoscopy research in Senegal.MethodsA search of PubMed and Google Scholar was carried out without limit of publication date. The keywords used were “senegal” AND “laparoscop*”. Duplicates were removed, and remaining articles were assessed for selection criteria. We included all articles about laparoscopy published in Senegal. The parameters studied in each included article were the place and year of study, average age, sex ratio, assessed indications and results.Results41 Studies published between 1984 and 2021 met selection criteria. The average age of patients was 33 years (range 4.7–63). The sex ratio was 0.33. The main indications for laparoscopy according to the studies were: benign gastrointestinal disorders in 11 studies (26.8%), abdominal emergencies in 9 studies (22%), gallbladder surgery in 5 studies (12.2%), benign gynecological pathology in 6 studies (14.6%), malignant gynecological pathology in 2 studies (4.9%), diagnostic laparoscopy in 2 studies (4.9%), groin hernia repair in 2 studies (4.9%) and testicular pathology in 1 study (2.4%). Overall mortality was estimated at 0.9% (95% CI 0.6–1.3) and overall morbidity for all complications was estimated at 5% (95% CI 3.4–6.9).ConclusionsThis systematic review showed a predominance of the laparoscopy publications from the capital in Dakar with favorable outcomes. This technique should be popularized in the different regions of the country and its indications expanded.

BackgroundCumulative sum (CUSUM) analysis is a valuable tool for quantifying the learning curve of surgical teams by detecting significant changes in operative length. However, there is limited research evaluating the learning curve of laparoscopic techniques in low-resource settings. The objective of this study is to evaluate the learning curve for laparoscopic appendectomy within a single surgical team in Senegal.MethodsThis was a single-center prospective study conducted from May 1, 2018, to August 31, 2023 of patients who underwent laparoscopic appendectomy at a tertiary care institution in West Africa. The AAST classification was used to describe the severity of appendicitis. Parameters studied included age, sex, operative length, conversion rate, and postoperative outcomes. To quantify the learning curve, CUSUM analysis of operative length was performed.ResultsA total of 81 patients were included. The mean age was 26.7 years (range 11–70 years) with a sex ratio of 1.9. Pre-operative severity according to AAST was Grade I in 75.4% (n = 61), Grade III in 7.4% (n = 6), Grade IV in 6.1% (n = 5), and Grade V in 11.1% (n = 9). Conversion occurred in 5 cases (6.1%). The average operative length was 76.8 min (range 30–180 min) and the average length of hospitalization was 2.7 days (range 1–13 days). Morbidity was observed in 3.7% (n = 3) and there were no deaths. The CUSUM analysis showed that a steady operative length was achieved after 28 procedures, with decreasing operative lengths thereafter.ConclusionSurgeons in our setting overcame the learning curve for laparoscopic appendectomy after performing 28 procedures. Moreover, laparoscopic appendectomy is safe and feasible throughout the learning curve. CUSUM analysis should be applied to other laparoscopic procedures and individualized by surgical teams to improve surgical performance and patient outcomes in low-resource settings.

IntroductionLaparoscopy has a clear patient benefit related to postoperative morbidity but may not be as commonly performed in low-and middle-income countries. The decision to convert to laparotomy can be complex and involve factors related to the surgeon, patient, and procedure. The objective of this work is to analyze the factors associated with conversion in laparoscopic surgery in a low-resource setting.MethodsThis is a single-center prospective study of patients who underwent laparoscopic surgery between May 1, 2018 and October 31, 2021. The parameters studied were age, sex, body mass index (BMI), intraoperative complication (e.g., accidental enterotomy, hemorrhage), equipment malfunction (e.g., technical failure of the equipment, break in CO2 supply line), operating time, and conversion rate.ResultsA total of 123 laparoscopic surgeries were performed. The average age of patients was 31.2 years (range 11–75). The procedures performed included appendix procedures (48%), followed by gynecological (18.7%), gallbladder (14.6%), digestive (10.56%), and abdominal procedures (4%). The average length of hospitalization was 3 days (range 1–16). Conversion to laparotomy was reported in 8.9% (n = 11) cases. Equipment malfunction was encountered in 9.8% (n = 12) cases. Surgical complications were noted in 11 cases (8.9%). Risk factors for conversion were shown to be BMI > 25 kg/m2 (OR 4.6; p = 0.034), intraoperative complications (OR 12.6; p = 0.028), and equipment malfunction (OR 9.4; p = 0.002).ConclusionA better understanding of the underlying factors associated with high conversion rates, such as overweight/obesity, intraoperative complications, and equipment failure, is the first step toward surgical planning to reduce postoperative morbidity in low-resource settings.

Introduction Video feedback, particularly with a head-mounted camera, has previously been described as a useful debriefing tool in well-funded health systems but has never been performed in a low-resource environment. The purpose of this randomized, intervention-controlled study is to evaluate the feasibility of using video feedback with a head-mounted camera during intestinal anastomosis simulation training in a low-resource setting. Methodology This study recruited 14 first-year surgery residents in Senegal, who were randomized into control and camera groups. Both groups received reading materials and video lectures before performing a manual end-to-end intestinal anastomosis using a synthetic model. The control group received oral feedback, while the camera group’s first attempt was recorded, reviewed, and discussed before the second attempt. The primary outcomes were OSATS scores and completion time. Results There were no significant demographic differences between the groups. Both groups showed significant improvement in OSATS scores from the first to the second attempt (control group: p  = 0.002; camera group: p  = 0.0021). The camera group demonstrated a significant reduction in completion time on the second attempt ( p  = 0.0038), unlike the control group ( p  = 0.17). Both groups reported increased confidence in performing the task (control group: p  = 0.003; camera group: p  = 0.0029) and had positive perceptions of the workshop’s effectiveness. Conclusion This pilot study suggests that video feedback with a head-mounted camera is feasible and effective for debriefing during intestinal anastomosis simulation training in a low-resource setting, offering a low-cost, effective way to enhance technical skills. Further research with larger sample sizes is recommended to validate these findings and explore long-term impacts on surgical proficiency.

Our study aimed to evaluate the outcome of the surgical treatment of appendicular plastron after deferred or emergency appendectomy. We conducted a retrospective, descriptive study of 27 patients treated for appendicular plastron from January 2000 to 31 December 2007. Diagnosis was based on clinical examination showing a mass in the right iliac fossa, on ultrasound or made intraoperatively. All patients undergoing emergency surgery were classified in Group I while those undergoing deferred surgery were classified in Group II. 18 men and 9 women were registered, with a sex-ratio man /Woman=2. The average age of patients was 33 years, ranging between 19 and 57 years. Clinical signs were dominated by pain in the right iliac fossa and fever in 25(92.6%) and 15 (55.6%) of cases respectively. In group I, appendectomy couldn't be performed in 7 cases (n= 15) due to surgical complications. In all other cases appendectomy was performed by enlarging Mac Burney's incision and was associated with longer length of stay in hospital. Group II included 12 patients (n=12), 9 underwent laparoscopy and 3 patients underwent Mac Burney's incision. 3 cases with peritoneal adhesions were detected during coelioscopy. Deferred appendectomy of appendicular plastron is a safe and efficient surgical procedure. It allows to avoid unattractive scarrings and iatrogenic digestive fistulas. Emergency appendectomy shouldn't be performed in patients with appendicular plastron because it increases the risks of morbidity.

Introduction Studying surgical services and the workforce in sub-Saharan Africa is crucial for enhancing access to quality surgical care in the region. Despite many recommendations to produce evidence based on reliable data on this subject to guide policymakers, there is still a knowledge gap on this topic. The aim of this nationwide survey was to describe the organization of abdominal emergency surgical care across healthcare services in Senegal. Methodology This was a cross-sectional nationwide survey. The study period was between October 1st, 2023, and January 20th, 2024. The target population included all registered healthcare facilities in Senegal offering emergency surgical services. A structured questionnaire was designed to gather infrastructure-related data, surgical activities, and human resources. Results All 33 identified healthcare facilities responded to the survey (100%). Emergency abdominal surgery services were available for 96.7% of the surveyed structures. The teams were mainly composed of surgeons and residents (45.2%) or surgeons and medical trainees (48.8%). The average bed capacity of the services was 21.9, with a standard deviation of 13.9. The absence of a dedicated hospitalization section for patients requiring special monitoring was found in 69.6% of the facilities. Operating rooms dedicated to emergency abdominal digestive surgery were present in 54.6% of the services. On average, the services performed 17.6 scheduled surgical interventions with a standard deviation of 11.5 and 29.7 emergency surgical interventions with a standard deviation of 16.8 per month. Morbidity and mortality conferences were not routinely held in the majority of departments (only 27.3%). Professional development programmes were present only in 24.2% of departments. Most of the departments did not have adequate human resources (69.6%). A total of 70 surgeons were identified, resulting in a national ratio of 0.39 general surgeons per 100,000 inhabitants. The strategies employed to address staff shortages included additional working hour by staff (54.5%), temporary workers (30.3%) or the use of trainee doctors or nurses (12.1%). Conclusion This research shows that significant deficiencies are present in the essential physical and human resources needed to conduct fundamental life-saving surgical procedures. These findings suggest potential areas for improvement in the delivery of emergency surgical care in the region.

BackgroundGroin hernia management has a significant worldwide diversity with multiple surgical techniques and variable outcomes. The International guidelines for groin hernia management serve to help in groin hernia management, but the acceptance among general surgeons remains unknown. The aim of our study was to gauge the degree of agreement with the guidelines among health care professionals worldwide.MethodsForty-six key statements and recommendations of the International guidelines for groin hernia management were selected and presented at plenary consensus conferences at four international congresses in Europe, the America’s and Asia. Participants could cast their votes through live voting. Additionally, a web survey was sent out to all society members allowing online voting after each congress. Consensus was defined as > 70% agreement among all participants.ResultsIn total 822 surgeons cast their vote on the key statements and recommendations during the four plenary consensus meetings or via the web survey. Consensus was reached on 34 out of 39 (87%) recommendations, and on six out of seven (86%) statements. No consensus was reached on the use of light versus heavy-weight meshes (69%), superior cost-effectiveness of day-case laparo-endoscopic repair (69%), omitting prophylactic antibiotics in hernia repair, general or local versus regional anesthesia in elderly patients (55%) and re-operation in case of immediate postoperative pain (59%).ConclusionGlobally, there is 87% consensus regarding the diagnosis and management of groin hernias. This provides a solid basis for standardizing the care path of patients with groin hernias.

La fistule anastomotique reste la complication la plus redoutée après chirurgie colorectale et continue à poser un problème diagnostique et thérapeutique. Le but de cette étude est de déterminer à la fois la prévalence et les éléments de prises en charge diagnostiques et thérapeutiques de la fistule colique après colectomie. Nous avons mené une étude rétrospective descriptive des cas de fistule colique après colectomie sur une période de 7 ans allant de janvier 2007 au décembre 2013. Il y avait 17 patients qui ont présenté une fistule colique parmi les 170 patients ayant bénéficié de colectomie dans notre service soit un taux de 10%. L'âge moyen au moment de l'intervention initiale était de 45,1 ans (extrêmes de 20 et 78 ans). Il y avait une prédominance des patients de sexe masculin (n=13) avec un sex ratio de 3,3. Les pathologies tumorales colorectales (n=9) et le volvulus de colon pelvien (n=7) était les principales indications de colectomie L'intervention initiale a été réalisée en urgence chez 13 patients. Le délai moyen d'apparition de la fistule était de 10,8 jours. Il y avait 10 patients ayant présenté une fistule colo-cutanée et 7 cas de péritonites postopératoires stercorales. Onze de nos patients présentaient une anémie (taux moyen d'hémoglobine de 9,1 g/dl) et 8 patients, une hyperleucocytose (taux moyen de 15100 leucocytes/mm3). Une échographie, réalisée chez 6 patients, était revenue normale chez 1 patient et avait mis en évidence un épanchement intra péritonéal chez 5 patients tandis que La tomodensitométrie (TDM) sans opacification digestive, réalisée chez 2 patients, n'était contributive au diagnostic que chez 1 seul patient. Neuf patients avaient bénéficié de traitement médical seul. Ce dernier consistait en une couverture antibiotique, un régime hyperprotéique, et un appareillage de la fistule par une poche de colostomie. La fistule s'est fermée spontanément, dans un délai moyen de 15 jours. La reprise chirurgicale a été réalisée chez 8 patients dans un délai moyen de 4,8 jours. Elle a été indiquée pour une péritonite par fistule anastomotique chez 7 patients et pour persistance de la fistule colo-cutanée malgré traitement médical chez 1 patient. Le geste chirurgical consistait en une stomie digestive dans 6 cas. Sept patients ont présenté au moins une complication liée à la fistule colique (2 récidives de la fistule, 3 suppurations et 2 éviscérations). La durée moyenne d'hospitalisation était de 55,2 jours (extrêmes de 15 et 168 jours). Deux décès étaient enregistrés consécutif à un choc septique. Une accessibilité des moyens thérapeutiques telles que la nutrition parentérale et le drainage percutané nous permettrait de réduire une durée d'hospitalisation prolongée et également des coûts de prise en charge élevés.

Spigelian hernia is a rare form of abdominal wall hernias. We report an unusual case of a strangulated spigelian hernia with necrotic contents of the caecum, appendix and terminal ileum in the elderly. An 84-year-old woman, with a history of eight pregnancies, was admitted for bowel obstruction evolving for 7 days. The computed tomography scan showed a strangulated right spigelian hernia. Surgical exploration with an incision centered on the mass confirmed the diagnosis with extensive necrosis of the caecum, appendix and 10 cm of the terminal ileum. A right hemi-colectomy with an ileo-colic anastomosis was performed. The post-operative course was marked by the death of the patient in intensive care due to multi-visceral failure. The occurrence of strangulation with necrosis of the caecum, appendix and terminal ileum in spigelian hernia is extremely rare. It requires early diagnosis and treatment to reduce post-operative morbidity and mortality.

Safety checklist (CL) in the operating block is a quality tool which allows to reduce perioperative morbidity and mortality. That is one of the French National Health Authority requirements for the certification procedure of healthcare institutions. This study aimed to conduct a quantitative and qualitative evaluation of the use of this tool in the central operating block at the Regional Medical Center in Saint Louis. A prospective evaluation of the indicators for monitoring the practical use of the checklist and the contribution to the improvement of surgical practices in the operating block at the Regional Medical Center in Saint Louis was initiated since the launch of this study in March 2016. CL utilization rate was 75%, compliance rate was 60%; information rate was 99% for the pre-induction items, 93% for the pre-incision items and 88% for the postoperative items. Only 73% of analyzed CL were filled with an effective oral communication according to the three items. CL helped to detect hardware failures and/or adverse events in 15% of cases. No patient's identification or operated side error were objectified in our study. CL contributes in the development of the culture of patient's safety in the operating block and has led to the establishment of a risk mapping in the operating block. Nevertheless, while important, it shouldn't be considered a magic tool to avoid errors but integrated into the improvement in health care quality with other programs such as the reporting of adverse events and the the review of morbidity and mortality.