The Challenges and Adaptations of Laparoscopy for Abdominal Pathologies in Nigeria: A Systematic Review.

Background: Even though, laparoscopy has evolved as the gold standard of treatment for abdominal surgical pathologies, a lot of problems and challenges are still associated with its routine use in the treatment of such patients in Nigeria. The hurdles involved in the use of laparoscopy are still pervasive even though most of the procedures performed are not advanced. This study aims to enumerate, via a qualitative synthesis performed on the selected studies, the challenges of laparoscopy in Nigeria. Methodology: We assessed articles, written in English language in the last 20 years, from PubMed, African Index Medicus and Scopus. A few were also manually added from bibliography and references of articles. The search terms were "challenges," "laparoscopy," and "Nigeria." The inclusion criteria were studies on laparoscopy in Nigeria whose content could be assessed. The challenges and adaptations and reason for converting to open surgery were subsequently noted. The exclusion criteria included studies on gynecologic laparoscopy, case reports, articles with fragmented data and articles not discussing the challenges that were encountered. PRISMA guideline for systematic review was followed. Results: The search yielded 226 papers. Seventeen papers which met the inclusion criteria were studied in-depth. The challenges identified included incessant power outages during surgery, staff apathy, high cost of set-up and incessant strikes. The adaptive strategies noted include the use of uninterrupted power system (UPS), training of support staff, re-use of disposable instruments. The reasons for conversion to open surgery varied from excessive bleeding to difficult anatomy. Conclusion: The challenges facing the laparoscopic surgeon in Nigeria are peculiar and likely to snowball in the future. In order to ensure its sustainability, policymakers should solve the highlighted challenges and also provide enabling environment. This might promote the adoption of laparoscopy for treating patients with abdominal pathology in the future. [ABSTRACT FROM AUTHOR]