Advance Laparoscopy in Minimal Resource Settings: Experience from a Public Sector Hospital in a Lower Middle Income Country

Author(s): Muhammad Adeel Kaiser, Awais Amjad Malik, Danish Ali, Muhammad Qasim Farooq, Anwar Zeb Khan, Muhammad Ahsan Ghumman, Suleman Asif, Tausief Fatima, Muhammad Imran Khokhar, Muhammad Farooq Afzal

Background
To share our experience of performing advanced laparoscopic procedures with minimal resources in a public sector hospital.

Methods
A retrospective study of laparoscopic cases performed from December 1st 2016 till Dec 31st 2020 was done. All the cases were done by single surgical unit but with different surgical teams both as elective as well as emergency procedure. Type of procedure, conversion to open, and immediate post operative complications and outcomes were recorded. Complications were recorded on the basis of the Clavian Dindo Classification.

Results
In 49 months a total of 1550 procedures were performed. 1133 basic and 417 advanced laparoscopic procedures were performed. Only advanced laparoscopic procedures are discussed further. Median patient aged was 33 years (Range 10 to 70 years). Male to female ratio was 1:1.2 (191:226). There was a conversion rate of 8.6% with 36 operations converted to open due to either technical issues or any complication. Median hospital stay was 2 to 12 days. Median operative time was 90minutes. Complications were seen in 48 patients. Grade 1/2 complications in 38 patients. Grade 3 complications were seen in 9 patients. Grade 4 in 1 patient. No Grade 5 (Mortality) complications were seen.

Conclusions
Advanced laparoscopic surgery can be safely undertaken in public sector hospitals in low resource countries with limited resources.