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Meta-Analysis
. 2024 Jul;48(7):1634-1650.
doi: 10.1002/wjs.12195. Epub 2024 May 29.

Current state of minimally invasive general surgical practice in Africa: A systematic review and meta-analysis of the laparoscopic procedures performed and outcomes

Adebayo Feranmi Falola  1   2 , Rhoda Tolulope Fadairo  1   2 , Oluwasina Samuel Dada  1   3 , Joseph Sanmi Adenikinju  1   4 , Emmanuella Ogbodu  1   5 , Blessing Effiong-John  1   2 , Damilola Grace Akande  1   2 , Madeleine Oluomachi Okere  1   6 , Anuoluwapo Adelotan  1   6 , Abdourahmane Ndong  1   7
Affiliations
Meta-Analysis

Current state of minimally invasive general surgical practice in Africa: A systematic review and meta-analysis of the laparoscopic procedures performed and outcomes

Adebayo Feranmi Falola et al. World J Surg. 2024 Jul.

Abstract

Background: Minimally invasive surgery, including laparoscopy and robotics, has significantly improved general surgical (GS) practice globally. While robot-assisted GS practice is yet to be adopted in the majority of Africa, laparoscopy has been utilized to improve surgical outcomes. This study aims to review the laparoscopic GS procedures (LGSPs) performed and evaluate outcomes such as conversion to open surgery, morbidity, and mortality in Africa.

Methods: Four databases (PubMed, Google Scholar, WoS, and AJOL) were searched, identifying 8022 publications. Following screening, 40 studies across Africa that reported LGSPs (n ≥ 2) performed and outcomes met the inclusion criteria. A meta-analysis conducted using R statistical software estimated the pooled prevalences with the 95% CI of conversion, morbidity, and mortality.

Results: A total of 6381 procedures performed in 15 African countries were analyzed in this study. Majority, 72.89%, of the procedures were performed in Senegal, South Africa, and Nigeria. The major procedures performed were cholecystectomy (37.09%), appendicectomy (33.36%), and diagnostic laparoscopy (9.98%). The meta-analysis revealed a conversion rate of 5% [95% CI: 4, 7]. Adhesion (28.13%), hemorrhage (16.67%), technical difficultly (12.50%), and equipment failure (11.46%) were the predominant indications for conversion. Surgical site infection (42.75%) was the major cause of morbidity. The prevalences of morbidity and mortality were 7% [95% CI: 5, 10] and 0.12% [95% CI: 0, 0.29], respectively.

Conclusion: A wide range of basic and advanced LGSPs were performed. The outcomes obtained indicate successful implementation of the laparoscopic approach. Importantly, this study serves as a foundational work for further research on minimally invasive surgery in Africa.

Keywords: Africa; general surgery; laparoscopic; laparoscopy; minimal access; minimally invasive.

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References

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