ETUDE DES COMPLICATIONS PER-COELIOSCOPIQUES AU SERVICE DE CHIRURGIE GENERALE DU CHU ARISTIDE LE DANTEC DE DAKAR

The laparoscopy, introduced in the 1990s at the Aristide Le Dantec Hospital in Dakar, is subject to difficulties in our daily practice. These may favor comlications during the laparosopic procedure. Objectives: determinate incidence and study the management of intra-operative laparoscopic complications Material and methods: This was a retrospective descriptive study carried out from 842 laparoscopic procedures over a period from January 1st of 2006 to 31 December 31st of 2015 within the Department of General Surgery of the Aristide Le Dantec Hospital in Dakar. We Included all cases of intraoperative complications (59 cases). We studied: the epidemiological data, the interventions concerned, their nature, and their management. Results: incidence of intra-operative complications was 7%. The female predominated with a sex ratio of 0.9 (28 men / 31 women). The mean age was 35 years (extremes of 12 and 85 years). The complications mostly occured in daily surgery (50 cases). They occurred mainly during hepatobiliary surgery, including cholecystectomy with 45 cases (76.2% of incidents). Gastrointestinal accidents dominated with 39 cases (66.1%). The biliary tract injury was the most common (n=24 or 40.6%). Daily surgical complications (n = 50 or 84.7%) were dominated by biliary complications with 19 cases of gallbladder opening (32.2%) and 8 liver wounds (14.1%). There were 9 cases (15.3%) of intraoperative complications in emergency procedures (5 ileal wounds (8.9%), 1 cecal wound (1.6%), 2 appendicular arterial bleeding (3, 2%), 1 case (1.6%) of pneumoperitoneum intolerance). The laparoscopic conversion rate was 40.7% (n = 24): uncontrolled bleeding in 10 cases; Intestinal injury in 8 cases; wound of the main biliary tract in 3 cases and 3 cases of intolerance to pneumoperitoneum. The sequences were simple in 37 cases (62.7%). An operative morbidity of 37.3% was noted (n = 22). Two deaths were observed following postoperative peritonitis (3.4%). The mean hospital stay of our patients was 11 days with extremes of 3 and 29 days. Conclusion: the per-coelisocopic complications are not negligible and it is necessary to take appropriate care in order to avoid dramatic consequences. Keywords: Coelioscopy, intra-operative incidents