Laparoscopic Management of Gall Bladder Diseases in Nigeria: A Systematic Review.

Abstract

Background: Globally, the incidence and mortality from gallbladder diseases is on the rise. The gold standard for the management of symptomatic gallbladder disease is laparoscopic cholecystectomy. The practice of laparoscopic cholecystectomy is at a nascent stage in Low and middle-income countries like Nigeria despite its obvious advantages over traditional open cholecystectomy. This systematic review aims to assess the extent to which laparoscopic cholecystectomy is performed for the management of gallbladder diseases in Nigeria.

Methodology: The review was guided by the PRISMA model. We searched MEDLINE, Embase, CINAHL, Scopus, and Global health databases. All searches were conducted in August 2023. All study designs reporting laparoscopic cholecystectomy in Nigeria, in the past 10 years were included. Three authors conducted the data extraction using data extraction tables and two authors independently assessed the data for accuracy and completeness. The Joanna Briggs Institute critical appraisal tool was used to assess the data quality. Twenty-two articles with 1569 patients were included in this review.

Results: Females accounted for 69.5% of the patients and 30.5% were males. Twelve (54.5%) of the studies were from the Southwest of the country, 3 (13.6%) each from the South East and North Central regions, 2 (9.1%) South-South, and 1 (4.5%) each from the North East and North West. Study designs were mostly cross-sectional with sample sizes from 1 to 400. The highest and lowest number of laparoscopic cholecystectomies reported were 300 and 1 respectively. The majority (95.2%) of laparoscopic cholecystectomies were on account of calculous cholecystitis and the methods reported were the 4-port and 3-port techniques. The follow-up period ranged from 3 weeks to 2 years with 54 (3.4%) complications reported.

Conclusions: Laparoscopic cholecystectomy in Nigeria is relatively safe with minimal complications. Its demand and uptake are on the rise, though slowly owing to its relatively high cost.