Laparoscopic Inguinal Hernia Repair in a Developing Nation: Short-term Outcomes in 103 Consecutive Procedures

Developing Laparoscopic Surgery on the Caribbean Island of St. Lucia: A Model for Public-Private Partnership

The first recorded laparoscopic operation in the Caribbean was a cholecystectomy performed in 1991. After a temporary peak in basic laparoscopic operations in subsequent years, the initial interest waned. While laparoscopic surgery was being popularized in the developed world, there was a stagnation in the Caribbean. There were many reasons for this stagnation, including a lack of surgical expertise, the negative attitudes of health-care workers, active opposition from surgical leaders, and equipment deficiencies, all exacerbated by the global financial recession in the early twenty-first century. A similar situation existed on the Caribbean island of St. Lucia, where laparoscopic surgery remained relatively dormant. After a strong desire by community surgeons to incorporate advanced laparoscopy into surgical practice, surgical leaders in St. Lucia engineered a public-private partnership to achieve this. This review article evaluates the available data, documents the obstacles encountered, and explains the mechanisms to overcome these obstacles to incorporate advanced laparoscopy in St. Lucia. This information is important because it can serve as a template for other developing Caribbean countries.

Experience and results of laparoscopic inguinal herniorrhaphy

Introducción. Con la invención de la cirugía poco invasiva, la herniorrafia inguinal por laparoscopia se ha convertido en un procedimiento de realización frecuente. En el presente artículo se publican los resultados de 92 herniorrafias inguinales por laparoscopia realizadas con técnica transabdominal preperitoneal (TAPP) entre agosto de 2001 y enero de 2014.Objetivo. Presentar resultados en cuanto a tasa de recurrencia, dolor post-operatorio y necesidad de conversión en las herniorrafias inguinales por laparoscopia analizadas.Materiales y métodos. Se analizaron de manera retrospectiva los resultados del procedimiento realizando técnica TAPP con seguimiento promedio de 8 años.Resultados. Se presentaron tres (3.2%) casos que requirieron conversión, tres (3.2%) de recurrencia y seis (6.4%) de dolor crónico.Conclusión. La herniorrafia por laparoscopia con técnica TAPP es un procedimiento seguro; esta tiene tasas similares de efectividad y complicaciones a la técnica abierta y totalmente extraperitoneal TEP.

Evolution of SILS Cholecystectomy in the Caribbean: The Direct Transfascial Puncture Technique Using Conventional Instruments without Working Ports

Introduction. Single incision laparoscopic cholecystectomy (SILC) has become accepted as an alternative to conventional multiport cholecystectomy. However, SILC is still limited in applicability in low resource centres due to the expense associated with specialized access platforms, curved instruments, and flexible scopes. Presentation of Case. We present three cases where a modified SILC technique was used with conventional instruments and no working ports. The evolution of this technique is described. Discussion. In order to contain cost, we used conventional instruments and three transfascial ports placed in an umbilical incision, but we noted significant instrument clashes that originated at the port platforms. Therefore, we modified our technique by omitting ports for the working instruments. The technique allowed us to exchange instruments as necessary, maximized ergonomics, and prevented collisions from the bulky port platforms. Finally, the puncture left by the instrument alone did not require fascial closure at the termination of the procedure. Conclusion. The direct transfascial puncture using conventional laparoscopic instruments without working ports is a feasible option that minimizes cost and increases ergonomics.