Mitigating the challenges of laparoscopic paediatric surgery in Ile Ife: The trend so far and lessons learnt.

Background: Paediatric laparoscopic surgery is fast growing worldwide, with many pathologies now being treated even in the youngest of patients. We hereby report our experience with the first 114 cases. Objectives: Our aim was to highlight our progress and lessons learnt practicing laparoscopic paediatric surgery in our institution. Materials and Methods: This is a retrospective study of the first 114 children who underwent laparoscopic surgery in our hospital. We focussed on demographics, indications, procedures performed, rate of conversion to open and complications. Records were retrieved from January 2011 to December 2019. Data were analysed using the SPSS software version 23 (SPSS Inc., Chicago, Illinois, USA). Results: There were 83 males and 31 females (ratio of 3:1). Age groups included infants (13.2%), 1–5 years (21.9%), 5–10 years (33.3%) and > 10 years (31.6%). There was a remarkable increase in the frequency and complexity of cases performed from an average of 5 per year between 2011 and 2015 to an average of 23.5 per year between 2016 and 2019. The conversion rate was 6%, 5 appendectomies, 1 Swenson pull-through, 1 diagnostic laparoscopy and 1 Ladd's procedure. Four complications were noted; one recurrent adhesive intestinal obstruction, one residual intra-abdominal abscess, one port site abscess and one excessive bleeding from liver biopsy requiring conversion to open surgery. Conclusion: We have demonstrated that the routine use of laparoscopy in children is feasible and safe in our environment. However, the need for training, endurance through a steep learning curve and the willingness to battle the technical challenges are necessary for success.