Contribution of Laparoscopy in the Management of Female Infertility in Low Resource Countries: A Review of 208 Cases at the Yaoundé General Hospital, Cameroon
Author(s)
Jean Dupont Kemfang Ngowa1,2*,
Jean Marie Kasia1,2,
Victorine Nkongo1,
Anny Ngassam2,
Jovanny Fouogue Tsuala1,
Philemon Nsem1,
Alexis Medou3
Affiliation(s)
1 Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. 2 Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital, Yaoundé, Cameroon. 3 Anesthesia Unit, Yaoundé General Hospital, Yaoundé, Cameroon.
1 Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. 2 Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital, Yaoundé, Cameroon. 3 Anesthesia Unit, Yaoundé General Hospital, Yaoundé, Cameroon.
ABSTRACT
Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives: This study aimed to assess contribution of laparoscopy as a diagnostic and therapeutic tool in infertile women in our setting. Methods: A descriptive review of complete medical records of 208 women who underwent laparoscopy at the Gynaecology Unit of Yaoundé General Hospital from December 2007 to December 2012. Results: Two hundred and eight women were enrolled in this study. Mean age was 32.6 ± 11.25 years. Infertility was secondary in 71.6% of cases; 125 (60.1%) women were married and 116 (55.8%) had a positive serology of Chlamydia trachomatis infection. The most frequent findings during diagnostic laparoscopy were: pelvic adhesions (83.7%), hydrosalpinx (21.6%), pyosalpinx (4.8%), perihepatic adhesions (25.5%), uterine fibromas (22.6%), pelvic endometriosis (13%) and ovarian abnormalities (10.1%). The surgical procedures during laparoscopy were: adhesiolysis (79.7%), tuboplasty (35.0%), salpingectomy (8.2%), ovarian cystectomy (5.8%) and myomectomy (1.9%). Three (1.4%) cases of uterine perforation and 1 (0.5%) case of laparoscopy conversion to laparotomy were observed. Conclusion: Diagnostic laparoscopy revealed that tubal lesions and pelvic adhesions were still the major causes of female infertility in developing countries. Adhesiolysis and tuboplasty were the most frequently performed surgical procedures during laparoscopy. Therefore, training in endoscopic surgery should be regarded as an important issue in developing countries.
Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives: This study aimed to assess contribution of laparoscopy as a diagnostic and therapeutic tool in infertile women in our setting. Methods: A descriptive review of complete medical records of 208 women who underwent laparoscopy at the Gynaecology Unit of Yaoundé General Hospital from December 2007 to December 2012. Results: Two hundred and eight women were enrolled in this study. Mean age was 32.6 ± 11.25 years. Infertility was secondary in 71.6% of cases; 125 (60.1%) women were married and 116 (55.8%) had a positive serology of Chlamydia trachomatis infection. The most frequent findings during diagnostic laparoscopy were: pelvic adhesions (83.7%), hydrosalpinx (21.6%), pyosalpinx (4.8%), perihepatic adhesions (25.5%), uterine fibromas (22.6%), pelvic endometriosis (13%) and ovarian abnormalities (10.1%). The surgical procedures during laparoscopy were: adhesiolysis (79.7%), tuboplasty (35.0%), salpingectomy (8.2%), ovarian cystectomy (5.8%) and myomectomy (1.9%). Three (1.4%) cases of uterine perforation and 1 (0.5%) case of laparoscopy conversion to laparotomy were observed. Conclusion: Diagnostic laparoscopy revealed that tubal lesions and pelvic adhesions were still the major causes of female infertility in developing countries. Adhesiolysis and tuboplasty were the most frequently performed surgical procedures during laparoscopy. Therefore, training in endoscopic surgery should be regarded as an important issue in developing countries.
Cite this paper
Kemfang Ngowa, J. , Kasia, J. , Nkongo, V. , Ngassam, A. , Tsuala, J. , Nsem, P. and Medou, A. (2015) Contribution of Laparoscopy in the Management of Female Infertility in Low Resource Countries: A Review of 208 Cases at the Yaoundé General Hospital, Cameroon. International Journal of Clinical Medicine, 6, 934-939. doi: 10.4236/ijcm.2015.612122.
Kemfang Ngowa, J. , Kasia, J. , Nkongo, V. , Ngassam, A. , Tsuala, J. , Nsem, P. and Medou, A. (2015) Contribution of Laparoscopy in the Management of Female Infertility in Low Resource Countries: A Review of 208 Cases at the Yaoundé General Hospital, Cameroon. International Journal of Clinical Medicine, 6, 934-939. doi: 10.4236/ijcm.2015.612122.
References
[1] Sharma, S., Mittal, S. and Aggarwal, P. (2009) Management of Infertility in Low Resource Countries. BJOG, 116, 77-83.
http://dx.doi.org/10.1111/j.1471-0528.2009.02311.x [2] Otolorin, E.O., Ojengbede, O. and Falase, A.O. (1987) Laparoscopic Evaluation of the Tuboperitoneal Factor in Infertile Nigerian Women. International Journal of Gynecology & Obstetrics, 25, 47-51.
http://dx.doi.org/10.1016/0020-7292(87)90183-4 [3] Berker, B., Mahdavi, A., Shahmohamady, B. and Nezhat, C. (2005) Role of Laparoscopic Surgery in Infertility. Middle East Fertility Society Journal, 10, 94-104. [4] Raiga, J., Kasia, J.M., Canis, M., Glowaczower, E., Doh, A.S. and Bruhat, M.A. (1994) Introduction of Gynecologic Endoscopic Surgery in an African Setting. International Journal of Gynecology & Obstetrics, 46, 261-264.
http://dx.doi.org/10.1016/0020-7292(94)90403-0 [5] Mbaye, M., Cissé, M.L., Guèye, S.M.K., Dièmé, F.M.E., Diouf, A.A., Guèye, M., et al. (2012) Premiers résultats de la coelioscopie gynécologique au Centre hospitalier universitaire (CHU) de Dakar série prospective de 128 cas. Journal of Obstetrics and Gynaecology Canada, 34, 939-946. [6] Ekwunife, C.N. and Nwobe, O. (2014) First 100 Laparoscopic Surgeries in a Predominantly Rural Nigerian Population: A Template for Future Growth. World Journal of Surgery, 38, 2813-2817.
http://dx.doi.org/10.1007/s00268-014-2656-2 [7] Mboudou, E.T., Foumane, P., Morfaw, L.I.F., Minkande, Z., Dohbit, S.J. aand Mbatsogo, E.B.A. (2013) Female Infertility and Laparoscopic Surgery: A Series of 415 Operations at the Yaounde Gyneco-Obstetric and Pediatric Hospital, Cameroon. Open Journal of Obstetrics and Gynecology, 3, 663-667.
http://dx.doi.org/10.4236/ojog.2013.39121 [8] Fouany, M.R. and Muasher, S.J. (2010) Is There a Role for Laparoscopy in the Diagnosis and Treatment of Infertility in the 21st Century? Middle East Fertility Society Journal, 15, 146-152.
http://dx.doi.org/10.1016/j.mefs.2010.06.011 [9] Tanahatoe, S.J., Hompes, P.G. and Lambalk, C.B. (2003) Investigation of the Infertile Couple. Should Diagnostic Laparoscopy Be Performed in the Infertility Work up Program in Patients Undergoing Intrauterine Insemination? Human Reproduction, 18, 8-11.
http://dx.doi.org/10.1093/humrep/deg034 [10] Mol, B.W., Collins, J.A., Burrows, E.A., Van der Veen, F. and Bossuyt, P.M. (1999) Comparison of Hysterosalpingography and Laparoscopy in Predicting Fertility Outcome. Human Reproduction, 14, 1237-1242.
http://dx.doi.org/10.1093/humrep/14.5.1237 [11] Tchente Nguefack, C., Mboudou, E., Tejiokem, M.C. and Doh, A. (2009) Les complications de la coeliochirurgie dans le service de gynécologie A de l’hôpital général de Yaoundé au Cameroun. Journal de Gynécologie-Obstétrique et Biologie de la Reproduction, 38, 545-551.
http://dx.doi.org/10.1016/j.jgyn.2009.06.008 [12] Gomel, V. (1983) Salpingo-Ovariolysis by Laparoscopy in Infertility. Fertility and Sterility, 40, 607-611. [13] Jain, G., Khatuja, R., Juneja, A. and Mehta, S. (2014) Laparoscopy: As a First Line Diagnostic Tool for Infertility Evaluation. Journal of Clinical and Diagnostic Research, 8, Article ID: OC01-2.
http://dx.doi.org/10.7860/JCDR/2014/9822.4929 [14] Okunlola, M.A., Adebayo, O.J., Odukogbe, A.A., Morhason-Bello, I.O. and Owonikoko, K.M. (2005) Assessment of Tubal Factor Contribution to Female Infertility in a Low Resource Setting (Southwest Nigeria): Hysterosalpingography vs. Laparoscopy. Journal of Obstetrics and Gynaecology, 25, 803-804.
http://dx.doi.org/10.1080/01443610500328348 [15] Steinkeler, J.A., Woodfield, C.A., Lazarus, E. and Hillstrom, M.M. (2009) Female Infertility: A Systematic Approach to Radiologic Imaging and Diagnosis. Radiographics, 29, 1353-1370.
http://dx.doi.org/10.1148/rg.295095047 [16] Umeora, O.U., Mbazor, J.O. and Okpere, E.E. (2007) Tubal Factor Infertility in Benin City, Nigeria-Sociodemographics of Patients and Aetio-Pathogenic Factors. Tropical Doctor, 37, 92-94.
http://dx.doi.org/10.1258/004947507780609446 [17] Okonofua, F.E., Ako-Nai, K.A. and Dighitoghi, M.D. (1995) Lower Genital Tract Infections in Infertile Nigerian Women Compared with Controls. Genitourinary Medicine, 71, 163-168.
http://dx.doi.org/10.1136/sti.71.3.163 [18] Kemfang Ngowa, J.D., Mboudou, E.T., Toukam, M., Ngassam, A. and Kasia, J.M. (2014) Séro-prévalence de l’infection à Chlamydia trachomatis chez les femmes consultant pour infertilité à l’Hôpital Général de Yaoundé. Guinée Médicale, 83, 17-21. [19] Roy, B.N. and Tulandi, T. (2006) Syndrome de Fitz-Hugh-Curtis. Journal of Obstetrics and Gynaecology Canada, 28, 860. [20] Nzintcheu Youssa, J.M., Foumane, P., Mboudou, E.T., Nana, P.N., Fomulu, J.N. and Doh, A.S. (2012) Perihepatitis as a Laparoscopic Finding in Infertile Women at the Yaoundé Gyneco-Obstetric and Pediatric Hospital: Prevalence and Correlation with Tubo-Pelvic Lesions. Clinics in Mother and Child Health, 9, 1-5.
http://dx.doi.org/10.4303/cmch/C120501 [21] Buyalosa, R.P. and Agarwal, S.K. (2000) Endometriosis-Associated Infertility. Current Opinion in Obstetrics and Gynecology, 12, 377-381.
http://dx.doi.org/10.1097/00001703-200010000-00006 [22] Berker, B., Mahdavi, A., Shahmohamady, B. and Nezhat, C. (2005) Role of Laparoscopic Surgery in Infertility. Middle East Fertility Society Journal, 10, 94-104. [23] Bruhat, M.A., Mage, G., Pouly, J.L., Manhes, H., Canis, M. and Wattiez, A. (1989) Coelioscopie opératoire. Medsi/McGraw-Hill, Healthcare Group, Paris, 215 p. [24] Kasia, J.M., Raiga, J., Doh, A.S., Biouele, J.M., Pouly, J.L., Kwiatkowski, F., et al. (1997) Laparoscopic Fimbrioplasty and Neosalpingostomy. Experience of the Yaoundé General Hospital, Cameroon (Report of 194 Cases). The European Journal of Obstetrics and Gynecology and Reproductive Biology, 73, 71-77.
http://dx.doi.org/10.1016/S0301-2115(96)02674-7
[1] Sharma, S., Mittal, S. and Aggarwal, P. (2009) Management of Infertility in Low Resource Countries. BJOG, 116, 77-83.
http://dx.doi.org/10.1111/j.1471-0528.2009.02311.x [2] Otolorin, E.O., Ojengbede, O. and Falase, A.O. (1987) Laparoscopic Evaluation of the Tuboperitoneal Factor in Infertile Nigerian Women. International Journal of Gynecology & Obstetrics, 25, 47-51.
http://dx.doi.org/10.1016/0020-7292(87)90183-4 [3] Berker, B., Mahdavi, A., Shahmohamady, B. and Nezhat, C. (2005) Role of Laparoscopic Surgery in Infertility. Middle East Fertility Society Journal, 10, 94-104. [4] Raiga, J., Kasia, J.M., Canis, M., Glowaczower, E., Doh, A.S. and Bruhat, M.A. (1994) Introduction of Gynecologic Endoscopic Surgery in an African Setting. International Journal of Gynecology & Obstetrics, 46, 261-264.
http://dx.doi.org/10.1016/0020-7292(94)90403-0 [5] Mbaye, M., Cissé, M.L., Guèye, S.M.K., Dièmé, F.M.E., Diouf, A.A., Guèye, M., et al. (2012) Premiers résultats de la coelioscopie gynécologique au Centre hospitalier universitaire (CHU) de Dakar série prospective de 128 cas. Journal of Obstetrics and Gynaecology Canada, 34, 939-946. [6] Ekwunife, C.N. and Nwobe, O. (2014) First 100 Laparoscopic Surgeries in a Predominantly Rural Nigerian Population: A Template for Future Growth. World Journal of Surgery, 38, 2813-2817.
http://dx.doi.org/10.1007/s00268-014-2656-2 [7] Mboudou, E.T., Foumane, P., Morfaw, L.I.F., Minkande, Z., Dohbit, S.J. aand Mbatsogo, E.B.A. (2013) Female Infertility and Laparoscopic Surgery: A Series of 415 Operations at the Yaounde Gyneco-Obstetric and Pediatric Hospital, Cameroon. Open Journal of Obstetrics and Gynecology, 3, 663-667.
http://dx.doi.org/10.4236/ojog.2013.39121 [8] Fouany, M.R. and Muasher, S.J. (2010) Is There a Role for Laparoscopy in the Diagnosis and Treatment of Infertility in the 21st Century? Middle East Fertility Society Journal, 15, 146-152.
http://dx.doi.org/10.1016/j.mefs.2010.06.011 [9] Tanahatoe, S.J., Hompes, P.G. and Lambalk, C.B. (2003) Investigation of the Infertile Couple. Should Diagnostic Laparoscopy Be Performed in the Infertility Work up Program in Patients Undergoing Intrauterine Insemination? Human Reproduction, 18, 8-11.
http://dx.doi.org/10.1093/humrep/deg034 [10] Mol, B.W., Collins, J.A., Burrows, E.A., Van der Veen, F. and Bossuyt, P.M. (1999) Comparison of Hysterosalpingography and Laparoscopy in Predicting Fertility Outcome. Human Reproduction, 14, 1237-1242.
http://dx.doi.org/10.1093/humrep/14.5.1237 [11] Tchente Nguefack, C., Mboudou, E., Tejiokem, M.C. and Doh, A. (2009) Les complications de la coeliochirurgie dans le service de gynécologie A de l’hôpital général de Yaoundé au Cameroun. Journal de Gynécologie-Obstétrique et Biologie de la Reproduction, 38, 545-551.
http://dx.doi.org/10.1016/j.jgyn.2009.06.008 [12] Gomel, V. (1983) Salpingo-Ovariolysis by Laparoscopy in Infertility. Fertility and Sterility, 40, 607-611. [13] Jain, G., Khatuja, R., Juneja, A. and Mehta, S. (2014) Laparoscopy: As a First Line Diagnostic Tool for Infertility Evaluation. Journal of Clinical and Diagnostic Research, 8, Article ID: OC01-2.
http://dx.doi.org/10.7860/JCDR/2014/9822.4929 [14] Okunlola, M.A., Adebayo, O.J., Odukogbe, A.A., Morhason-Bello, I.O. and Owonikoko, K.M. (2005) Assessment of Tubal Factor Contribution to Female Infertility in a Low Resource Setting (Southwest Nigeria): Hysterosalpingography vs. Laparoscopy. Journal of Obstetrics and Gynaecology, 25, 803-804.
http://dx.doi.org/10.1080/01443610500328348 [15] Steinkeler, J.A., Woodfield, C.A., Lazarus, E. and Hillstrom, M.M. (2009) Female Infertility: A Systematic Approach to Radiologic Imaging and Diagnosis. Radiographics, 29, 1353-1370.
http://dx.doi.org/10.1148/rg.295095047 [16] Umeora, O.U., Mbazor, J.O. and Okpere, E.E. (2007) Tubal Factor Infertility in Benin City, Nigeria-Sociodemographics of Patients and Aetio-Pathogenic Factors. Tropical Doctor, 37, 92-94.
http://dx.doi.org/10.1258/004947507780609446 [17] Okonofua, F.E., Ako-Nai, K.A. and Dighitoghi, M.D. (1995) Lower Genital Tract Infections in Infertile Nigerian Women Compared with Controls. Genitourinary Medicine, 71, 163-168.
http://dx.doi.org/10.1136/sti.71.3.163 [18] Kemfang Ngowa, J.D., Mboudou, E.T., Toukam, M., Ngassam, A. and Kasia, J.M. (2014) Séro-prévalence de l’infection à Chlamydia trachomatis chez les femmes consultant pour infertilité à l’Hôpital Général de Yaoundé. Guinée Médicale, 83, 17-21. [19] Roy, B.N. and Tulandi, T. (2006) Syndrome de Fitz-Hugh-Curtis. Journal of Obstetrics and Gynaecology Canada, 28, 860. [20] Nzintcheu Youssa, J.M., Foumane, P., Mboudou, E.T., Nana, P.N., Fomulu, J.N. and Doh, A.S. (2012) Perihepatitis as a Laparoscopic Finding in Infertile Women at the Yaoundé Gyneco-Obstetric and Pediatric Hospital: Prevalence and Correlation with Tubo-Pelvic Lesions. Clinics in Mother and Child Health, 9, 1-5.
http://dx.doi.org/10.4303/cmch/C120501 [21] Buyalosa, R.P. and Agarwal, S.K. (2000) Endometriosis-Associated Infertility. Current Opinion in Obstetrics and Gynecology, 12, 377-381.
http://dx.doi.org/10.1097/00001703-200010000-00006 [22] Berker, B., Mahdavi, A., Shahmohamady, B. and Nezhat, C. (2005) Role of Laparoscopic Surgery in Infertility. Middle East Fertility Society Journal, 10, 94-104. [23] Bruhat, M.A., Mage, G., Pouly, J.L., Manhes, H., Canis, M. and Wattiez, A. (1989) Coelioscopie opératoire. Medsi/McGraw-Hill, Healthcare Group, Paris, 215 p. [24] Kasia, J.M., Raiga, J., Doh, A.S., Biouele, J.M., Pouly, J.L., Kwiatkowski, F., et al. (1997) Laparoscopic Fimbrioplasty and Neosalpingostomy. Experience of the Yaoundé General Hospital, Cameroon (Report of 194 Cases). The European Journal of Obstetrics and Gynecology and Reproductive Biology, 73, 71-77.
http://dx.doi.org/10.1016/S0301-2115(96)02674-7