The Types and Indications of Cholecystectomy in Nigeria: Our Experience in Damaturu, North-Eastern Nigeria

Background: Hepato-biliary disease, especially gallbladder related, was hitherto considered an exclusive problem of the developed nations of Europe, North-America and Asia. The African continent has changed remarkably, and globalisation has brought with it a cultural change in Africa. This change is characterised by both cultural and nutritional transition. The largely starch rich carbohydrate diet of the African is replaced by high calorie, fat laden meals with accompanying consumption of sugar rich snacks and beverages. The African continent has therefore seen a rise in gallbladder related pathologies and the indications and types of gallbladder related surgeries have also changed.

Objective: To determine the indications and types of cholecystectomies performed over an 11-year period at the State Specialist Hospital Damaturu, Yobe state, Nigeria.

Patients and Methods: A prospective cross-sectional study of 31 patients that presented at the General surgery unit of the State Specialist Hospital Damaturu, Yobe state, Nigeria. It is an 11-year study of patients that presented with clinically, radiologically, and histologically diagnosed Cholecystitis between 2003-2013. Patients’ characteristics studied included the age, gender, clinical symptoms, risk factors, radiological tool of assessment, type of surgery performed, and types of post-operative complications observed. Informed consent was obtained according to the Helsinki guidelines and Ethical clearance was given by the hospital management. All data obtained was assessed using the Statistical Package for Social Sciences, version 20.0 (IBM, Armonk, NY, USA).

Results: A total of 31 patients were studied. 12(38.7%) were males and 19(61.3%) were females. The mean age of the patients is 40.5(+_ 3.1) with peak age between 26-35 years and an age range of 16-75 years. The most common clinical symptom is right hypochondriac pain, typically a biliary colic, except for acute Cholecystitis where the pain last longer. It is seen in 100% of the patients. The least common clinical symptoms are Fever (29.0%) and Vomiting (35.5%). All diagnosed cases where confirmed by abdominal Ultrasonography (USS). All the patients had Open Cholecystectomy. The most common indications for Cholecystectomy are chronic calculous Cholecystitis (61.3%) followed by chronic acalculous Cholecystitis (25.8%). The most common post-operative complication is Surgical Site Infection (SSI) at 6.5%, as majority suffered no complications (80.6%).

Conclusion: Chronic calculous Cholecystitis is the most common indication for cholecystectomy in Nigeria and open cholecystectomy is the most practiced surgery except at tertiary health facilities with expertise for laparoscopic procedures.

Keywords: Types and Indications; Cholecystectomy; North-Eastern Nigeria