With this procedure, surgery doesn’t have to be a nightmare

For years, Grace Ndagire suffered excruciating pain during her period that sometimes, she would have to miss school. Even when she started working in 2013, Ndagire was often absent from work since now she had backache and pain in the legs.
At first, she was diagnosed with tuberculosis of the bones before a scan at Kampala Imaging Centre showed growths in her stomach, hence a recommendation for surgery. Just like many, the idea of surgery was so frightening for Ndagire who shelved it for a while. 
“Choosing to endure the pain with every passing month, I let the doctor’s recommendation gather dust. However, while visiting my mother, she pointed out a swollen stomach and twisted gait as I had started to lean to one side,” she recalls.
To ease her mother’s worry, Ndagire promised to book the surgery in 2015.  When a second scan was done, it revealed she had fibroids and fluid in her abdomen. 
“In December 2015, I booked the surgery at a hospital in Kampala. The surgery lasted six hours and stabilising took five days before I was discharged,” she says. Given a month to recuperate, she returned to work only for the pain to resurface. 
“I called the doctor and he proposed another scan, which revealed a nine centimetre cyst on my right ovary. A second surgery was booked but it was aborted when he noticed several scars and the fact that my uterus, bladder and colon were stuck together. Additionally, the liquid in my abdomen had returned,” she says.
Hospital became Ndagire’s second home with each visit revealing a different ailment. 
“At one time, it was constipation, then diarrhoea, an infection, or unexplained stomach pain but every doctor gave a different diagnosis while MRI scans came up with nothing. I felt my life slowly slip away without a solution.” 
One day, despite desiring to ease herself, the pain was so unbearable that all she could do was scream causing her workmates to run to her rescue. 
“After discussions, my bosses agreed to pay for me to seek further help in Kenya. Admitted immediately at a hospital in Nairobi, several tests were done where it was discovered that there was water in my abdomen which was drained out. There was also lots of stool in the colon for which I was given two jars of salt mixture to clean it out,” she recalls.
Thereafter, a laparoscopy was performed and it was revealed that indeed, her uterus, bladder and colon were joined, causing difficulty and pain during bowel movement. “Some tissue was taken for further tests, which later revealed that I had endometriosis,” Ndagire shares. She has to take endless painkillers but is glad to know what causes the pain.

Breakthrough 
Laparoscopy is a new invention in the medical corridors that is less invasive compared to other surgeries. Also referred to as keyhole surgery or minimally invasive surgery, Dr Omanwa Kireki, an obstetrician and gynecologist, says it is used to diagnose and treat several conditions, such as endometriosis.
On the other hand, traditional or open surgery is invasive, and involves creating a large incision in the skin through which tissues and organs are cut around.
“This results in a standard loss of blood, tissue trauma, and long recovery time. Due to the large incision, the patient will also have a visible scar, their stay in the hospital will be longer, and the risk of readmission is higher,” Dr Paul Ivan Kato, an obstetrician and gynaecologist, at Mildmay Hospital, explains.
 “For minimally invasive surgery, the surgeon uses ultrasound technology or endoscopic procedures, with a small video camera and a monitor to easily and directly view and access images of the internal organs,” he adds.

Benefits 
Unlike the traditional, Dr Kireki says this unique surgery has a small incision. “You have three small holes, the largest being about one centimetre above the belly button and the other two, which are a half a centimetre each, on the lower abdominal wall,” he explains, adding that because the incisions are not deep, the after-surgery pain is less,” Dr Kireki adds.
Also, recovery is faster. “Patients undergoing this procedure will walk into the hospital and leave right after the surgery. 
It is also possible that they return to work almost immediately depending on the kind of work they are engaged in,” he says adding that with small incisions, post-surgery scars are minimal.

Operations done by laparoscopy 
 Dr Vianney Kweyamba, a visiting surgeon at UMC Victoria Hospital, says any abdominal surgery can be done by laparoscopy.  “These include cystectomy where ovarian cysts are removed, opening of blocked fallopian tubes, ovarian drilling to treat polycystic ovaries (PCOS), diagnosis of pelvic adhesions, removal of endometriosis caused scar tissue, cysts, and implants.” 
He adds that the procedure is also used to evaluate unexplained infertility, myomectomy (remove of fibroids), tubal ligation for family planning, study and treat digestive and urinary system ailments among others.

When the surgery can’t happen
Save for exceptions, there are times when the procedure cannot be done inasmuch as it were a possible surgery. Dr Omanwa Kireki, an obstetrician and gynecologist, shares some of the possible hinderances:
If the patient has contraindications for any surgeries such as hypertension, and diabetes mellitus which are not well controlled, then the surgery cannot be carried out. Other patient driven limitations include blood clotting problems where the person has low platelets, advanced stages of cancer as well as lack of patient consent.
Another set of hinderances are those stemming from health care providers such as poor state or lack of equipment which are also costly hence the reason for few medical facilities carrying out the procedure. 

When surgery fails
Dr Paul Ivan Kato, an obstetrician and gynaecologist, shares that failed laparoscopies are more frequent among patients with prior abdominal surgery or obesity. “Patients who have had previous operations face greater difficulty because access or surgical manoeuvre are a little hard because of adhesions,” he explains.  He adds that complications may arise involving the viscera (intestine, bladder, or ureter) or great vessels hence severe hemorrhage. “In case of difficult entry or complications, we usually convert to a laparotomy,” he says.
Similar procedure 
While laparoscopy is used to examine one’s abdomen and pelvis, Dr Kweyamba cites a similar procedure, hysteroscopy, which is used to examine a woman’s uterus. “Using a hysteroscope, a thin lighted tube, a doctor inserts it into the vagina to examine inside the uterus and cervix to diagnose an ailment or perform an operation,” she says.