Advertisement

Surgical Endoscopy

, Volume 33, Issue 12, pp 4128–4132 | Cite as

Barriers to adoption of laparoscopic cholecystectomy in a county hospital in Guatemala

  • Jonathan B. Imran
  • Annie Ochoa-Hernandez
  • Juan Herrejon
  • Cesar Ortiz
  • Blarimir Mijangos
  • Tarik Madni
  • Sergio HuertaEmail author
Article

Abstract

Background

Despite international efforts to increase performance of laparoscopic cholecystectomy (LC) in rural Guatemala, the vast majority of cholecystectomies are still performed via the open cholecystectomy (OC) approach. Our goal was to explore barriers to the adoption of LC in Guatemala as well as possible mechanisms to overcome them.

Methods

We reviewed 9402 cholecystectomies performed over 14 years by surgeons at the Hospital Nacional de San Benito (HNSB) in El Peten, Guatemala, with either an open or a laparoscopic approach. We conducted personal interviews with all the surgeons who perform cholecystectomies at HNSB to determine current practice and barriers to adopting LC.

Results

Overall, seven general surgeons were interviewed who regularly perform cholecystectomy. Of the total number of cholecystectomies reviewed, 8440 (90%) were open and 962 (10%) were laparoscopic. The mean number of cholecystectomies performed per surgeon was 1341.1 ± 1244.9, with OC at 1205.7 ± 1194.9, and LC at 137.4 ± 188.0. Lack of formal training in laparoscopy was identified in 57% of surgeons. Lack of government funds to implement a laparoscopic program was noted by 71% of surgeons (29% felt there was insufficient ancillary staff, 29% poor allocation of hospital funding to purchase laparoscopic equipment/training). Lack of sufficient laparoscopic equipment was identified by 71% of surgeons.

Conclusions

Ninety percent of cholecystectomies performed by surgeons at HNSB continue to be OC. The major limitation is the lack of funding to provide sufficient equipment or ancillary staff. The majority of surgeons preferred to perform LC if these problems could be addressed.

Keywords

Guatemala Laparoscopic Cholecystectomy Rural Low-income Barriers 

Notes

Acknowledgements

The authors would like to thank Dave Primm for his expertise in editing this manuscript.

Compliance with ethical standards

Disclosures

Jonathan B. Imran, Annie Ochoa-Hernandez, Juan Herrejon, Cesar Ortiz, Blarimir Mijangos, Tarik Madni, and Sergio Huerta have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR (1998) Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc 12(4):315–321CrossRefGoogle Scholar
  2. 2.
    Nande AG, Shrikhande SV, Rathod V, Adyanthaya K, Shrikhande VN (2002) Modified technique of gasless laparoscopic cholecystectomy in a developing country: a 5-year experience. Dig Surg 19(5):366–371 (discussion 372)CrossRefGoogle Scholar
  3. 3.
    Okrainec A, Smith L, Azzie G (2009) Surgical simulation in Africa: the feasibility and impact of a 3-day fundamentals of laparoscopic surgery course. Surg Endosc 23(11):2493–2498CrossRefGoogle Scholar
  4. 4.
    Choy I, Kitto S, Adu-Aryee N, Okrainec A (2013) Barriers to the uptake of laparoscopic surgery in a lower-middle-income country. Surg Endosc 27(11):4009–4015CrossRefGoogle Scholar
  5. 5.
    Imran JB, Ochoa-Hernandez A, Herrejon J, Madni TD, Clark AT, Huerta S (2017) Surgical approach to gallbladder disease in rural Guatemala. J Surg Res 218:329–333CrossRefGoogle Scholar
  6. 6.
    Timmerman C, Hernandez AO, Ortiz C, Huertas VL, Lopez R, Huerta S (2018) Current view on the nonoperative management of acute appendicitis in a county hospital in Guatemala. J Surg Res.  https://doi.org/10.1016/j.jss.2018.03.004 CrossRefPubMedGoogle Scholar
  7. 7.
    Refuge International. http://www.refugeinternational.com. Accessed Jul 2017
  8. 8.
    Chao TE, Mandigo M, Opoku-Anane J, Maine R (2016) Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies. Surg Endosc 30(1):1–10CrossRefGoogle Scholar
  9. 9.
    Nguyen NT, Goldman C, Rosenquist CJ et al (2001) Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 234(3):279–289 (discussion 289–291)CrossRefGoogle Scholar
  10. 10.
    Murphy AA, Nager CW, Wujek JJ, Kettel LM, Torp VA, Chin HG (1992) Operative laparoscopy versus laparotomy for the management of ectopic pregnancy: a prospective trial. Fertil Steril 57(6):1180–1185CrossRefGoogle Scholar
  11. 11.
    Straub CM, Price RR, Matthews D, Handrahan DL, Sergelen D (2011) Expanding laparoscopic cholecystectomy to rural Mongolia. World J Surg 35(4):751–759CrossRefGoogle Scholar
  12. 12.
    Manning RG, Aziz AQ (2009) Should laparoscopic cholecystectomy be practiced in the developing world?: the experience of the first training program in Afghanistan. Ann Surg 249(5):794–798CrossRefGoogle Scholar
  13. 13.
    Teerawattananon Y, Mugford M (2005) Is it worth offering a routine laparoscopic cholecystectomy in developing countries? A Thailand case study. Cost Eff Resour Alloc 3:10CrossRefGoogle Scholar
  14. 14.
    Contini S, Taqdeer A, Gosselin RA (2010) Should laparoscopic cholecystectomy be practiced in the developing world? The experience of the first training program in Afghanistan. Ann Surg 251(3):574 (author reply 575)CrossRefGoogle Scholar
  15. 15.
    Piukala S (2006) Laparoscopic cholecystectomy: complications and experiences in Tonga. Pac Health Dialog 13(2):107–110PubMedGoogle Scholar
  16. 16.
    Udwadia TE (2001) One world, one people, one surgery. Surg Endosc 15(4):337–343CrossRefGoogle Scholar
  17. 17.
    Alfa-Wali M, Osaghae S (2017) Practice, training and safety of laparoscopic surgery in low and middle-income countries. World J Gastrointest Surg 9(1):13–18CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jonathan B. Imran
    • 1
  • Annie Ochoa-Hernandez
    • 2
  • Juan Herrejon
    • 1
  • Cesar Ortiz
    • 2
  • Blarimir Mijangos
    • 2
  • Tarik Madni
    • 1
  • Sergio Huerta
    • 1
    • 3
    Email author
  1. 1.Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Hospital Nacional de San BenitoEl PetenGuatemala
  3. 3.VA North Texas Health Care System, Dallas VA Medical CenterUniversity of Texas SouthwesternDallasUSA

Personalised recommendations