JSLS : Journal of the Society of Laparoendoscopic Surgeons最新文献

Background and objectives: Acute appendicitis (AA) is a frequent surgical emergency. Although laparoscopic appendectomy (LA) is associated with favorable postoperative outcomes, open appendectomy (OA) remains widely used. Surgical site infection (SSI) is a common complication, with obesity recognized as a risk factor. However, body mass index (BMI) may not reliably reflect fat distribution. Subcutaneous fat thickness (SFT) measured on computed tomography (CT) may offer improved predictive value for surgical outcomes.

Methods: This retrospective study included 1,231 patients who underwent LA or OA for AA between 2017 and 2022. Preoperative SFT was measured on CT, and patients were analyzed by surgical technique and SFT subgroups. Postoperative complications, including SSI, were recorded. Receiver operating characteristic (ROC) analysis identified the SFT threshold associated with increased SSI risk.

Results: Despite similar BMI values between groups, SFT was significantly higher in LA patients (P < .001), highlighting the nonlinear relationship between BMI and SFT. LA was associated with shorter operative time (P = .004), reduced hospital stay (P = .009), and lower SSI rate (5.6% vs 13.5%, P < .001). Among patients with SFT ≥33 mm, LA resulted in significantly fewer SSIs (22 vs 50, P < .001) and shorter hospitalizations. ROC analysis confirmed SFT ≥33 mm as a strong predictor of SSI (area under the curve [AUC] = 0.841).

Conclusion: LA offers superior outcomes compared to open surgery, particularly in patients with higher SFT. The discrepancy between BMI and SFT underscores the need for direct fat measurement in surgical risk assessment. Incorporating SFT into preoperative evaluation can guide optimal surgical strategy and improve patient outcomes.

Background and objectives: Staple line leakage is a major complication after bariatric surgery, often requiring prolonged and complex treatment. While ultrasonography has been used for gastric cancer screening, its role in evaluating gastric wall before bariatric surgery is not well studied. This study aimed to measure antral gastric wall thickness preoperatively using ultrasonography to provide objective data that may guide stapler selection and reduce complication rates.

Methods: Between December 2024 and May 2025, 42 bariatric surgery patients underwent preoperative ultrasonography to measure the total thickness of the gastric antrum's 5 layers. Immediately after surgery, a pressure of 8 g/mm² was applied to the fresh specimen for 15 seconds, and antral wall thickness was measured using the micrometer.

Results: Mean antral, corpus, and fundus wall thicknesses measured by the micrometer under standardized pressure were 2.81 ± 0.36, 2.47 ± 0.27, and 1.71 ± 0.29 mm, respectively. A significant difference was found among these regions (P < .001). Mean antral wall thickness by ultrasonography was 3.97 ± 1.08 mm. No significant correlation was observed between ultrasonographic and micrometric antral measurements (P = .178).

Conclusion: Preoperative ultrasonography may be sufficient for measuring gastric wall thickness at rest; however, it is inadequate for estimating thickness under intraoperative conditions. Based on our findings and the limited existing literature, conventional ultrasonography does not reliably predict gastric wall thickness under compression. Therefore, noninvasive and cost-effective methods are still needed for accurate preoperative or intraoperative assessment of gastric wall thickness.

Background and objective: Laparoscopic suturing is a key skill in minimally invasive gynecologic surgery but remains technically demanding. Traditional training has relied on in-person courses, which became less accessible during the COVID-19 pandemic. This study compares the effectiveness of an online simulation-based suturing course with a conventional onsite training program.

Methods: A prospective observational study was conducted from January 2020 to October 2023. A total of 151 gynecology trainees participated. A total of 62 attended a 3-day onsite course using physical simulation systems with one mentor per 4 participants. A total of 89 completed a 5-day online course using home-based simulators with one mentor guiding the entire group. All trainees completed the same pre and postcourse assessments measuring precision, knot quality, and task completion time. Statistical analysis included paired and independent tests with significance set at a standard level.

Results: Both groups significantly improved in precision and time. The onsite group showed greater improvement in knot quality and total score. The online group had higher baseline precision and showed slightly greater precision gains. After adjusting for baseline scores, the onsite group had greater overall improvement.

Conclusions: Both onsite and online laparoscopic suturing courses significantly enhance technical performance. Onsite training showed a modest advantage, likely due to real-time feedback and hands-on guidance. Nonetheless, online simulation represents a viable, scalable option for surgical training, especially in resource-limited settings.

Objective: This study evaluates the long-term safety, efficacy, and recurrence of laparoscopic totally extraperitoneal (TEP) repair for bilateral inguinal hernias using a dual-mesh technique.

Background: TEP repair is a well-established approach for inguinal hernia, offering advantages such as reduced postoperative pain, faster recovery, and fewer wound complications.

Methods: A retrospective review was conducted of 426 patients with bilateral inguinal hernias who underwent TEP repair between January 2012 and May 2025. All procedures were performed by a single experienced surgeon using the standardized dual-mesh technique.

Results: The mean patient age was 48.46 years (range: 17-82). The mean operative time was 47.73 minutes, and the hospital stay was 27.45 hours. The mean follow-up was 74.2 months (range: 12-188). The overall complication rate was low: 34 (7.9%) cases of seroma, urinary retention 2 (0.47%), hematoma 6 (1.4%), hydrocele 3 (0.7%), and no mesh-related infections or chronic pain. Four recurrences (0.94%) were detected, attributed mainly to incomplete dissection, overlooked cord lipomas, or mesh shrinkage. No complications were attributable to the overlapping dual-mesh technique. No intensive care admissions, or deaths occurred.

Conclusion: Laparoscopic TEP repair with the novel dual-mesh technique provides reliable reinforcement of the myopectineal orifice (MPO), yielding low recurrence rates while avoiding vascular injury or mesh-related complications.

Background and objectives: Many patients with uterine fibroids turn to social media for information, where fibroid-related content has grown substantially. To effectively address misconceptions and deliver high-quality, patient-centered care, physicians should be aware of the online information their patients encounter. This study analyzes fibroid-related content on social media to better understand the information being consumed.

Methods: The top 100 "liked" posts using "#fibroids" were identified on Facebook, Instagram, and TikTok using a third-party web scraping tool. Post demographics and content were assessed by two reviewers and were included if they were in English and related to uterine fibroids. Information quality was measured with the DISCERN instrument; understandability and actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT).

Results: A total of 300 social media posts were analyzed (100 per platform) from October 2019 to June 2024. TikTok posts had the highest engagement, with a median of 23,150 "likes" and 510,800 views. Content themes included promotional (51%), diet/supplements (41%), awareness (36%), and educational (33%). Alternative remedies were the most frequently mentioned treatment (46%), followed by surgery (29%) though with low mention of minimally invasive procedures (6.7%). DISCERN scores indicated poor information quality (mean 28.4), while PEMAT scores showed high understandability (mean 94.9%).

Conclusion: Social media contains a large volume of mostly low-quality fibroid-related content and especially lacks representation of minimally invasive surgical options. Improved efforts are needed to promote accurate, evidence-based information online.

Objective: This study evaluates emergency department (ED) visits within the first 30 days following hysterectomy for benign gynecologic conditions, identifying risk factors and strategies for prevention.

Methods: A retrospective cohort analysis was conducted on 2,119 patients who underwent hysterectomy at a high-volume tertiary center between January 2023 and December 2024. Demographic, perioperative, and postoperative variables were analyzed, and predictors of ED visits were assessed using multivariable logistic regression.

Results: ED visits occurred in 8.6% of patients, with older age, higher intraoperative blood loss, longer operative time, and prior abdominal surgery being significant predictors (P < .05). Vaginal cuff hematoma (29.7%) was the most common cause of hospitalization, whereas abdominal pain (39.3%) and nausea/vomiting (40.7%) were the most frequent nonhospitalized complaints. Minimally invasive techniques were associated with lower ED visit rates compared to total abdominal hysterectomy.

Conclusion: Identifying high-risk patients and implementing structured postoperative monitoring may reduce unnecessary ED visits. Optimizing surgical techniques, perioperative management, and patient education is crucial for enhancing outcomes and reducing healthcare burden. Multicenter prospective studies are needed to validate these findings and refine perioperative strategies.

Background: This study examines the efficacy of robotic colorectal surgery across a large health system, focusing on factors such as hospital stay, operative time, pain management, and postoperative complications. The objective of this study is to compare outcomes of colorectal surgery by robotic, laparoscopic, and open techniques in a multicenter study.

Methods: A retrospective cohort study analyzed patients undergoing colorectal surgery from 2016 to 2022 using a clinical database from a large United States hospital system. Multivariable regression adjusted outcomes for various patient factors and institutional practices.

Results: Among 19,769 patients, robotic surgery was associated with shorter hospital stays (5.6 days vs 7.9 for laparoscopic and 11.2 for open, P < .0001), fewer postoperative complications, and lower pain levels. Despite longer operating room (OR) times, robotic surgery showed favorable trends in mortality, hospice discharge, and readmission rates compared to other approaches.

Conclusion: Robotic-assisted colorectal surgery may lead to decreased hospital stays, readmission rates, and improved patient outcomes across various healthcare settings.

Objectıve: In this study, we aimed to investigate the effectiveness of preperitoneal closed suction drainage in reducing postoperative complications in total extraperitoneal (TEP) repair inguinal hernia repair.

Methods: Between May 2021 and February 2023, 125 patients aged 18-80 years who were admitted to our hospital with primary unilateral (PM2, PM3 and PL2, PL3) inguinal hernia were included in preperitoneal drainage (group 1, n = 45) and no drainage groups (group 2, n = 80). Hematoma and seroma size, early postoperative bleeding, postoperative hospital stay, pain score and recurrence were recorded on the 6th day and 3rd month after surgery.

Results: A total of 114 of the patients were male and 11 were female. Hematoma and seroma were detected in 5 patients in Group I and 15 patients in Group II on the 6th day after surgery (P < .024). Two patients in Group I were re-explored on the first postoperative day due to the amount of drain and hemodynamic instability. There was no difference between the groups in terms of seromas seen in the third postoperative month. There was no difference between the groups in terms of VAS scores and hospital stay.

Conclusion: Especially for young surgeons who are new to surgical procedures, the placement of a drain that is removed after 24 hours will both reduce the development of hematoma and seroma and contribute to early diagnosis and timely intervention in case of serious bleeding.

Background: Inguinal hernia repair (IHR) is a common procedure, and patients with a history of IHR may later require radical prostatectomy. Prior IHR can complicate prostatectomy by altering anatomy, but its impact on extraperitoneal laparoscopic radical prostatectomy (ELRP) remains unclear. This study evaluates the feasibility and outcomes of ELRP in patients with prior IHR.

Materials and methods: This retrospective cross-sectional study included male patients aged 40-80 who underwent ELRP for localized prostate cancer between 2019 and 2024. Patients were stratified into two groups based on prior IHR status (group 1: without IHR; group 2: with IHR). Comparative analyses were performed on demographic data, perioperative metrics, and oncological outcomes to assess the impact of prior IHR on ELRP. Statistical significance was accepted as P < .05.

Results: A total of 255 patients (group 1: 220, group 2: 35) were included. No significant differences were found between the groups in terms of age and demographic characteristics. However, the operation duration was longer in group 2 (194.86 vs 176.87 minutes, P = .002), and peritoneal opening occurred more frequently (34.3% vs 9.1%, P < .001). There was no significant difference in the rates of pelvic lymph node dissection (PLND) (25.9% vs 28.5%, P = .149).

Concluison: ELRP outcomes in patients with a history of IHR are similar to standard ELRP. However, when planning surgery for this group, the risk of peritoneal opening, prolonged operation time, and the careful execution of lymph node dissection should be considered.

Objective: To describe clinical, surgical, and cosmetic outcomes in patients with germline mutations undergoing endoscopic nipple- and skin-sparing mastectomy (eNSM) with immediate reconstruction.

Methods: We conducted a retrospective review of 6 patients (11 breasts) treated between March 2022 and May 2024. All patients had confirmed BRCA1, BRCA2, CHEK2, or MUTYH mutations. Data on operative time, bleeding, specimen weight, reconstruction satisfaction (BRECON 31), complications, and recurrence were collected.

Results: All surgeries were completed without conversion to open surgery. Mean age was 41 ± 9.2 years; mean surgical time was 115.6 ± 11.0 minutes; mean blood loss was 110 ± 70.9 mL. No complications were reported. BRECON 31 satisfaction score at 6 months was 15.3/16. Median follow-up was 13 months with no recurrences.

Conclusions: eNSM is a feasible and effective option for patients with high-risk genetic mutations, offering oncologic safety and high satisfaction in our initial Latin American experience.