Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

Background: Acute uncomplicated appendicitis has traditionally been managed surgically, but recent trials suggest nonoperative treatment with antibiotics may be effective in selected adults. This meta-analysis compares long-term outcomes of antibiotics versus surgery and evaluates predictors of treatment failure, including the presence of an appendicolith.

Methods: We systematically searched MEDLINE, Embase, CENTRAL, and clinical trial registries up to July 2024. We included randomized controlled trials (RCTs) comparing antibiotics versus appendectomy in adults with imaging-confirmed uncomplicated appendicitis. The primary outcome was 1-year treatment success. Secondary outcomes included complication rates, recurrence, and subgroup analysis by appendicolith. A meta-regression explored the relationship between appendicolith prevalence and treatment failure.

Results: Seven RCTs (n=3164) were included. The 1-year treatment success rate was significantly lower in the antibiotics group (73.8%) versus surgery (98.1%) (RR 0.78, 95% CI: 0.73-0.84). Complication rates were comparable (RR 0.57, 95% CI: 0.29-1.12). Patients with appendicolith had a significantly higher failure rate (up to 46%). Meta-regression confirmed a positive correlation between appendicolith prevalence and antibiotic failure.

Conclusions: Antibiotics can be effective in selected patients, but recurrence and treatment failure remain concerns, particularly in the presence of appendicolith. Appendectomy remains the definitive treatment. This meta-analysis, including the most recent trials and a novel meta-regression, provides timely insights for shared decision-making.

Aim: Temporary ileostomy is a valuable aid in reducing the severity of complications associated with rectal cancer surgery. The purpose of the present study was to determine the reasons for delays in ileostomy closure in patients who underwent laparoscopic rectal cancer surgery and protective loop ileostomy and to prevent delays in closure timing.

Methods: A retrospective analysis was conducted with patients who underwent loop ileostomy and its reversal in laparoscopic rectal surgery for rectal cancer at the Surgical Oncology Clinic of Tokat Gaziosmanpaşa University. Patients who had loop ileostomy closure between 2018 and 2023 were included in the study. Demographic data of the patients, neoadjuvant status, adjuvant chemotherapy, presence of comorbidities, smoking, American Society of Anesthesiologist's classification (ASA) score, primary surgical method [low anterior resection (LAR), very low anterior resection (VLAR), transanal total mesorectal excision (TaTME)], pathologic stage, anticoagulant use, presence of anastomotic leak, postoperative bleeding, presence of ileus, length of hospital stay, time from index surgery to closure, 90-day complications (Clavien-Dindo classification), unexpected 30-day readmission, reoperation status, and ileostomy closure time values were recorded, and a database was created. Multivariate regression analysis was used to identify clinically significant risk factors for delayed closure.

Results: A total of 129 patients underwent loop ileostomy closure during the study. The median time to closure in patients with rectal cancer was 5.47 months (range: 1 to 22). Thirty-nine of the 129 patients (30.2%) underwent reversal >6 months after index surgery. Anastomotic level (P=0.004), Clavien-Dindo complication grade (P=0.005), and hospital readmission after index surgery (P=0.004) were associated with delayed ileostomy closure (P<0.005).

Conclusions: Reasons for delay included factors such as degree of complication, hospital readmission, and anastomosis level. Addressing these causes would benefit patients in terms of improving their quality of life after closure.

Background: Previous studies have reported deaths due to undiagnosed cardiac tamponade following hiatal hernia surgery, with an alarmingly high associated mortality rate. This review aims to raise awareness and improve the diagnostic accuracy of cardiac tamponade among surgeons who perform hiatal hernia repair.

Methods: A retrospective analysis was conducted on cases of cardiac tamponade following hiatal hernia repair. Data collected included patient age, surgical approach, mesh fixation method, timing of cardiac tamponade diagnosis, and treatment strategies.

Results: A total of 23 eligible articles reporting on 30 patients with cardiac tamponade after hiatal hernia repair were included in this review. The age of patients ranged from 40 to 84 years, with a median age of 66 years. Tacker was used in 20 patients (66.7%) for mesh fixation. In half of the cases (50.0%), cardiac tamponade was diagnosed within 48 hours after surgery. Treatment mainly included pericardiocentesis and open drainage. Seven (23.3%) patients died postoperatively. Cardiac tamponade was undiagnosed in 4 patients (13.3%), all of whom died. Mortality rates were 100.0% in the undiagnosed group and 4.3% in the diagnosed group.

Conclusions: Accurate diagnosis and prompt management are crucial for rescuing patients from life-threatening cardiac tamponade following hiatal hernia surgery.

Background and aims: Cold forceps biopsy (CFB) is commonly used for the suspected diagnosis of colorectal cancer (CRC). With larger pathologic specimens, cold snare biopsy (CSB) of CRC may be an attractive alternative. We performed a cohort study to compare the effectiveness and safety of CSB to CFB.

Methods: Suspected CRC patients were retrospective and prospectively included and assigned to CFB or CSB at a single tertiary center. The primary outcome was the diagnostic consistency between endoscopic visual diagnosis and final biopsy tissue based on the duration required to determine diagnosis. And the diagnostic consistency between surgical postoperative pathology and final biopsy tissue. Secondary outcomes were clinically significant CSB or CFB-related bleeding, perforation, and technical success.

Results: A total of 2000 suspected CRCs in 2000 patients were enrolled in CSB group (n=411) and CFB group (n=1589). The technical success rate of the 2 groups was 100%. Two groups were significantly different for diagnostic consistency: 411/411 (100.0%), 381/411 (92.7%) CSB versus CFB 1438/1589 (90.5%), 1388/1589 (87.35%) (OR 1.035 and 1.839; 95% CI: 1.026-1.045 and 1.233-2.744; P ＜0.001 and P = 0.002). Bleeding and perforation occurred similarly in the 2 groups (16/411, 2/411, 0/411, 0/411 vs. 73/1589, 11/1589, 0/1589, 0/1589; P ＞0.05).

Conclusions: Compared with CFB, CSB is more effective in diagnosing suspected CRC without increasing adverse events.

Background: Metabolic and bariatric surgery (MBS) is an established treatment for severe obesity and its related comorbidities. While long-term outcomes are often emphasized, early postoperative complications remain a critical metric of safety and resource utilization. Large database studies have reported national trends in MBS outcomes but are limited by lack of granularity, inconsistent definitions, and inclusion of heterogeneous surgical experience. This study aimed to provide a detailed analysis of 30-day postoperative complications following sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch (DS) over a 17-year period at a single high-volume quaternary academic center.

Materials and methods: A retrospective cohort study of adult patients who underwent primary laparoscopic SG, RYGB, or DS between 2008 and 2024. All procedures were performed by fellowship-trained, minimally invasive bariatric surgeons. Complications occurring within 30 days postoperatively were identified through comprehensive chart review and classified using the Clavien-Dindo grading system. Primary outcomes included incidence, severity, and type of complications, as well as rates of readmission, reoperation, and reintervention. Multivariable logistic regression was used to identify predictors of overall and major complications.

Results: Of 2190 patients included, 413 (18.9%) experienced at least 1 early complication, totaling 467 discrete events. DS had the highest complication rate (29.3%), followed by RYGB (18.4%) and SG (17.5%). RYGB was associated with a high burden of major complications, including anastomotic strictures, GI bleeding, and reoperations for obstruction or leak. The 30-day rates of readmission (2.0%) and reoperation (1.3%) were low across all groups. Independent predictors of major complications included venous stasis (aOR=3.22), renal insufficiency (aOR=2.65), and type 2 diabetes (aOR=1.96); both RYGB (aOR=2.25) and DS (aOR=2.77) carried higher risk than SG.

Conclusion: This study provides a granular, procedure-specific profile of early complications after SG, RYGB, and DS. While all 3 procedures demonstrated acceptable safety profiles, DS had the highest overall complication rate, and RYGB carried the greatest burden of major complications. These findings underscore the variability in early postoperative outcomes by procedure type and reflect the value of institutional experience in characterizing complication profiles.

Background: Robot-assisted surgery has been widely adopted in digestive, urological, and gynecologic procedures, leading to its application in complex operations such as pelvic exenteration (PE). However, limited data are available regarding the perioperative outcomes of robotic PE compared directly to conventional laparoscopic PE in the treatment of colorectal cancer.

Methods: To assess the feasibility of robotic PE compared with laparoscopic PE for locally advanced colorectal cancer invading the anterior pelvic organs, we retrospectively reviewed patients who underwent either robotic or laparoscopic PE with curative intent (R0 resection) between May 2012 and August 2024.

Results: A total of 24 patients were included in the study (12 in the robotic group and 12 in the laparoscopic group). Patient characteristics revealed that the robotic group had an older median age and a lower prognostic nutritional index. In terms of surgical outcomes, no significant differences were observed in PE type, total operative time, estimated blood loss, or the number of retrieved lymph nodes. Conversion to open surgery occurred in 3 patients in the laparoscopic group, whereas no conversions were noted in the robotic group ( P = 0.032). The reasons for conversion in the laparoscopic group included uncontrollable bleeding and technical difficulty due to large tumor size.

Conclusions: Robotic surgery may offer greater suitability for complex procedures such as PE, compared with conventional laparoscopic surgery, particularly in challenging cases involving large tumors.

Background: Gastroesophageal reflux (GERD) disease is a common condition. It is caused by different underlying causes, ranging from lower oesophageal sphincter (LOS) dysfunction to an impaired gastric emptying and esophageal motility disorders. Although initially representing a benign condition, persistent GERD can result in precancerous lesions. Over time, various surgical and endoscopic solutions have been proposed, particularly for patients in whom medical therapy is either ineffective or poorly tolerated. Both endoscopic and surgical techniques aim to enhance the function of the anti-reflux barrier.

Methods: We provided an extensive narrative review of the diagnosis and treatment of GERD treatment, exploring both endoscopic and surgical solutions.

Results: Endoscopic procedures generally involve techniques such as gastric plication, delivery of radiofrequency energy at the gastroesophageal junction (EGJ), and the injection bulking agents into the EGJ.

Conclusions: The efficacy of endoscopic treatments is not yet supported by robust scientific evidence. To date surgical fundoplication remains the gold standard for the treatment of GERD.

Background: Corrosive ingestion frequently leads to upper aerodigestive tract strictures, with the optimal surgical approach debated. This study investigates the safety and effectiveness of colonic interposition for this condition.

Methods: We retrospectively reviewed 21 patients with corrosive-induced esophageal stricture who underwent left colonic interposition between 2017 and 2024. Procedures involved cervical dissection, colonic mobilization, retrosternal tunnel creation, and reconstruction. Four patients underwent fully open surgical procedures, and 17 patients underwent laparoscopic colon mobilization and retrosternal tunnel creation. Outcomes included surgical complications and short-term and long-term feeding function.

Results: The mean age was 37 years, with a male predominance (14/21 patients). All had esophageal stricture secondary to chemical burn for >1 year, and 14 were malnourished. Stricture locations were cervical (5 patients), upper third (8 patients), middle third (8 patients), and lower third (3 patients). Laparoscopic surgery had longer mean operative times than open surgery (361 vs. 294 min). One patient developed gastric outlet obstruction due to an undiagnosed pyloric stenosis. All patients resumed oral feeding by postoperative day 2, and feeding jejunostomy were removed at 1 month. During a median 30-month follow-up, all maintained normal oral intake and survived.

Conclusions: Left colonic graft interposition for esophageal reconstruction in caustic strictures is safe and effective. However, the technique is complex, particularly laparoscopically. Adequate graft length, vascularity, and isoperistaltic anastomosis are crucial for success.

Background: We designed a study to determine the impact of transversalis fascia repair (TFR) during TEP surgery for inguinal hernias on hospital stay duration, recurrence rates, quality of life, and related adverse outcomes in a randomized, double-blinded, controlled clinical trial. We screened patients presenting with inguinal hernias requiring elective surgery.

Methods: Eligible patients were randomly allocated into 2 groups: the TFR group, whose inguinal ring defect was narrowed; and the Routine Treatment Group (RTG) group, whose defect left unchanged. The prespecified primary outcomes were the length of hospital stay and the time of surgery. Patients were followed for 6 months to be evaluated regarding the Visual Analogue Scale (VAS), the rate of recurrence and seroma formation, and their Carolina Comfort Scale (CCS) hernia-specific quality of life.

Results: A total of 60 patients were allocated to study arms with no significant differences in the baseline characteristics. The intervention did not have a significant impact on the duration of hospitalization. However, the operation time in the TFR group was significantly longer than in the RTG group (Cohen's d=-1.13, 95% CI: -1.67 to -0.58, P <0.001). In contrast, no statistically or clinically significant differences were noted between the groups concerning postoperative pain, analgesic usage, or rates of acute and chronic pain. Furthermore, the TFR group had a much lower risk of seroma formation during the first week after surgery compared with the routine nonclosing defect group, showing an almost 80% lower risk of seroma formation. However, this finding did not reach statistical significance.

Conclusion: Although the defect-closing approach resulted in longer operation times, our study did not demonstrate any beneficial effects on hospital stay duration, postoperative pain, or quality of life. However, this approach may reduce seroma formation in the first week postsurgery, which should be confirmed in future meta-analyses.

Trial registration: This trial was prospectively registered on the Iranian Registry of Clinical Trials on February 29, 2024 (IRCT20180312039067N2).

Background and objectives: The occurrence of anastomotic leakage (AL) and gastroparesis syndrome (GS), common and severe complications after laparoscopic radical gastrectomy, significantly impacts the prognosis of patients. The objective of this study was to investigate the risk factors associated with AL after laparoscopic radical gastrectomy and GS after laparoscopic distal gastrectomy.

Methods: In this retrospective cohort study, 3779 patients who underwent laparoscopic radical gastrectomy and met the inclusion criteria were included. Of the 3779 patients, 85 (2.2%) were diagnosed with AL. The diagnosis of GS was made in 35 (2.4%) patients who underwent laparoscopic distal gastrectomy. Subsequently, univariate and multivariate logistic regression analyses were performed to determine the risk factors associated with AL and GS.

Results: The presence of hypoalbuminemia [odds ratio (OR)=2.437, 95% CI: 1.416-4.196, P =0.001] and intraoperative blood loss >150 ml (OR=1.712, 95% CI: 1.073-2.731, P =0.024) could be used as independent risk factors for AL. Total gastrectomy (OR=0.461, 95% CI: 0.264-0.805, P =0.006) and distal gastrectomy (OR=0.488, 95% CI: 0.276-0.863, P =0.014) were identified as the protective factors for AL. The presence of smoking history (OR=2.022, 95% CI: 1.022-4.001, P =0.043), pyloric obstruction (OR=3.748, 95% CI: 1.476-9.518, P =0.005), and Roux-en-Y anastomosis (OR=4.432, 95% CI: 1.292-15.206, P =0.018) were proved to be independently associated with GS for patients who underwent laparoscopic distal gastrectomy.

Conclusions: This study delineates distinct risk factors for AL and GS after laparoscopic gastrectomy. Contrary to preservation paradigms, total gastrectomy reduced AL risk versus proximal gastrectomy, challenging current proximal tumor management strategies.