Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

Background: Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive malignancy that predominantly affects young male patients. Its nonspecific clinical presentation and low diagnostic yield from ascitic fluid cytology pose a significant diagnostic challenge, particularly when presenting as ascites of unknown origin.

Case presentation: A 30-year-old previously healthy young man presented with a 4-week history of progressive abdominal distention, intermittent fullness, unexplained weight gain, and bloody ascites. Cytology from paracentesis and tumor markers were nondiagnostic. Imaging revealed omental caking and multiple peritoneal nodules, suggestive of peritoneal carcinomatosis. Diagnostic laparoscopy identified extensive tumor seeding, and biopsy confirmed DSRCT based on histopathology, immunohistochemistry, and the presence of an EWS-WT1 fusion transcript on cytogenetic analysis, establishing the diagnosis of DSRCT. Chemotherapy was recommended; however, the patient's condition deteriorated rapidly, and he died within a few weeks before receiving treatment.

Conclusions: DSRCT, although rare, is noted for aggressiveness and rapid progression and therefore should ideally be considered in the differential diagnosis of bloody ascites in young male patients, even when initial cytology is negative. Early application of diagnostic laparoscopy and biopsy may facilitate timely tissue diagnosis, particularly when imaging mimics peritoneal carcinomatosis.

Background: Reoperative metabolic and bariatric surgery (MBS), consisting of revision and conversion surgery, carries higher morbidity and mortality compared with primary procedures, yet robust long-term data are limited.

Methods: A retrospective review was conducted of all patients 18 years of age or older who underwent first-time reoperative MBS between 2000 and 2024 at a single large quaternary referral center. Data were stored securely and analyzed in R (v4.4.2) using standard descriptive statistics and group tests (t tests/Wilcoxon/Kruskal-Wallis; χ²/Fisher). Sparse late-complication data precluded pairwise tests.

Results: Three hundred sixty patients, 86% female, mean age 50 years, underwent reoperative MBS. Conversion to Roux-en-Y gastric bypass (49%) was the most common surgery. The majority were performed for weight recidivism (37%). Length of stay, estimated blood loss, length of surgery, complication rates, readmission rates, and reintervention rates varied by type of reoperative MBS performed and indication. Most early complications were Clavien-Dindo 2, and most late complications were Clavien-Dindo 3b for all approaches. There was one procedure-related death in the study following an open conversion.

Conclusion: In this 24-year single-center cohort, weight recidivism was the most frequent indication for reoperation and was associated with improved perioperative outcomes and durable long-term weight loss. As the landscape of bariatric surgery continues to evolve, we recommend early referral to centers with reoperative MBS expertise.

Background: Intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) helps to clarify the biliary anatomy, detect common bile duct (CBD) stones, and prevent or promptly detect bile duct injuries (BDI). However, the indication for routine or selective cholangiography remains controversial. We aimed to compare the results of a routine versus selective IOC policy during LC in an urban teaching hospital.

Methods: A prospective cohort study was designed, including a consecutive series of patients undergoing LC with either routine IOC (RC) or selective IOC (SC). SC was performed in emergent LC for cholecystitis and in patients with preoperative risk factors for CBD stones. The primary outcomes of interest were CBD stones, BDI, and anatomic variations of the biliary tract rates. Secondary outcomes of interest were the IOC success rate and readmission for residual CBD stones.

Results: A total of 1506 patients were analyzed: 1003 (66.6%) with RC and 503 (33.4%) with SC. Demographic variables were comparable between groups. Emergent LC was more frequent in SC (RC: 29.7% vs. SC: 36.2%, P=0.01). The IOC success rate was higher in RC (RC: 93.5% vs. SC: 82.6%, P<0.001). LC with SC had higher rates of positive IOC (RC: 6.7% vs. SC: 11%, P=0.04) and CBD stones detection (RC: 6.3% vs. SC: 10.4%, P=0.05). BDI was comparable between groups (RC: 0.5% vs. SC: 0%, P=0.3%), and none of them were detected by IOC. Residual CBD stones were similar between groups (RC: 0.4% vs. SC: 0.2%, P=0.5). Overall morbidity (RC: 4.5% vs. SC: 4.9%, P=0.6), readmissions (RC: 1.2% vs. SC: 1.7%, P=0.4), and reoperations (RC: 0.7% vs. SC: 0.2%, P=0.3) were comparable between groups.

Conclusion: Selective use of IOC appears to be a safe and effective strategy with comparable BDI and residual CBD stone rates, compared with routine IOC. However, as selective IOC was associated with a lower success rate of IOC, surgical training for its performance should not be neglected.

Objective: This study aimed to systematically evaluate the effectiveness of fascial closure (FC) compared with nonfascial closure (NFC) in reducing trocar-site hernia (TSH) and improving postoperative outcomes in laparoscopic metabolic and bariatric surgery (LMBS).

Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO. Five major databases were searched up to November 2025. Randomized controlled trials and high-quality observational studies comparing FC versus NFC in LMBS were included. Primary outcome was TSH incidence; secondary outcomes included trocar-site bleeding, wound healing, operative time, and postoperative weight loss. Effect sizes were calculated using odds ratios (OR) and mean differences (MD) with 95% CI.

Results: Four studies (1 RCT and 3 observational studies) involving 1127 patients were included. Pooled analysis showed no significant increase in TSH with NFC compared with FC (OR: 1.72, 95% CI: 0.81-3.65, P=0.16). FC did not significantly decrease trocar-site bleeding (OR: 1.67, 95% CI: 0.41-6.72, P=0.47) or improve wound healing (OR: 1.10, 95% CI: 0.53-2.28, P=0.79). No differences were observed in operative time (MD: -6.96 min, 95% CI: -35.51 to 21.59, P=0.63) or postoperative weight loss. One RCT reported substantially increased postoperative pain associated with FC.

Conclusions: Current evidence does not support a clear clinical advantage of FC in reducing TSH or improving postoperative outcomes in LMBS. Considering the potential for increased postoperative pain and substantial interstudy heterogeneity, decisions regarding FC should be individualized. Larger multicenter RCTs with standardized techniques and longer follow-up are warranted.

Background: Achalasia is a rare esophageal motility disorder that causes dysphagia owing to impaired lower esophageal sphincter (LES) relaxation. This study aimed to evaluate a modified dissection and radial myotomy technique during peroral endoscopic myotomy (POEM) and to compare its outcomes with those of the standard approach.

Methods: This prospective, single-center study was conducted between February 2022 and December 2022. Eighty total with 80 achalasia patients undergoing POEM were divided into 2 groups: Group A (n=40), treated with the novel technique, and Group B (n=40), treated with the standard approach. Demographics, Eckardt score (ES), submucosal tunnel (ST), myotomy length, intervention duration, and adverse events were recorded. The follow-up period ranged from 3 to 20 months.

Results: Patients who underwent the novel radial myotomy technique (Group A) had significantly longer myotomy lengths (11.8±2.4 vs. 8.1±2.0 cm, P<0.001), greater myotomy extension beyond the esophagogastric junction (4.2±0.8 vs. 2.7±0.6 cm, P<0.001), and improved postoperative Eckardt scores (median 1 [0-1] vs. 2,1-3P=0.006) compared with the conventional POEM group (Group B). Subgroup analysis revealed that in Type III achalasia patients, the novel approach yielded longer submucosal tunnel lengths (15.6±0.8 cm, P=0.038) and favorable symptom relief. Despite extended dissection, there was no increase in gastroesophageal reflux disease (GERD)-related symptoms.

Conclusion: The novel dissection and radial myotomy technique demonstrated superior outcomes in reducing dysphagia symptoms and LES resistance compared with the standard approach. Tailoring ST and myotomy lengths based on the achalasia type and EGJ involvement may optimize outcomes without increasing the risk of GERD.

Background: Current guidelines on follow-up for acute appendicitis (AA) neglect the risk of colorectal cancer after AA. Heterogeneous and low-level evidence hinders drawing recommendations on follow-up of 40-year-old or older patients after AA, looking for colorectal neoplasms. This study aims to summarize existing research and identify gaps for future studies.

Methods: This scoping review was conducted following the 5-stage framework described by Arksey and O'Malley, and is based on the JBI (Joanna Briggs Institute) guidelines. The searching process followed the Cochrane Handbook and the Cochrane Methodological Expectations of Cochrane Intervention Reviews (MECIR) for conducting the search and the PRISMA 2020 for reporting. Protocol registration on Open Science Framework.

Results: Seventeen of 3778 studies met the inclusion criteria, all retrospective: 4 population-based and 13 cohort studies. Half focused on patients 40 years of age or older, while others analyzed older patients or performed a subanalysis by age. Seven studies had a 36-month follow-up, 2 had 24 months, and one had 12 months. Remaining studies provided subclassifications. The rate of colorectal neoplasms found at follow-up ranged from 0.5% to 34.6%, while the increased risk varied from 1.2 to 38.5 times, reflecting marked heterogeneity in study design and follow-up modality. Neoplasms were detected in all colorectal regions. Thirteen studies supported follow-up after AA, 3 expressed conditional favor, and one opposed it.

Conclusions: Many retrospective studies suggest an increased risk of colorectal neoplasms in AA patients aged 40 years or older. However, current evidence does not support solid recommendations for standard follow-up. This scoping review highlighted a gap in the literature, and a prospective study framework has been outlined to improve evidence quality on this topic.

Aim: Obesity is a well-known risk factor for surgical complications. Laparoscopic adrenalectomy is now preferred over open surgery for adrenal masses of <6 cm without high malignancy suspicion. This study evaluates the impact of obesity on surgical complication rates in laparoscopic adrenalectomy.

Materials and methods: Patients who underwent laparoscopic transabdominal adrenalectomy between 2013 and 2024 were retrospectively analyzed. They were divided into two groups: obese (BMI ≥30 kg/m2) and nonobese (BMI <30 kg/m2). Demographic data, perioperative, and postoperative outcomes were compared.

Results: A total of 110 patients (75 females, 35 males) were included, with 40 in the obese group and 70 in the nonobese group. The mean age was 46.6±12.4 years, and the mean BMI was 28.7±5.5 kg/m2. Surgery was performed on the right side in 58 patients (52.7%), left side in 51 (46.4%), and bilaterally in 1 (0.9%). The most common indications were Cushing syndrome (38 patients), pheochromocytoma (31), Conn syndrome (11), and incidentaloma (28). There were no significant differences between groups in terms of operative time, blood loss, tumor size, pathology, and hospital stay. Postoperative complications occurred in 6/40 obese (15.0%) and 3/70 nonobese (4.3%) patients, without a statistically significant difference (P=0.07). Complications in the obese group included wound infection (4 cases), toxic hepatitis (1), atrial fibrillation (1), and respiratory infection (1).

Conclusion: Obesity was associated with a trend toward higher postoperative complication rates, while operative time and length of stay were not significantly different. These findings emphasize the importance of surgical expertise and careful perioperative planning in obese patients.

Objective: To investigate the impact of preoperative nasopancreatic duct stent placement on local resection of benign pancreatic tumors, particularly its efficacy in reducing secondary surgeries due to postoperative pancreatic fistula.

Methods: The clinical data of 306 patients with benign pancreatic tumors larger than 2 cm who underwent local resection at the Department of Pancreatic Surgery, Hubei Provincial People's Hospital, over the past 6 years were retrospectively analyzed. Propensity score matching was used to minimize the selection bias.

Results: The incidence of grade C pancreatic fistula in the nasopancreatic duct placement group was 5% (2/40), significantly lower than the 20% (32/160) observed in the non-nasopancreatic duct placement group, with a statistically significant difference (Fisher exact test, P=0.02). In addition, the rate of secondary surgery in the nasopancreatic duct placement group was 5% (2/40), significantly lower than the 16% (29/160) in the non-nasopancreatic duct placement group (Fisher exact test, P=0.04). However, there was no significant difference in the incidence of postoperative complications such as septic shock, overall pancreatic fistula, and postoperative mortality between the 2 groups.

Conclusion: Preoperative nasopancreatic duct stent placement is a safe and effective procedure that significantly reduces the incidence of grade C pancreatic fistula following surgery for benign pancreatic tumors. Consequently, this decreases the necessity for secondary interventions related to grade C pancreatic fistula, ultimately enhancing patient prognosis and quality of life.

Introduction: Virtual reality simulation is a fundamental adjunct to robotic surgery training. It is not clear if individual performance at the simulator can be affected by predisposing factors such as gender, video gaming, and instrument playing.

Methods: Sixty-three volunteering medical students performed five times the same exercise at the DaVinci Simulator, and performance scores were collected for each participant (Overall Score, Time to Complete, Economy of Motion, Penalty Score) along with their demographics. Data were collected and analyzed within an electronic database. The difference (delta) between the highest score obtained in tests 2 to 5 and the score obtained in test 1 was calculated for each of the 4 scores and for each participant.

Results: All participants showed a significant improvement in their scores with practice (deltas were always positive). Median PS was significantly lower in women, but PSdelta was significantly higher in women than in men. Median TC and median PS were significantly lower in non-video game users. No significant difference of performance scores was found between music players and non-music players. Multivariable analysis confirmed that female gender was an independent prognostic variable towards PSdelta, that is, women showed a steeper improvement in their performance.

Conclusion: Repeated simulation improves the performance of surgically naïve medical students. Women and non-video gamers had higher penalty scores, but women tend to improve their skills quickly. As videogaming is much more frequent within the group of men, it is possible that videogaming itself, and not gender, can have a positive effect by enhancing eye-hand coordination.

Background: Postoperative intra-abdominal abscess (IAA) is the most feared complication after laparoscopic appendectomy (LA). The management of IAA measuring 2 to 4 cm remains controversial. We aimed to compare the effectiveness of antibiotic treatment versus percutaneous drainage for the treatment of IAA measuring 2 to 4 cm following LA.

Methods: A consecutive series of patients with post-appendectomy IAA measuring 2 to 4 cm from January 2006 to April 2024 was included for analysis. The patient cohort was divided into 2 groups according to the treatment modality: antibiotic therapy alone (ATB) versus computed tomography-guided percutaneous drainage (PERC). The primary outcome was to compare the success rate between groups. Secondary endpoints included overall and major complications, length of stay (LOS), readmissions, and mortality.

Results: During the study period, 2700 LA were performed, and 123 (4.5%) patients developed an IAA. Of these, 47 (38%) measured 2 to 4 cm: 25 (53%) received antibiotics only (ATB), and 22 (47%) underwent percutaneous drainage (PERC). The success rates were comparable between groups (ATB: 92% vs. PERC: 95.4%, P=0.6). Patients who failed conservative management in both groups underwent laparoscopic lavage without further complications. No readmissions, morbidity or mortality were observed. The mean LOS was longer in the PERC group (ATB: 2.0 vs. PERC: 3.5 d, P=0.03).

Conclusions: Antibiotic therapy and percutaneous drainage are both highly effective for treating IAA measuring 2 to 4 cm following LA. Given the less invasive nature of antibiotic therapy with shorter length of stay, it should be considered the initial treatment of choice.