Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

Objective: The objective of this investigation was to ascertain the effectiveness of an ultrasound-guided erector spinae plane block (ESPB) administered to patients diagnosed with hepatocellular carcinoma who were subjected to laparoscopic left hemihepatectomy.

Methods: A retrospective analysis was conducted on 172 patients, comparing 2 groups: one comprising 90 individuals who were administered intravenous patient-controlled analgesia (PCA) simultaneously with ESPB, and a second group of 82 patients who received PCA monotherapy. To equilibrate covariates across the groups, propensity score matching was executed, yielding 25 matched pairs as a result.

Results: At 12 and 24 hours postprocedure, visual analog scale (VAS) pain scores, both at rest and during movement, were significantly reduced in the group receiving PCA in conjunction with ESPB. Furthermore, this group exhibited a substantially lower incidence of rescue analgesia utilization, a significantly abbreviated duration to ambulation, a reduced hospitalization period, and a significantly elevated level of patient satisfaction.

Conclusion: ESPB serves as an efficacious ancillary analgesic for laparoscopic left hemihepatectomy, offering superior pain management and recuperation relative to the administration of intravenous analgesia in isolation. The implementation of ESPB as an adjunct to PCA in patients with hepatocellular carcinoma undergoing laparoscopic left hemihepatectomy proved to be both safe and efficacious. Notably, PCA augmented with ESPB demonstrated greater efficacy in mitigating postoperative pain compared with PCA as a standalone therapy.

Background: Rectal eversion (RE) is a natural orifice specimen extraction (NOSE) method that allows anus-sparing resection in very low rectal tumors. This study aims to share the long-term results of RE in laparoscopic rectal resection performed with double stapling anastomosis.

Materials and methods: A single-center retrospective cohort study was conducted for patients who underwent laparoscopic low anterior resection with RE. Age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, type of surgery, distance of the tumor to the dentate line, specimen extraction site, cancer stage, preoperative chemoradiotherapy, postoperative complications, and postoperative clinical follow-up findings were recorded. Incontinence was assessed using the Wexner score (WS). Low anterior resection syndrome (LARS) is determined by the LARS score. A 7-point Likert scale was used to evaluate the satisfaction of the patients.

Results: A total of 17 patients underwent resection by RE for rectal tumors. Of the 11 patients included in the study, 4 were female and 7 were male. The mean age was 66.09±15.04 years. The mean follow-up was 64.18±16.83 months. The mean tumor diameter was 3.1 cm (range: 0.9 to 7.2 cm). The mean distance of the tumor from the dentate line was 2.7 cm (range: 1.2 to 5.6 cm). No anastomotic leak was observed in any patient. One patient had an anastomotic stenosis and was treated with balloon dilatation. The median LARS score was 16 (range 0 to 32) and 64% of the patients had no LARS. Two patients had minor LARS and 2 patients had major LARS. The median Wexner score was 3.5 (range 0 to 14). The median Likert scale was 7 (range 5 to 7). It was found that 55% of the patients were extremely satisfied, 18% were satisfied, and 27% were slightly satisfied with their surgery. There were no dissatisfied patients.

Conclusion: RE is a safe NOSE technique in laparoscopic double stapling anastomosis for rectal resection. There is a high level of long-term patient satisfaction with anus-sparing procedures via RE, even in the presence of various symptoms.

Objective: Thoracoscopic sympathicotomy is a well-established treatment for severe palmar hyperhidrosis. This study evaluates the safety and efficacy of a novel one-stage, bilateral, single-port laser sympathicotomy with minimal dissection.

Methods: We retrospectively reviewed 73 patients with severe palmar hyperhidrosis who underwent this novel surgical technique between June 2023 and October 2023. Outcomes included complications, recurrent hyperhidrosis, and compensatory hyperhidrosis (CH). Hyperhidrosis severity was assessed using the hyperhidrosis disease severity score (HDSS).

Results: The mean patient age was 21.3 ± 7.7 years, with a female predominance (52.1%). Sympathicotomy was performed at the T3 level only in 46 patients (63%), with the remaining undergoing sympathicotomy at both T3 and T4 levels. Median cauterization and operating times were 78 seconds and 8.7 minutes, respectively. No complications occurred. Two patients experienced recurrent hyperhidrosis during a median follow-up of 9 months, both were mild (HDSS grade 1). CH developed in 41 patients (56.2%), with all occurring within the first month postoperatively. The most common sites for CH were the back (51.2%), chest (43.9%), thigh (41.5%), abdomen (36.6%), and lower leg (36.6%). The majority of patients with CH (95.1%) reported mild (HDSS grade 1) or moderate (HDSS grade 2) hyperhidrosis. A higher body mass index was a significant risk factor for CH (odds ratio: 1.36, 95% CI: 1.12-1.71 for every 1 kg/m2 increase).

Conclusions: This minimally invasive, single-port thoracoscopic laser sympathicotomy appears to be safe and effective for patients with palmar primary hyperhidrosis. Future studies should investigate long-term outcomes and refine the technique to minimize invasiveness even further.

Background: Percutaneous transhepatic biliary drainage (PTBD) is a common procedure for biliary obstruction jaundice caused by biliary tract obstruction. PTBD can be performed using external or external-internal methods, by the right or left lobe approach. However, differences in both the method used and the hepatic approach may affect success rates and complications. Therefore, this study aimed to examine the outcomes and complications of PTBD and compare them according to different methods and hepatic approaches.

Methods: Patients who underwent PTBD procedures in our interventional radiology department due to benign or malignant pathologies between March 2021 and March 2024 were included in the study. The diagnoses of the patients, and total and direct bilirubin values before and after the procedure were recorded. The clinical results and the complications of PTBD were compared statistically according to the hepatic approach and method. Univariate logistic regression analysis was performed to determine significant factors associated with PTBD success and complications.

Results: Sixty patients were included in our study (32 men, 28 women; mean age: 67.14±13.61 y). The most common indication was malignant bile duct obstruction (90%). The obstruction was mostly at the level of the common bile duct (46.7%). The success rate of PTBD was the highest with the left-side external biliary drainage approach (left-side external biliary drainage, 81.2%; right-side internal-external biliary drainage, 77.8%; right-side external biliary drainage, 69.2%; P=0.596). The complication rate was higher for right-side access (right side 15.9%, left side 12.5%, P=0.744). Univariate logistic regression analysis revealed that PTBD success in females was 5 times higher than in males [Exp(B): 5.000, β: 1.609, P<0.05]. Univariate logistic regression analysis revealed that methods used, entry lobes, and entry levels did not significantly affect PTBD success and complication incidence (P>0.05).

Conclusion: All approaches and methods used during PTBD were associated with low complications and high success rates. Nevertheless, external biliary drainage with right hepatic access has the lowest clinical success rate and a higher complication rate than the left-lobe approach. We observed that left-sided external biliary drainage was the most successful method and had fewer complications.

Background: This study was designed to investigate the clinical efficacy of laparoscopic left hemihepatectomy combined with choledochoscopic lithotomy for patients with complex intrahepatic bile duct stones.

Materials and methods: The clinical data of 97 patients with complex intrahepatic bile duct stones treated in our hospital between February 2019 and April 2022 were retrospectively collected. Patients were allocated into 2 groups based on their surgical approaches. In the control group, 46 patients underwent laparoscopic left hemihepatectomy, while in the combined group, 51 patients underwent laparoscopic left hemihepatectomy combined with choledochoscopic lithotomy. Parameters such as clinical efficacy, surgical indices, stress response markers (CRP, EP, COR), coagulation metrics (FIB, APTT, PT), liver function indicators (GGT, TBIL, ALT), complications, and quality of life were compared between the 2 groups.

Results: The combined group exhibited a significantly higher total effective rate compared with the control group (98.04% vs. 82.61%) (P<0.05). The operation duration of the combined group was longer than that of the control group. However, the duration for postoperative anal exhaustion, postoperative bed mobility, postoperative drainage, and hospital stay was shorter in the combined group than in the control group (P<0.05). CRP, EP, and COR concentrations were substantially elevated in both groups on the third postoperative day (P<0.05), but were lower in the combined group. Similarly, levels of FIB, APTT, and PT were markedly increased in both groups on the third postoperative day (P<0.05), but were lower in the combined group. On the seventh postoperative day, GGT, TBIL, and ALT were notably decreased in both groups, with the combined group exhibiting lower levels (P<0.05). The incidence of complications in the combined group was lower than that of the control group (5.88% vs. 19.57%) (P<0.05). At 3 months postoperatively, all GIQLI scores were markedly elevated in both groups, with superior scores observed in the combined group (P<0.05).

Conclusion: The combined laparoscopy and choledochoscopy demonstrate a remarkable efficacy for complex intrahepatic bile duct stones, which significantly facilitate liver function recuperation, reduce stress reactions, reduce complications, enhance the quality of life, and exert a minimal impact on coagulation functions.

Background: Retained gallstones are the most common cause of postcholecystectomy pain. They may be in a long remnant cystic duct (CD), the common bile duct (CBD), or within a remnant gallbladder (GB) post subtotal cholecystectomy. Although endoscopic management is often attempted, occasionally surgical clearance is required. Rates of preoperative surgery to remove stones in a remnant GB are rising due to the increased practice of subtotal cholecystectomy during a problematic laparoscopic cholecystectomy. This study aims to review the surgical management of symptomatic retained stones at a tertiary hepatobiliary referral center in Sydney, Australia.

Patients and methods: This retrospective analysis of prospectively collected data was performed on patients who underwent an operation for retained stones after a previous cholecystectomy over 18 years (2004-2022). All of the patients with residual CBD stones had failed endoscopic retrograde cholangiopancreatogram (ERCP) attempts or could not have an ERCP because of prior foregut surgery. All patients underwent a systematic preoperative workup confirming the biliary anatomy and pathology.

Results: Fourteen patients had surgical intervention for retained stones. All cases were attempted laparoscopically and were successful in 11/14 patients (78%). Retained stones were found within a remnant GB (29%, n=4), a remnant CD (36%, n=5), or the CBD (36%, n=5). Conversion to an open procedure in 3 patients was for dense fibrosis associated with a long low-insertion of the CD, necessitating a hepatico-jejunostomy, failure to delineate the biliary anatomy, and inability to clear CBD stones, respectively. One patient developed a minor postoperative complication (superficial wound infection), and all patients were free of symptoms at a median follow-up of 33.5 months.

Conclusion: This study demonstrates favorable outcomes in patients undergoing laparoscopic intervention for retained gallstones. A systematic approach to the workup and surgical management of patients with retained stones is essential.

Background: Although originally described as an open procedure, the application in the setting of minimally invasive surgery of the Pauli technique for parastomal hernia repair is gaining interest among surgeons owing to encouraging early results. We aimed at combining and analyzing the results of minimally invasive Pauli repair by assessing the available evidence.

Methods: A literature search in Pubmed, Embase, and Web of Science was undertaken to include all articles reporting on minimally invasive repair of parastomal hernias using the Pauli technique.

Results: Data regarding a total of 75 patients across 11 articles published between 2019 and 2023 were included. Patients received surgery either by a laparoscopic (27%) or robotic (73%) approach. A transabdominal route was chosen in 62 patients (83%), while an extraperitoneal technique was employed in the remaining 13 patients. The rate of postoperative morbidity was 34%, with 10% being the incidence of grade >II complications. The reported overall rate of recurrence was 7% at a median follow-up of 1 to 43 months.

Conclusions: The available evidence derived from a growing number of centers suggests that minimally invasive Pauli repair is a viable option to treat parastomal hernias. Despite robust, high-level data still lacking, preliminary experiences indicate promising results.

Background: Laparoscopic hepatectomy has been widely accepted owing to its advantages as a minimally invasive surgery; however, laparoscopic segment 7 (S7) hepatectomy (LSH) has been rarely reported. We aimed to explore the safety and feasibility of LSH by comparing it with open surgical approaches.

Methods: Twenty-nine patients who underwent S7 hepatectomy between January 2016 and January 2023 were enrolled in this study. The patients' characteristics, intraoperative details, and postoperative outcomes were compared between the 2 groups.

Results: No significant differences were observed in the preoperative data. The patients who underwent LSH had significantly shorter hospital stays (P=0.016) but longer operative times (P=0.034) than those who underwent open S7 hepatectomy. No significant differences in blood loss (P=0.614), transfusion (P=0.316), hospital expenses (P=0.391), surgical margin (P=0.442), rate of other complications, postoperative white blood cell count, and alanine aminotransferase and aspartate aminotransferase levels were noted between the 2 groups (P>0.05). For hepatocellular carcinoma, the results showed no differences in either disease-free survival (P=0.432) or overall survival (P=0.923) between the 2 groups.

Conclusions: LSH is a safe and feasible surgical procedure that is efficient from an oncological point of view. It may be the preferred technique for lesions in the S7 of the liver.

Objective: To analyze device safety and clinical outcomes of ventral hernia repair with the GORE SYNECOR Preperitoneal Biomaterial (PRE device), a permanent high-strength mesh with bioabsorbable web scaffold technology.

Materials and methods: This multicenter retrospective review analyzed device/procedure endpoints and patient-reported outcomes in patients treated for hernia repair ≥1 year from study enrollment.

Results: Included in this analysis were 148 patients with a mean age of 56 years; 66.2% met the Ventral Hernia Working Group grade 2 classification. Median hernia size was 30.0 cm 2 and 58.8% of patients had an incisional hernia. Repairs were primarily a robotic (53.4%) or open approach (41.9%). All meshes were placed extraperitoneal. Procedure-related adverse events within 30 days occurred in 13 (8.8%) patients and included 7 (4.8%) patients with surgical site infection, 2 (1.4%) with surgical site occurrence (SSO), 4 (2.7%) requiring readmission, and 3 (2.0%) who had reoperation. The rate of SSO events requiring procedural intervention was 2.7% (4 patients) through 30 days and 3.4% (5 patients) at 12 months. The rate of procedure-related surgical site infection remained at 4.8% through 12 months (no further reports after 30 d) and 3.4% for SSO (2 reports after 30 d). There were no site-reported clinically diagnosed hernia recurrences throughout the study. Median patient follow-up including in-person visit, physical examination, reported adverse event, explant, death, and questionnaire response was 28 months (n = 148). Median patient follow-up with patient questionnaire was 36 months (n = 88).

Conclusions: Use of the PRE device, which incorporates the proven advantages of both an absorbable synthetic mesh and the long-term durability of a permanent macroporous mesh, is safe and effective in complex ventral hernia repairs. When used in the retromuscular space, the combination of these 2 materials had lower wound complications and recurrence rates than either type of material alone.

Background: Intra-abdominal abscess (IAA) is a very common postoperative complication after laparoscopic appendectomy and is associated with poor prognosis.

Materials and methods: This study retrospectively analyzed elderly patients who underwent laparoscopic appendectomy from 2015 to 2024, examining demographic, clinical, and laboratory data to identify IAA risk factors. Independent risk factors for IAA were screened and finally identified by multivariate logistic regression analysis.

Results: A total of 37 patients developed IAA within postoperative 30 days, with an incidence of 9.6% (37/385). Receiver operating characteristic (ROC) curve analysis indicated white blood cell (cut-off value: 13.35, sensitivity: 54.60%, specificity: 70.27%, P=0.003) and Prognostic Nutritional Index (PNI) (cut-off value: 41.95, sensitivity: 72.41%, specificity: 59.46%, P<0.0001) were 2 predictors for IAA with an area under the curve of 0.649 and 0.727, respectively. Based on the multivariate analysis, perforated appendicitis (odds ratio: 2.48, 95% CI: 1.15-5.32, P=0.021) and a lower PNI score (odds ratio: 3.44, 95% CI: 1.49-7.58, P=0.002) were 2 independent risk factors for IAA in elderly patients after laparoscopic appendectomy.

Conclusions: Elderly patients with perforated appendicitis and a PNI score <41.95 have higher risks for IAA after laparoscopic appendectomy.