Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

Introduction: Postoperative pancreatic fistula (POPF) is a serious complication that can lead to potentially fatal outcomes; therefore, early intervention with drainage is warranted whenever clinically feasible. Endoscopic ultrasound-guided transmural drainage (EUS-TD) is becoming an alternative to percutaneous drainage for managing POPF. While EUS-TD is increasingly used, there is no consensus on stent type or the need for external drainage in early postoperative EUS-TD for POPF. This study aimed to evaluate the feasibility of EUS-TD using multiple plastic stents (PSs) without external drainage for managing POPF within postoperative day 15.

Methods: This retrospective case series included 11 patients who developed POPF and underwent EUS-TD within postoperative day 15 between January 2021 and June 2024. The primary outcome was clinical success of EUS-TD with multiple PSs without external drainage. Secondary outcomes included technical success, complications, length of hospital stay, and recurrence rate.

Results: Eleven POPF patients underwent EUS-TD. Two or more PSs were successfully placed in all cases, with clinical success achieved in 10 of 11 cases. One case required additional percutaneous drainage. A pseudoaneurysm rupture occurred in one case and was successfully managed with interventional radiology. The mean length of hospital stay was 19.1 days. No recurrences were observed during a median follow-up period of 26.0 months. Stents were removed after 6 months or later.

Conclusions: EUS-TD using multiple PSs without external drainage may be a feasible approach for managing POPF within postoperative day 15. Further prospective studies are needed to validate these findings and optimize early postoperative management strategies for POPF.

Background: The optimal timing of percutaneous cholecystostomy (PC) in acute cholecystitis remains unclear, despite its increasing adoption as a treatment option for elderly and critically ill patients. This study aimed to evaluate the impact of PC timing on complications, hospital stay, and mortality in high-risk patients with moderate and severe acute calculous cholecystitis.

Materials and methods: Between 2020 and 2024, 124 consecutive patients who underwent PC were retrospectively reviewed. The time periods from admission to PC were measured. Patients with grade II cholecystitis who had a Charlson Comorbidity Index (CCI) score ≥6 and an American Society of Anesthesiologists Physical Status (ASA-PS) score ≥3, and those with grade III cholecystitis who had a CCI score ≥4 and an ASA-PS score ≥3, were defined as high-risk patients using TG18-aligned thresholds. Among these 82 high-risk patients, the median time from admission to PC was 39 hours (range: 21 to 62 h).

Results: Early high-risk group (≤48 h; n=51) had shorter hospital stay [7 (5 to 8) vs. 13 (6 to 20) d; P<0.001], lower ≤90-day mortality rate (5.9% vs. 22.6%; P=0.037) and lower ≤365-day mortality rate (7.8% vs. 25.8%; P=0.049) as compared with delayed high-risk group (>48 h; n=31). Delayed PC (OR=4.80, P=0.004) and complications related to PC (OR=4.37, P=0.015) were independent risk factors for longer hospital stay. A higher CCI Score (≥7) (OR=13.68, P=0.047) and delayed PC (OR=8.64, P=0.04) were independent risk factors for in-hospital mortality.

Conclusions: While emergency cholecystectomy remains the gold standard for the treatment of acute cholecystitis, PC represents a valuable initial treatment alternative in high-risk patients when performed at an early stage. Early PC provides significant advantages, including fewer complications, shorter hospitalization, and reduced in-hospital mortality.

Background: Nonmidline ventral hernias (NMVH) are encountered less frequently than midline ventral hernias. Laparoscopic NMVH repairs are considered technically more difficult than midline hernias. For this reason, various intraperitoneal and extraperitoneal approach methods have been defined in the surgery of this group of hernias. In this study, we aimed to present the clinical data and follow-up results of patients who underwent laparoscopic repair of NMVH using the transabdominal partial extraperitoneal (TAPE) technique.

Methods: In this single-center and retrospective study, demographic information, hernia characteristics, operative findings, and follow-up data of laparoscopic NMVH surgeries performed by a hernia-specific general surgery unit between January 2022 and June 2024 were scanned and analyzed.

Results: Data from 26 patients with NMVH who underwent laparoscopic repair using the TAPE technique were analyzed. The mean age of the patients was 52.9±13.5 years. No intraoperative complications or conversion to open surgery were observed in any case. The median operative time was 100 (82.5 to 120) minutes. The median VAS score on the first postoperative day was 5 (3.75 to 6). Complications developed in 38.5% of patients during hospitalization; 26.9% were Clavien-Dindo class 1 and 11.5% were class 3a. The median hospital stay was 3 (3 to 5) days. The mean follow-up period was 17.8 (9 to 48) months, during which 2 patients (7.7%) experienced recurrence.

Conclusions: The TAPE technique is among the reliable techniques that can be applied in the laparoscopic repair of NMVH with low complication and recurrence rates.

Background: Single-incision laparoscopic cholecystectomy (SILC) offers excellent cosmetic results but is technically challenging. Robotic systems can overcome these limitations, and although the da Vinci Xi is designed for multiport surgery, it can be adapted for single-port procedures. This study reports our experience performing single-port robotic cholecystectomy (SPRC) with straight instruments, emphasizing technical optimization and perioperative outcomes.

Methods: SPRC was performed using an optimized umbilical port configuration and docking technique. Surgical steps were standardized to ensure stable traction and precise dissection, with a crossover method applied in difficult cases to improve exposure (see Supplemental Videos 1, Supplemental Digital Content 1, http://links.lww.com/SLE/A507 , and 2, Supplemental Digital Content 2, http://links.lww.com/SLE/A508 ). Eleven patients underwent SPRC, and demographic, operative, and perioperative data were analyzed.

Results: All procedures were completed without conversion to open or multiport surgery. The mean operative time was 116.7 ± 22.2 minutes, with minimal blood loss (13.8 ± 7.5 mL). No intraoperative complications or gallbladder perforations occurred, and only one patient required temporary drainage for minor oozing. Postoperative VAS scores averaged 3.1 ± 1.0 on day 0 and 1.6 ± 0.5 on day 1, with a mean hospital stay of 2.2 ± 1.1 days. No readmissions or port-site complications were observed.

Conclusions: SPRC with the da Vinci Xi system using straight instruments is feasible and safe. Optimized port placement and instrument coordination yield outcomes comparable to those reported for the SP system or single-site platform, providing an accessible alternative for centers without these platforms.

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: 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).