Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

Background: Gastrointestinal endoscopes are essential for diagnosing and treating digestive disorders, although some drawbacks exist, such as patient discomfort and sedation.

Methods: Disposable, minimally invasive gastrointestinal endoscopes have garnered attention among endoscopists due to portability, improved patient comfort, and lack of post-procedural requirements. This innovation shows potential as an alternative to traditional endoscopy methods, with several studies confirming efficacy and safety in clinical settings.

Results: This review discusses the latest advances and ongoing research involving disposable gastrointestinal endoscopes with a focus on technological enhancements, patient outcomes, and the practical implications of integration into standard medical procedures.

Conclusions: Examining these developments provides a comprehensive analysis of the current disposable gastrointestinal endoscope technology status and future potential, emphasizing the role in enhancing patient care and procedural efficiency in gastroenterology.

Background: This study aims to evaluate the retrospective results of peptic ulcer perforation (PUP) treatment and assess the effectiveness and safety of early postoperative endoscopy.

Methods: Patients who underwent PUP surgery at Mersin University Hospital between 2010 and 2024 were analyzed. Demographic data, treatment methods, clinical outcomes, and early postoperative (6-8 wk) endoscopy results were evaluated for healing, complications, and recurrence. The correlation between treatment approach and clinical outcomes was statistically analyzed.

Results: A total of 176 patients underwent PUP surgery. A total of 70.4% (124) of the citizens are male. A total of 29.6% (52) of the patients are female. The average age was 61.2 years. Surgical interventions were performed by open surgery in 77.3% (136) and by laparoscopic method in 22.7% (40). Omental patching was performed in 93.8% (165) of the patients, simple closure was performed in 4.5% (8), and gastric resection was performed in 1.7% (3 patients). Peroperative biopsy was taken from all patients. In the biopsy results, Helicobacter pylori -positive ulcer was detected in 88.3% (156) of the patients, chronic inflammation was detected in 10.2% (18), and malignancy was detected in 1.1% (2). All patients were recommended a complete gastrointestinal endoscopy within 6 to 8 weeks after surgery. However, endoscopy was not performed in 54.6% of the patients (96 patients). In endoscopic evaluation, 15.6% (15) ulcers, 81.3% (78) normal findings, and 3.1% (3) malignancies were detected.

Conclusions: PUP can be effectively treated with laparatomy/laparoscopy, and omental patch repairment. Postoperative upper gastrointestinal endoscopy should be performed with an initial biopsy to avoid missing an underlying malignancy.

Background: Metabolic and bariatric surgery (MBS) has been an effective solution not only to obesity but also to metabolic diseases. As the demand for revisional surgery increases with the expansion of MBS, possible risks and complications of reoperation should be considered.

Method: We have collected and analyzed 3 patients diagnosed with class III obesity who underwent the single anastomosis sleeve ileal bypass (SASI) as a primary operation. Due to excessive weight loss or severe malnutrition, they were indicated for revisional surgery, where SASI was reversed to sleeve gastrectomy (SG) ( Fig. 1 ). The perioperative characteristics as well as outcomes after SASI and revisional surgery are reviewed.

Results: The confirmed measurement of their common channels in 3 patients with SASI revealed 350, 250, and 250 cm, respectively. The mean operative time was 42.3 minutes and blood loss was <20 mL. There were no intraoperative or postoperative complications. The patients had uneventful postoperative courses and the mean hospital stay was 2.3 days. There was no mortality in our cases. Malabsorption with nutrition issues was improved in each patient.

Conclusion: Laparoscopic revision of SASI to SG is a technically feasible and practical procedure for patients with excessive weight loss or malnutrition.

Background: Marginal ulcer (MU) remains a serious complication after Roux-en-Y gastric bypass (RYGB). This can be a life-threatening problem, even years after RYGB. Patients can present with pain or even with hemorrhage or perforation. There is no agreed-upon standard in prevention or treatment, although most perforated ulcers are treated with an omental patch. We present our results of treatment of MU with truncal vagotomy (TV).

Methods: A retrospective chart review identified patients who required surgical intervention for nonhealing MU or those presenting with perforated MU. Free perforation was treated with surgical intervention at the time of presentation. In patients with recalcitrant MU (without perforation), preoperative upper endoscopy confirmed the diagnosis. In all cases, the gastrojejunal anastomosis was revised or the marginal ulcer was resected, followed by laparoscopic TV. We reviewed operative time, ulcer recurrence, and complications in the cases identified.

Results: Forty-two patients underwent revision/resection following presentation with a recalcitrant ulcer or free perforation of a MU. Concomitant TV was performed in all cases. Average time from the RYGB was 71.8 months. There were no 30-day mortalities and no leaks. Average follow-up was 21 months. Sixty-two percent of patients had a follow-up endoscopy by 1 year with no recurrences. There were no reoperations or major complications.

Conclusion: Marginal ulceration remains a common complication after Roux-en-Y gastric bypass. Medical therapy is the first-line therapy but some patients will go on to develop refractory disease. This can be chronic, or acute with perforation or hemorrhage. Laparoscopic truncal vagotomy with revision of the gastrojejunal anastomosis is safe and effective in the treatment of marginal ulcers with low recurrence rates.

Objective: A comparative assessment of analgesic effectiveness and recovery quality between the anterior quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL) and the transversus abdominis plane block (TAPB) in patients undergoing laparoscopic partial hepatectomy (LPH).

Method: A total of 56 patients scheduled for LPH were randomly allocated to either the QLB-LSAL group or the TAPB group in a 1:1 ratio. Patients in the QLB-LSAL group received bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament, while those in the TAPB group received bilateral subcostal transversus abdominis plane block before surgery. The primary outcome was the morphine equivalent consumption (MEC) at 24 hours postoperatively. Secondary outcomes included MEC at 48 and 72 hours, as well as numeric rating scale (NRS) pain scores at rest and during movement, recorded at 2, 4, 6, 12, 24, and 48 hours postoperatively. The quality of recovery was assessed using QoR-15 scores, measured 1 day before surgery and on the first and third postoperative days.

Results: The QLB-LSAL group demonstrated significantly lower MEC at 24, 48, and 72 hours postoperatively compared with the TAPB group. NRS scores for pain at rest and during movement were also significantly lower in the QLB-LSAL group at 2, 4, 6, 12, and 24 hours following surgery. In addition, the QoR-15 scores, which assess the quality of recovery, were significantly higher in the QLB-LSAL group compared with the TAPB group on both the first and third postoperative days.

Conclusion: The QLB-LSAL method provides superior analgesia and enhances recovery quality compared with the TAPB approach in patients undergoing LPH.

Background: Inguinal hernias are among the most prevalent surgical problems worldwide. Preoperative and postoperative groin pain has the potential to affect quality of life (QOL) significantly. The purpose of this study is to identify whether the pain experienced by patients may be predicted by a number of preoperative and postoperative clinical and socioeconomic factors.

Methods: A retrospective review was conducted for all adult patients who underwent inguinal hernia repair with the study's senior author from January 1, 2016, to December 31, 2020. Data collected include medical history, groin pain ratings at preoperative and postoperative (2 wk) clinic visits, long-term pain, and quality of life (QOL) data >1 year after surgery. Median household income of the patient's residential zip code was used as a proxy for socioeconomic status (SES). Patient factors were evaluated for their correlation with pain ratings.

Results: Three hundred eighty patients were included in this study. Patients with higher preoperative pain (rated 5-10 out of 10, vs . 0-4 out of 10) had higher postoperative pain on average (3.18 vs . 1.0, P <0.001). Nearly all patients with preoperative pain had partial or complete pain relief long-term. Obesity ( P <0.05) and smoking history ( P <0.05) were both associated with higher preoperative pain and greater pain reduction through surgery. Lower income ( P <0.05) and younger age ( P <0.05) were associated with higher preoperative and postoperative pain.

Conclusions: Obesity, smoking history, lower income, and younger age were all significantly associated with higher pain levels before surgery, with obesity and smoking also linked to greater pain reduction after surgery. These findings highlight potential disparities, but patients with severe preoperative pain and comorbid conditions can still benefit from pain relief through surgery.

Introduction: Peritoneal tears (PTs) are an intraoperative complication that may occur during extraperitoneal space opening or hernia sac dissection in laparoscopic total extraperitoneal hernia repair (TEP) surgeries and are an important cause of conversion. There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of peritoneal tears during TEP.

Materials and methods: We included 288 consecutive patients who underwent TEP between May 2019 and December 2023. All data were collected retrospectively. Patients who developed PTs and those who did not develop PTs were compared in 2 groups. The demographic characteristics of the patients, hernia types, hernia defect diameters, surgery times, and intraoperative and postoperative complications were compared. Multivariate analysis identified independent risk factors for PTs in TEP.

Results: The overall incidence of PTs was 22.2% (n=64). The median age was 50.4±14.5 years and the body mass index was 25.9±2.9 kg/m 2 . Significant clinical factors associated with PTs included body mass i̇ndex (BMI), previous surgery, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for PTs: previous lower abdominal surgery and scrotal hernia.

Conclusion: Peritoneal tears are an intraoperative event that is the most important reason for conversion in TEP surgeries. The most important independent risk factors for peritoneal tear formation were scrotal hernia and previous lower abdominal surgery.

Introduction: Robotic-assisted kidney autotransplantation (RAKAT) is a minimally invasive approach to managing complex renal pathologies. While increasingly utilized, experience with RAKAT in patients with prior renal surgery remains limited.

Methods: We present a case of recurrent nutcracker syndrome (NCS) in a 29-year-old female who had previously undergone left renal vein transposition. Due to recurrent symptoms, she underwent RAKAT with extracorporeal vascular reconstruction using cryopreserved allografts to manage the foreshortened renal vessels. The surgical technique involved a multiport robotic approach with a hand-assist device, extracorporeal bench surgery, and repositioning for the autotransplantation phase.

Results: The procedure was completed successfully with a total operative time of 779 minutes and estimated blood loss was 100 mL. The cold ischemic time was 90 minutes. Postoperative complications included urinary tract infections requiring intravenous antibiotics (Clavien-Dindo grade II). At 7 months follow-up, the patient had excellent graft function and no evidence of recurrent NCS.

Conclusion: This case demonstrates the feasibility of RAKAT with extracorporeal vascular reconstruction using allografts as a salvage therapy for recurrent NCS after prior open surgery. This approach requires advanced robotic and vascular expertise and careful preoperative planning.

Objective: This study aims to compare the outcomes of single stapling natural orifice specimen extraction surgery (ssNOSES) with double stapling natural orifice specimen extraction surgery (dsNOSES) in anterior resection for rectal cancer.

Methods: A total of 100 patients with rectal cancer were selected from the Colorectal Department of the Second Hospital of Hebei Medical University. These patients underwent Natural Orifice Specimen Extraction Surgery (NOSES) between July 2018 and July 2020. Fifty patients who underwent ssNOSES were compared with fifty patients who underwent dsNOSES. The comparison focused on patient demographics, surgical outcomes, and complications, with a particular emphasis on operative time, cost, and complications.

Results: Four cases of anastomotic leakage were observed in the dsNOSES group, and this group also incurred higher costs. Although the surgical time for ssNOSES was longer, the procedure was associated with lower costs and no cases of anastomotic leakage.

Conclusions: ssNOSES is a cost-effective and safer alternative to dsNOSES. Furthermore, the surgical time for ssNOSES can be reduced through training and experience.

Background: Gastrointestinal (GI) perforations typically occur as complications following endoscopic procedures or intestinal anastomosis surgery. Endoscopic closure of these perforations is desirable as it avoids the risks associated with surgery. Although several endoscopic devices have been developed to address this issue, none have yet demonstrated consistently effective clinical outcomes. This study introduces a novel endoscopic clip assembly designed to overcome these challenges.

Materials and methods: The Z-shaped clip, named the kinetic utility (KU) clip, was constructed with nitinol, allowing it to operate at 45 °C. When the clip is delivered endoscopically, it can close perforations with a predeformed configuration that is triggered by temperature. Ex vivo experiments were conducted using porcine stomach tissue to compare the performance of the KU clip with through-the-scope clips (TTSCs). Maximal force and area under the curve (AUC) on the force-displacement curve were measured to assess the retention capability of the clip in tissue. The in vivo experiment involved creating iatrogenic perforations in a pig, applying the KU clip, and monitoring its healing and safety outcomes.

Results: Ex vivo experiments showed a difference between the TTSC and KU groups with a P -value of 0.08 for maximal force and 0.01 for AUC. The in vivo experiment validates the effectiveness of the KU clip, as there was complete healing of the perforation site with no significant adverse reactions during the experimental period.

Conclusions: The KU clip demonstrates potential as a versatile and effective tool for endoscopic management of GI perforations.