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Evaluation of Laparoscopic Colorectal Resection Among Elderly Individuals With Colorectal Malignancy: A Single-center Retrospective Analysis. 评估结肠直肠恶性肿瘤老年人的腹腔镜结肠直肠切除术:单中心回顾性分析
IF 1 4区 医学 Q3 SURGERY Pub Date : 2024-06-01 DOI: 10.1097/SLE.0000000000001281
Yanru Zhang, Tufeng Chen, Xiaofeng Yang, Yiquan Li, Purun Lei

Objective: The purpose of the current study was to statistically clarify the precise risk age in elderly patients undergoing colorectal surgery and to evaluate the safety and efficacy of laparoscopic colorectal resection in these patients.

Methods: Patients' clinical variables were extracted from the database of the Gastrointestinal Surgery Centre, Third Affiliated Hospital of Sun Yat-sen University, from 2015 to 2019. Logistic regression was conducted to identify independent risk factors of postoperative complications and ORs for each age. Curves of odds ratios (ORs) and CIs for each age were fitted by using a locally weighted scatterplot smoother, and a structural breakpoint was determined by the Chow test to identify a precise cutoff risk age for elderly patients. Comparison and subgroup analysis were conducted between surgical approach groups using the Student t test and χ 2 analysis.

Results: Locally weighted scatterplot smoother OR analysis manifested that patients aged 69 years old or older suffered a higher possibility of postoperative complications and should be defined as high-risk age. Comparison according to the high-risk age revealed laparoscopic colorectal surgery is better than laparotomic surgery for elderly individuals in terms of hospital stay (9.46 ± 5.96 vs 15.01 ± 6.34, P < 0.05), the incidence of intensive care unit transfer (4 vs 20, P < 0.05), and incidence of surgical site infection (15 vs 20, P < 0.05). Patients who underwent laparotomic surgery had a greater prevalence of Clavien-Dindo II/III complications ( P < 0.05). These findings remained stable even after propensity matching. Furthermore, such superiority was proved especially significant for patients who underwent left-side colorectal resection. In addition, overall survival was improved in the laparoscopic surgery group, whereas no differences were observed in disease-free survival.

Conclusion: In our study population, age 69 or older was a cutoff point age suggests a higher possibility of postoperative morbidity after colorectal surgery. Laparoscopic colorectal resection should be regarded as a superior therapeutic choice for these elderly individuals, especially for left-side colorectal surgeries.

研究目的本研究旨在统计明确老年结直肠手术患者的确切风险年龄,并评估腹腔镜结直肠切除术在这些患者中的安全性和有效性:从中山大学附属第三医院胃肠外科中心2015年至2019年的数据库中提取患者的临床变量。进行逻辑回归以确定术后并发症的独立风险因素及各年龄段的OR。使用局部加权散点图平滑器拟合了各年龄段的几率比(ORs)曲线和CIs,并通过Chow检验确定了结构断点,以确定老年患者的精确风险年龄临界点。采用Student ttest和χ2分析法对手术方法组间进行比较和亚组分析:结果:局部加权散点图平滑OR分析表明,69岁或以上的患者术后并发症发生的可能性更高,应被定义为高危年龄。根据高危年龄进行比较后发现,腹腔镜结直肠手术在住院时间(9.46 ± 5.96 vs 15.01 ± 6.34,P< 0.05)、转入重症监护室的发生率(4 vs 20,P< 0.05)和手术部位感染的发生率(15 vs 20,P< 0.05)方面均优于腹腔镜手术。接受开腹手术的患者出现 Clavien-Dindo II/III 并发症的比例更高(P< 0.05)。即使进行倾向匹配后,这些结果仍保持稳定。此外,这种优越性在接受左侧结直肠切除术的患者中尤为明显。此外,腹腔镜手术组的总生存率有所提高,而无病生存率方面则没有观察到差异:结论:在我们的研究人群中,69 岁或以上是一个分界点,表明结直肠手术后发病的可能性较高。腹腔镜结直肠切除术应被视为这些老年人的最佳治疗选择,尤其是左侧结直肠手术。
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引用次数: 0
The Effect of Virtual Reality Practice and Music on Patients' Pain, Comfort, and Vital Signs After Laparoscopic Abdominal Surgery. 虚拟现实练习和音乐对腹腔镜腹部手术后患者疼痛、舒适度和生命体征的影响。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-06-01 DOI: 10.1097/SLE.0000000000001279
Şerafettin Okutan, Serdar Saritaş

Aim: This research was conducted to identify the effect of virtual reality and music on patients' pain, comfort, and vital signs after laparoscopic abdominal surgery.

Methods: This study was designed as a prospective randomized controlled single-blind clinical trial. The research population consisted of adult patients who underwent laparoscopic abdominal surgery in surgery clinics. The research sample comprised 225 patients who had laparoscopic abdominal surgery. Experimental groups watched virtual reality videos and listened to music, whereas no intervention was administered to the control group. The research data were evaluated with descriptive statistics, the χ 2 test, the Friedman test, the one-way analysis of variance, the Kruskal-Wallis test, and Tukey's and Dunn's post hoc tests.

Findings: In the post-test phase after the 2 interventions, the virtual reality and music groups had lower pain and comfort levels than the control group, and this intergroup difference was statistically significant ( P <0.05). Results for vital signs in successively repeated post-test measurements after interventions were in general different, and these differences were statistically significant. Patients in the virtual reality group generally had higher pulse rate, diastolic blood pressure, respiratory rate, and body temperature values in successively repeated post-test measurements than patients in other groups ( P <0.05). Patients in the control group generally had higher systolic blood pressure and saturation values in successively repeated post-test measurements than patients in other groups ( P <0.05).

Conclusion: It was discerned that music and the virtual reality practice reduced patients' pain and comfort levels and had positive effects on their vital signs after laparoscopic abdominal surgery.

目的:本研究旨在确定虚拟现实和音乐对腹腔镜腹部手术后患者疼痛、舒适度和生命体征的影响:本研究设计为前瞻性随机对照单盲临床试验。研究对象包括在外科诊所接受腹腔镜腹部手术的成年患者。研究样本包括225名接受腹腔镜腹部手术的患者。实验组观看虚拟现实视频并聆听音乐,而对照组不进行任何干预。研究数据采用描述性统计、χ2 检验、Friedman 检验、单因素方差分析、Kruskal-Wallis 检验、Tukey's 和 Dunn's 事后检验进行评估:结果:在两次干预后的后测阶段,虚拟现实组和音乐组的疼痛和舒适程度均低于对照组,且组间差异具有统计学意义(PC结论:研究发现,音乐和虚拟现实练习降低了腹腔镜腹部手术后患者的疼痛和舒适度,并对其生命体征产生了积极影响。
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引用次数: 0
Examining the Frequency of Second Endoscopy and Its Effect on Patient Outcomes With Upper Gastrointestinal Bleeding in Southeast of Iran. 研究伊朗东南部地区上消化道出血患者接受第二次内窥镜检查的频率及其对治疗效果的影响。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2024-06-01 DOI: 10.1097/SLE.0000000000001290
Fatemeh Alijani, Seyedeh Mahdieh Khoshnazar, Omid Eslami

Background: This study investigated the frequency and impact of repeat endoscopy in patients with acute upper gastrointestinal bleeding (AUGIB) in a referral hospital in Southeast Iran.

Materials and methods: A cross-sectional descriptive-analytical study was conducted on the records of 190 patients who underwent endoscopy for AUGIB in 2019. The study compared the demographic and clinical characteristics, outcomes, and treatments of patients who had a second endoscopy (n=64) with those who did not (n=126). The data were analyzed with SPSS software, and a P value less than 0.05 was considered significant.

Results: The results showed that repeat endoscopy was not significantly associated with age, gender, initial symptoms, bleeding site, first endoscopy time, or disease outcome. However, repeat endoscopy was significantly associated with higher bleeding severity, different wound types, different bleeding causes, longer hospital stay, and different treatments in the first endoscopy. The main reasons for repeat endoscopy were poor visibility and recurrent bleeding. The majority of repeat endoscopies were performed within 2 days of the first one. Most patients who had a second endoscopy did not receive any treatment, and those who did received combined thermal and epinephrine injections.

Conclusions: The study concluded that routine second endoscopy is not necessary for all patients with AUGIB, but it may be beneficial for some cases. Further research is needed to clarify the indications and timing of repeat endoscopy in AUGIB.

背景:本研究调查了伊朗东南部转诊医院急性上消化道出血(AUGIB)患者重复内镜检查的频率和影响:本研究调查了伊朗东南部一家转诊医院急性上消化道出血(AUGIB)患者重复内镜检查的频率和影响:对2019年因AUGIB接受内镜检查的190名患者的记录进行了横断面描述性分析研究。研究比较了接受第二次内镜检查的患者(64 人)与未接受第二次内镜检查的患者(126 人)的人口统计学和临床特征、结果和治疗方法。数据采用SPSS软件进行分析,P值小于0.05为显著:结果显示,重复内镜检查与年龄、性别、最初症状、出血部位、首次内镜检查时间或疾病结果无明显关系。然而,重复内镜检查与出血严重程度较高、伤口类型不同、出血原因不同、住院时间较长以及首次内镜检查的治疗方法不同有明显关系。重复内镜检查的主要原因是能见度差和反复出血。大多数重复内镜检查都是在第一次内镜检查后两天内进行的。大多数接受第二次内窥镜检查的患者没有接受任何治疗,接受治疗的患者则接受了热疗和肾上腺素联合注射:该研究认为,并非所有 AUGIB 患者都有必要进行常规的第二次内窥镜检查,但它可能对某些病例有益。还需要进一步研究,以明确 AUGIB 重复内镜检查的适应症和时机。
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引用次数: 0
Implementation of the Versius Surgical System in Complex Abdominal Wall Repair: First Reported Case of an Robotic ETEP/TAR Procedure. 在复杂腹壁修复中使用 Versius 手术系统:首例机器人ETEP/TAR手术报告
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-06-01 DOI: 10.1097/SLE.0000000000001231
Renato D Pinto, Pedro Trauczynski, Diego L Lima, Leandro T Cavazzola

Background: Robotic ventral hernia repair has been increasing globally, with comparable outcomes to laparoscopic repair and lower rates of conversion to open surgery. Robotic surgery is increasing in popularity, and there is a number of new robotic systems entering the marketing. We report the first case of a Roboic eTEP using the Versius robotic system in a patient with an incisional hernia.

Methods: Surgery was performed using the Versius system from CMR surgical which consists of bedside units for each instrument and a console. The patient presented with an incisional hernia measuring 9.5×5 cm in the left flank.

Results: The patient was discharged on postoperative day (POD) 2 with a drain. There was no need for opioids. The drain was removed at POD 7. The patient presented at POD 10 with erythema and cellulitis in the area that previously had tape on it, and it was resolved with a short course of oral antibiotics.

Conclusion: The eTEP technique for hernia surgery was safe and feasible using the Versius robotic system. Implementation is possible in experienced hands with minimal changes to the surgical techniques.

背景:机器人腹股沟疝修补术在全球范围内日益增多,其疗效与腹腔镜修补术相当,而且转为开腹手术的比例较低。机器人手术越来越受欢迎,许多新的机器人系统已进入市场。我们报告了首例使用 Versius 机器人系统对切口疝患者进行机器人 eTEP 的病例:手术使用的是 CMR surgical 公司的 Versius 系统,该系统由用于每种器械的床旁装置和控制台组成。患者左侧腹部有一个 9.5×5 厘米的切口疝:患者于术后第 2 天(POD)带引流管出院。无需使用阿片类药物。引流管于术后第 7 天拔除。患者在术后第 10 天出现红斑和蜂窝组织炎,之前贴有胶布的部位出现红斑和蜂窝组织炎,经过短期口服抗生素治疗后,红斑和蜂窝组织炎得到缓解:结论:使用 Versius 机器人系统进行疝气手术的 eTEP 技术既安全又可行。结论:使用 Versius 机器人系统进行疝气手术的 eTEP 技术既安全又可行,经验丰富的医生只需对手术技术进行最小程度的改动即可实施。
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引用次数: 0
Disposable Gastrointestinal Scopes: A Systematic Review. 一次性胃肠镜:系统综述。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2024-06-01 DOI: 10.1097/SLE.0000000000001278
Matthew Udine, Mallorie L Huff, Katherine Tsay, Abdul-Rahman F Diab, Joseph Sujka, Christopher DuCoin, Salvatore Docimo
<p><strong>Objective: </strong>Endoscopes are an essential tool in the diagnosis, screening, and treatment of gastrointestinal diseases. In 2019, the Food and Drug Administration issued a news release, recommending that duodenoscope manufacturers and health care facilities phase out fully reusable duodenoscopes with fixed endcaps in lieu of duodenoscopes that are either fully disposable or those that contain disposable endcaps. With this study, we systematically reviewed the published literature on single-use disposable gastrointestinal scopes to describe the current state of the literature and provide summary recommendations on the role of disposable gastrointestinal endoscopes.</p><p><strong>Materials and methods: </strong>For our inclusion criteria, we searched for studies that were published in the year 2015 and afterward. We performed a literature search in PubMed using the keywords, "disposable," "reusable," "choledochoscope," "colonoscope," "duodenoscope," "esophagoscope," "gastroscope," and "sigmoidoscope." After our review, we identified our final article set, including 13 articles relating to disposable scopes, published from 2015 to 2023.</p><p><strong>Results: </strong>In this review, we show 13 articles discussing the infection rate, functionality, safety, and affordability of disposable gastrointestinal scopes in comparison to reusable gastrointestinal scopes. Of the 3 articles that discussed infection rates (by Forbes and colleagues, Ridtitid and colleagues, and Ofosu and colleagues), each demonstrated a decreased risk of infection in disposable gastrointestinal scopes. Functionality was another common theme among these articles. Six articles (by Muthusamy and colleagues, Bang and colleagues, Lisotti and colleagues, Ross and colleagues, Kang and colleagues, and Forbes and colleagues) demonstrated comparable functionality of disposable scopes to reusable scopes. The most reported functionality issue in disposable scopes was decreased camera resolution. Disposable scopes also showed comparable safety profiles compared with reusable scopes. Six articles (by Kalipershad and colleagues, Muthusamy and colleagues, Bang and colleagues, Lisotti and colleagues, Luo and colleagues, and Huynh and colleagues) showed comparable rates of AEs, whereas 1 article (by Ofosu and colleagues) demonstrated increased rates of AEs with disposable scopes. Lastly, a cost analysis was looked at in 3 of the articles. Two articles (by Larsen et al and Ross and colleagues) remarked that further research is needed to understand the cost of disposable scopes, whereas 1 article (by Kang and colleagues) showed a favorable cost analysis.</p><p><strong>Conclusions: </strong>After a review of the literature published since the 2015 Food and Drug Administration safety communication, disposable scopes have been shown to be effective in decreasing infection risks while maintaining similar safety profiles to conventional reusable scopes. However, more research is required
目的:内窥镜是诊断、筛查和治疗胃肠道疾病的重要工具。2019 年,美国食品和药物管理局发布了一则新闻,建议十二指肠镜制造商和医疗机构逐步淘汰可完全重复使用的带有固定端盖的十二指肠镜,取而代之的是可完全一次性使用或含有一次性端盖的十二指肠镜。通过这项研究,我们系统地回顾了已发表的有关一次性胃肠镜的文献,以描述文献的现状,并就一次性胃肠内窥镜的作用提出简要建议:根据纳入标准,我们搜索了 2015 年及以后发表的研究。我们使用关键词 "一次性"、"可重复使用"、"胆道镜"、"结肠镜"、"十二指肠镜"、"食道镜"、"胃镜 "和 "乙状结肠镜 "在 PubMed 上进行了文献检索。经过审查,我们确定了最终的文章集,其中包括 13 篇与一次性窥镜有关的文章,发表时间为 2015 年至 2023 年:在这篇综述中,我们展示了 13 篇讨论一次性胃肠镜与可重复使用胃肠镜的感染率、功能、安全性和经济性的文章。在 3 篇讨论感染率的文章(作者分别是 Forbes 及其同事、Ridtitid 及其同事以及 Ofosu 及其同事)中,每篇文章都表明一次性胃肠镜的感染风险有所降低。功能性是这些文章的另一个共同主题。六篇文章(作者分别是 Muthusamy 及其同事、Bang 及其同事、Lisotti 及其同事、Ross 及其同事、Kang 及其同事以及 Forbes 及其同事)证明一次性胃镜的功能与可重复使用胃镜相当。报告最多的一次性显微镜功能问题是摄像头分辨率降低。与可重复使用的显微镜相比,一次性显微镜的安全性也不相上下。六篇文章(Kalipershad 及其同事、Muthusamy 及其同事、Bang 及其同事、Lisotti 及其同事、Luo 及其同事、Huynh 及其同事)显示,一次性手术镜的AEs 发生率相当,而一篇文章(Ofosu 及其同事)显示,一次性手术镜的AEs 发生率增加。最后,有 3 篇文章进行了成本分析。两篇文章(Larsen 等人和 Ross 及其同事的文章)指出需要进一步研究以了解一次性手术器械的成本,而一篇文章(Kang 及其同事的文章)则进行了有利的成本分析:对自 2015 年食品药品管理局安全通报发布以来发表的文献进行回顾后发现,一次性手术窥镜能有效降低感染风险,同时与传统的可重复使用手术窥镜保持相似的安全性。不过,还需要进行更多研究,以比较一次性和可重复使用手术窥镜的功能和成本效益。
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引用次数: 0
Application of Carbon Nanoparticles in Transoral Endoscopic Thyroidectomy Vestibular Approach for Unilateral Papillary Thyroid Cancer. 碳纳米粒子在经口内窥镜甲状腺切除术前庭入路治疗单侧甲状腺乳头状癌中的应用
IF 1 4区 医学 Q3 SURGERY Pub Date : 2024-06-01 DOI: 10.1097/SLE.0000000000001286
Wei-Dong Zhang, Qi Le, Ke-Jie Yu, Ying-Chun Wang, Xian-Jiang Wu

Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is newly applied technology. Carbon nanoparticles (CNs) are novel lymph node tracers that have been widely used in China to help remove central lymph nodes (CLNs) and protect the parathyroid glands (PGs) in open thyroid cancer surgery. This study is to evaluate the effectiveness and safety of CNs in TOETVA.

Materials and methods: A total of 158 patients who underwent TOETVA with unilateral papillary thyroid carcinoma were enrolled in this study from March 2019 to February 2022. The participants were divided into a CNs group (n=88) and a control group (n=70), based on whether they received a intraoperative injection of CNs or not. Meanwhile, the CNs group were additionally divided into 2 subgroups, leakage subgroup (n=26) and standard subgroup (n=62). The 2 groups and subgroups were compared in terms of patient characteristics, perioperative clinical results, and postoperative outcomes.

Results: All common metrics had no significant differences were found between the CNs group and the control group ( P >0.05). The standard subgroup of CNs group had advantage over the control group on PGs identification (59/62 vs. 59/70 for superior PG, 56/62 vs. 52/70 for inferior PG, P <0.05). Moreover, the standard subgroup harvested more CLNs than the control group (8.97±2.96 vs. 7.47±2.93, P <0.05). More operation time was spent on the leakage subgroup of CNs group than the control group (160.00±17.61 vs. 140.00±13.32, P <0.05). Meanwhile, the leakage subgroup had disadvantage on intraoperative hemorrhage (26.15±10.80 vs. 21.21±7.09, P <0.05) and hospital durations (4.96±0.72 vs. 4.57±0.69, P <0.05). Furthermore, the leakage group identified fewer inferior PG than the control group (7/26 vs. 52/70, P <0.05). Contrary to the standard subgroup, the CLNs of the leakage subgroup was also unsatisfactory compared with the control group (4.96±1.84 vs. 7.47±2.93, P <0.05).

Conclusions: The application of CNs suspension tracing technology has a definite effect in TOETVA. It can improve the thoroughness of lymph node dissection in the central region and enhance recognition of the PG. However, refined extracapsular anatomy is indispensable to prevent CN leakage. Leaked CNs will also be counterproductive to the operation.

背景:经口内镜甲状腺前庭切除术(TOETVA)是一项新的应用技术。碳纳米颗粒(CNs)是一种新型淋巴结示踪剂,在中国已被广泛应用于开放性甲状腺癌手术中帮助切除中央淋巴结(CLNs)和保护甲状旁腺(PGs)。本研究旨在评估CNs在TOETVA中的有效性和安全性:从2019年3月至2022年2月,共有158名单侧甲状腺乳头状癌患者接受了TOETVA手术。根据术中是否注射 CNs,将参与者分为 CNs 组(88 人)和对照组(70 人)。同时,CNs 组又分为两个亚组,即渗漏亚组(26 人)和标准亚组(62 人)。比较两组和亚组的患者特征、围手术期临床结果和术后效果:结果:CNs 组与对照组在所有常见指标上均无显着差异(P>0.05)。CNs 组的标准亚组在 PGs 识别方面优于对照组(PGs 上部识别率为 59/62 对 59/70,PGs 下部识别率为 56/62 对 52/70,PConclusions):CNs 悬浮追踪技术在 TOETVA 中的应用具有确切的效果。它可以提高中央区淋巴结清扫的彻底性,并增强对 PG 的识别。然而,精细的囊外解剖是防止 CN 泄漏的必要条件。漏出的 CN 也会对手术产生反作用。
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引用次数: 0
Analysis of the Correlation Between Dynamic Characteristics and Symptoms of Gastroesophageal Reflux Disease. 胃食管反流病动态特征与症状之间的相关性分析
IF 1 4区 医学 Q3 SURGERY Pub Date : 2024-06-01 DOI: 10.1097/SLE.0000000000001187
Yan Tian, Weihao Zhang, Tingting Zhang, Lan Liu, Jianqiang Guo

Objective: To investigate the esophageal motility characteristics of gastroesophageal reflux disease (GERD) and their relationship with symptoms.

Patients and methods: We examined 101 patients diagnosed with GERD by endoscopy and divided them into 3 groups as follows: nonerosive reflux disease (NERD), reflux esophagitis, and Barrett esophagus. Esophageal high-resolution manometry and the GERD Questionnaire were used to investigate the characteristics of esophageal dynamics and symptoms. In addition, the reflux symptom index was completed and the patients were divided into 7 groups according to symptoms. We then determined the correlation between dynamic esophageal characteristics and clinical symptoms.

Results: Upper (UES) and lower (LES) esophageal sphincter pressures and the 4-second integrated relaxation pressure in the RE group were lower than those in the NERD group. The 4-second integrated relaxation pressure in the Barrett esophagus group was also lower than that in the NERD group. In the analysis of extraesophageal symptoms, high-resolution manometry showed significant differences in UES pressures among all groups. Further subgroup analysis showed that compared with the group without extraesophageal symptoms, the UES pressure of the groups with pharyngeal foreign body sensation, throat clearing, and multiple extraesophageal symptoms was lower.

Conclusions: As GERD severity increases, motor dysfunction of the LES and esophageal body gradually worsens, and the LES plays an important role in GERD development. Decreased UES pressure plays an important role in the occurrence of extraesophageal symptoms, which is more noticeable in patients with pharyngeal foreign body sensation and throat clearing.

目的:研究胃食管反流病(GERD)的食管运动特征及其与症状的关系:研究胃食管反流病(GERD)的食管运动特征及其与症状的关系:我们对 101 名经内镜检查确诊为胃食管反流病的患者进行了检查,并将他们分为以下三组:非侵蚀性反流病(NERD)、反流性食管炎和巴雷特食管。采用食管高分辨率测压法和胃食管反流病问卷调查食管动态特征和症状。此外,还填写了反流症状指数,并根据症状将患者分为 7 组。然后,我们确定了食管动态特征与临床症状之间的相关性:结果:RE 组食管上括约肌压力(UES)和食管下括约肌压力(LES)以及 4 秒综合松弛压力均低于 NERD 组。巴雷特食管组的 4 秒综合松弛压也低于 NERD 组。在分析食管外症状时,高分辨率测压法显示各组之间的上消化道压力存在显著差异。进一步的亚组分析显示,与无食管外症状组相比,有咽异物感、清嗓子和多种食管外症状组的上咽部压力较低:结论:随着胃食管反流病严重程度的增加,LES和食管体的运动功能障碍逐渐加重,LES在胃食管反流病的发生发展中起着重要作用。上咽部压力下降在食管外症状的发生中起着重要作用,这在有咽部异物感和清嗓症状的患者中更为明显。
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引用次数: 0
The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery. 腹腔镜腹膜外疝气手术中脊髓硬膜外联合麻醉对肩痛的影响
IF 1 4区 医学 Q3 SURGERY Pub Date : 2024-06-01 DOI: 10.1097/SLE.0000000000001276
Deniz Guzey, Turgut Donmez, Mehmet Karabulut, Ahmet Surek, Nalan Saygi Emir, Can Ertug Cayirci, Hande Kandemir, Engin Hatipoglu

Background: Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique.

Methods: The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications.

Results: The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 ( P <0.001). Postoperative pain was significantly less in group 2 for the 4th hour ( P <0.0001) and the 12th hour ( P =0.047). There was no difference between the 2 groups in terms of peritoneal tear ( P =0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 ( P =0.038, P =0015, respectively).

Conclusion: CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.

背景:肩部疼痛是腹腔镜腹膜外疝修补术(TEP)手术中腹膜撕裂导致患者严重不适的一种症状。虽然外科医生通常倾向于在 TEP 技术中使用全身麻醉,但近年来也有许多关于使用区域麻醉的研究。在我们的研究中,我们旨在探讨脊髓/硬膜外联合麻醉(CSEA)方法在 TEP 技术中预防肩痛的有效性和安全性:将接受 TEP 手术的患者分为两组:SA 组(第 1 组)和 CSEA 组(第 2 组)。比较两组患者的性别、年龄、体重指数、手术时间、手术总时间、患者满意度、疼痛评分、住院时间、不良反应、术中和术后并发症:第一组患者人数为 42 人,第二组患者人数为 40 人。第 1 组和第 2 组的平均手术时间分别为 55.9 分钟和 80.2 分钟,第 1 组的手术时间明显短于第 2 组:CSEA 是一种有效且安全的麻醉方法,可有效预防 TEP 手术后出现的肩部疼痛。
{"title":"The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery.","authors":"Deniz Guzey, Turgut Donmez, Mehmet Karabulut, Ahmet Surek, Nalan Saygi Emir, Can Ertug Cayirci, Hande Kandemir, Engin Hatipoglu","doi":"10.1097/SLE.0000000000001276","DOIUrl":"10.1097/SLE.0000000000001276","url":null,"abstract":"<p><strong>Background: </strong>Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique.</p><p><strong>Methods: </strong>The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications.</p><p><strong>Results: </strong>The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 ( P <0.001). Postoperative pain was significantly less in group 2 for the 4th hour ( P <0.0001) and the 12th hour ( P =0.047). There was no difference between the 2 groups in terms of peritoneal tear ( P =0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 ( P =0.038, P =0015, respectively).</p><p><strong>Conclusion: </strong>CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"275-280"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140294594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy of Pancreatic Dissection With a Triple-row Stapler in Laparoscopic Distal Pancreatectomy: A Retrospective Observational Study. 腹腔镜胰腺远端切除术中使用三排缝合器进行胰腺分割的效果:回顾性观察研究
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-06-01 DOI: 10.1097/SLE.0000000000001284
Hideki Izumi, Hisamichi Yoshii, Rika Fujino, Shigeya Takeo, Eiji Nomura, Masaya Mukai, Hiroyasu Makuuchi

Background: Postoperative pancreatic fistulas (POPFs) occur after 20% to 30% of laparoscopic distal pancreatectomies. This study aimed to evaluate the clinical efficacy of laparoscopic distal pancreatectomy using triple-row staplers in preventing POPFs.

Methods: Between April 2016 and May 2023, 59 patients underwent complete laparoscopic distal pancreatectomies. There were more females (n=34, 57.6%) than males (n=25, 42.4%). The median age of the patients was 68.9 years. The patients were divided into slow-compression (n=19) and no-compression (n=40) groups and examined for pancreatic leakage. Both groups were examined with respect to age, sex, body mass index (BMI), pancreatic thickness at the pancreatic dissection site, pancreatic texture, diagnosis, operative time, blood loss, presence of POPF, date of drain removal, and length of hospital stay. In addition, risk factors for POPF were examined in a multivariate analysis.

Results: Grade B POPFs were found in 9 patients (15.3%). Using univariate analysis, the operative time, blood loss, postoperative pancreatic fluid leakage, day of drain removal, and hospital stay were shorter in the no-compression group than in the slow-compression group. Using multivariate analysis, the absence of POPFs was significantly more frequent in the no-compression group (odds ratio, 5.69; 95% CI, 1.241-26.109; P =0.025). The no-compression pancreatic dissection method was a simple method for reducing POPF incidence.

Conclusions: The method of quickly dissecting the pancreas without compression yielded better results than the method of slowly dissecting the pancreas with slow compression. This quick dissection without compression was a simple and safe method that minimized postoperative pancreatic fluid leakage, shortened the operative time and length of hospital stay, and reduced medical costs. Therefore, this method might be a clinically successful option.

背景:20%至30%的腹腔镜胰腺远端切除术后会出现术后胰瘘(POPFs)。本研究旨在评估使用三排订书机的腹腔镜胰腺远端切除术在预防 POPFs 方面的临床疗效:2016年4月至2023年5月期间,59名患者接受了完整的腹腔镜胰腺远端切除术。其中女性(34 人,57.6%)多于男性(25 人,42.4%)。患者的中位年龄为 68.9 岁。患者被分为慢压迫组(19 人)和无压迫组(40 人),并对胰腺渗漏情况进行了检查。对两组患者的年龄、性别、体重指数(BMI)、胰腺解剖部位的胰腺厚度、胰腺纹理、诊断、手术时间、失血量、是否存在 POPF、引流管拔除日期和住院时间进行了检查。此外,还对POPF的风险因素进行了多变量分析:结果:9 名患者(15.3%)出现了 B 级 POPF。通过单变量分析,不加压组的手术时间、失血量、术后胰液渗漏、引流管拔除天数和住院时间均短于缓慢加压组。通过多变量分析,不加压组出现 POPFs 的频率明显更高(几率比,5.69;95% CI,1.241-26.109;P=0.025)。无压迫胰腺解剖法是降低 POPF 发生率的一种简单方法:结论:不加压快速解剖胰腺的方法比加压缓慢解剖胰腺的方法效果更好。这种不加压快速解剖胰腺的方法简单安全,能最大限度地减少术后胰液渗漏,缩短手术时间和住院时间,降低医疗费用。因此,这种方法在临床上可能是一种成功的选择。
{"title":"Efficacy of Pancreatic Dissection With a Triple-row Stapler in Laparoscopic Distal Pancreatectomy: A Retrospective Observational Study.","authors":"Hideki Izumi, Hisamichi Yoshii, Rika Fujino, Shigeya Takeo, Eiji Nomura, Masaya Mukai, Hiroyasu Makuuchi","doi":"10.1097/SLE.0000000000001284","DOIUrl":"10.1097/SLE.0000000000001284","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pancreatic fistulas (POPFs) occur after 20% to 30% of laparoscopic distal pancreatectomies. This study aimed to evaluate the clinical efficacy of laparoscopic distal pancreatectomy using triple-row staplers in preventing POPFs.</p><p><strong>Methods: </strong>Between April 2016 and May 2023, 59 patients underwent complete laparoscopic distal pancreatectomies. There were more females (n=34, 57.6%) than males (n=25, 42.4%). The median age of the patients was 68.9 years. The patients were divided into slow-compression (n=19) and no-compression (n=40) groups and examined for pancreatic leakage. Both groups were examined with respect to age, sex, body mass index (BMI), pancreatic thickness at the pancreatic dissection site, pancreatic texture, diagnosis, operative time, blood loss, presence of POPF, date of drain removal, and length of hospital stay. In addition, risk factors for POPF were examined in a multivariate analysis.</p><p><strong>Results: </strong>Grade B POPFs were found in 9 patients (15.3%). Using univariate analysis, the operative time, blood loss, postoperative pancreatic fluid leakage, day of drain removal, and hospital stay were shorter in the no-compression group than in the slow-compression group. Using multivariate analysis, the absence of POPFs was significantly more frequent in the no-compression group (odds ratio, 5.69; 95% CI, 1.241-26.109; P =0.025). The no-compression pancreatic dissection method was a simple method for reducing POPF incidence.</p><p><strong>Conclusions: </strong>The method of quickly dissecting the pancreas without compression yielded better results than the method of slowly dissecting the pancreas with slow compression. This quick dissection without compression was a simple and safe method that minimized postoperative pancreatic fluid leakage, shortened the operative time and length of hospital stay, and reduced medical costs. Therefore, this method might be a clinically successful option.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"295-300"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reinforcement in Laparoscopic Sleeve Gastrectomy: Is It Effective? 腹腔镜袖带胃切除术中的强化治疗:有效吗?
IF 1 4区 医学 Q3 SURGERY Pub Date : 2024-06-01 DOI: 10.1097/SLE.0000000000001283
Mümin Coşkun, Tevfik Kivilcim Uprak, Ömer Günal, Aygün Aliyeva, Asim Cingi

Background: Despite the success of bariatric surgery in treating obesity, it can still lead to complications. The most serious and feared technical complications are bleeding and leakage from the gastric staple line. In this study, stapler line reinforcement was investigated to determine whether it affects postoperative leakage and bleeding rates and their management.

Materials and methods: Overall, 510 patients who underwent sleeve gastrectomy were evaluated retrospectively. They were divided into 2 groups according to whether reinforcement of the staple line with running imbricating sutures was performed.

Results: In the reinforcement group, there were two leaks (0.7%), which were diagnosed seven and eight days after surgery. In the non-reinforcement group, there were nine leaks (4%). There was no difference between the two groups in staple line bleeding.

Conclusions: This study shows that reinforcement with continuous imbricating sutures is associated with less stapler line leakage and a lower reoperation rate at the cost of increased operative time.

背景:尽管减肥手术在治疗肥胖症方面取得了成功,但仍有可能导致并发症。最严重和最令人担忧的技术并发症是胃缝合线出血和渗漏。本研究对缝合线加固进行了调查,以确定其是否会影响术后渗漏和出血率及其处理:对 510 例袖状胃切除术患者进行了回顾性评估。结果:在加固组中,术后渗漏和出血的发生率低于对照组:结果:在加固组中,有两处渗漏(0.7%),分别在术后 7 天和 8 天确诊。非加固组有九处渗漏(4%)。两组在缝合线出血方面没有差异:这项研究表明,使用连续嵌合缝合线进行加固可减少缝合线渗漏,降低再次手术率,但代价是增加手术时间。
{"title":"Reinforcement in Laparoscopic Sleeve Gastrectomy: Is It Effective?","authors":"Mümin Coşkun, Tevfik Kivilcim Uprak, Ömer Günal, Aygün Aliyeva, Asim Cingi","doi":"10.1097/SLE.0000000000001283","DOIUrl":"10.1097/SLE.0000000000001283","url":null,"abstract":"<p><strong>Background: </strong>Despite the success of bariatric surgery in treating obesity, it can still lead to complications. The most serious and feared technical complications are bleeding and leakage from the gastric staple line. In this study, stapler line reinforcement was investigated to determine whether it affects postoperative leakage and bleeding rates and their management.</p><p><strong>Materials and methods: </strong>Overall, 510 patients who underwent sleeve gastrectomy were evaluated retrospectively. They were divided into 2 groups according to whether reinforcement of the staple line with running imbricating sutures was performed.</p><p><strong>Results: </strong>In the reinforcement group, there were two leaks (0.7%), which were diagnosed seven and eight days after surgery. In the non-reinforcement group, there were nine leaks (4%). There was no difference between the two groups in staple line bleeding.</p><p><strong>Conclusions: </strong>This study shows that reinforcement with continuous imbricating sutures is associated with less stapler line leakage and a lower reoperation rate at the cost of increased operative time.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"290-294"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
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