Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

Background and aim: Gastroesophageal reflux disease (GERD) is a widely prevalent disease that severely influences patients' quality of life and is a known risk factor for esophageal adenoma and carcinoma. Endoscopic submucosal dissection (ESD) is a tissue resection technique that involves circumferential en bloc resection of the mucosa that surrounds the tumor followed by dissection of the esophagogastric junction (EGJ) submucosa under the lesion. After mucosal resection, the mucosal healing results in scar formation, which in turn results in shrinkage and remodeling of gastric cardia flap valve, thereby theoretically reducing reflux events. This study investigated the safety and efficacy of ESD for GERD-related neoplasms.

Methods: We performed a retrospective analysis of data collected from 96 patients with GERD-related neoplasms treated with ESD between December 2018 and May 2023. Clinical, endoscopic, histologic, and follow-up data were collected.

Results: The overall rates of en bloc resection, complete resection, curative resection, and major complications were 100%, 99.0%, 95.8%, and 8.4%, respectively. During the follow-up period, all patients remained free from local recurrence and metastasis. The proportion of patients who remained alleviation of GERD symptom was 69.6% after 6 months. The proportion of the resected lumen circumference was the factor that affected the alleviation of GERD symptoms.

Conclusions: ESD is safe and effective for GERD-related neoplasms and is efficacious for the high probability of alleviation of GERD symptoms.

Objective: Traumatic pancreatic fistula is challenging and complicated to manage. Our aim was to assess the efficacy of endoscopic pancreatic duct stenting in the treatment of traumatic pancreatic fistula.

Methods: Patients with pancreatic trauma treated by endoscopic pancreatic duct stenting at Jinling Hospital from May 2016 to October 2022 were enrolled. We recorded clinical data, the cause of pancreatic trauma, the location of injuries, pancreatic injury grade, the timing and duration of stent placement and removal, and long-term outcomes.

Results: Twenty-six patients with traumatic pancreatic fistula who underwent 33 endoscopic pancreatic duct stenting procedures were enrolled. Most patients (20/26, 76.9%) were grade IV. The median time interval from injury to endoscopic stenting was 48 (range: 1 to 959) days. The main pancreatic duct (MPD) was visualized in all patients, and the average diameter of the MPD was 1.73±0.45 mm. Serum amylase levels, drain amylase levels, and drainage volume were significantly decreased after stent placement. One patient had a pancreatic duct stricture at the neck, 1 patient had poor drainage after stenting, and there were no other complications. The technical success rate was 93.9% (31/33), and the clinical efficacy rate was 76.9% (20/26). Univariate analysis revealed that the interval from injury to stenting (HR: 10.500, 95% CI: 1.115-98.914, P =0.040) was associated with stent success.

Conclusion: Pancreatic duct stenting is a safe and effective treatment modality and should be an optional treatment for the management of traumatic pancreatic fistula. Before stent placement, the duration of pancreatic fistula should be assessed since it is related to fistula healing.

Background: Minimally invasive surgery is recognized as the gold standard for cholecystectomy, with various approaches having been implemented over time. Since 2018, the da Vinci Single-Port (DVSP) robotic system (Intuitive) has been used in experimental surgical contexts, revitalizing interest in single-site surgical techniques. The authors' aim is to describe the learning curve associated with single-port robotic cholecystectomy (SPRC).

Methods: A prospective series of 266 consecutive off-label SPRC performed by a single surgeon experienced in laparoscopy, single-site surgery, and multiport robotic surgery was analyzed. These procedures were conducted under an Institutional Review Board-approved protocol. Preoperative, intraoperative, and postoperative data were collected and organized. Indications for SPRC included symptomatic cholelithiasis, acute cholecystitis, chronic cholecystitis, porcelain gallbladder, gallbladder polyps, choledocholithiasis, and gallstone pancreatitis. A learning curve was generated using the cumulative sum analysis (CUSUM) to assess changes in overall operation time, docking time, pre-console time, and surgeon console time.

Results: Our analysis demonstrated a statistically significant reduction in docking time and pre-console time ( P <0.001) in the 3 phases identified by the CUSUM analysis. The CUSUM analysis identified only 1 phase regarding the console time with a mean time of 20 (7 to 113) minutes. The average overall time was 59 (19 to 175) minutes. CUSUM analysis identified 3 phases for overall time, with reduction from 59 to 46 minutes ( P <0.001). The general characteristics of the groups identified for OT were homogeneous. Analysis of early surgical outcomes did not differ between the groups.

Conclusions: SPRC is a safe and feasible procedure, the docking time, pre-console time, and overall time were improving over time, meanwhile the console time was stable throughout the case series demonstrating a significant ability transfer between other mininvasive approaches and DVSP Platform.

Objective: To evaluate the treatment effect of endoscopic ligation and cap-assisted endoscopic sclerotherapy (CAES) for patients with internal hemorrhoids, symptom relief, complication rate and psychological condition, and the anorectal function were observed.

Methods: Thirty-two patients who underwent minimally invasive endoscopic treatment for internal hemorrhoids were recruited, with a 3-month follow-up. Patients were divided into 2 groups, with Group A undergoing endoscopic ligation (n=14) and Group B receiving CAES (n=18). The Clinical efficacy and anorectal function between the 2 groups before and after treatment were compared, and the psychological changes in patients before and after treatment were evaluated by various scales.

Results: There was no significant difference in the treatment effect of postoperative bleeding, prolapse, constipation, and complications between the 2 groups. However, Group A has certain advantages in the treatment of prolapse and constipation before and after treatment, and Group B has certain advantages in bleeding. The comprehensive multiscale psychological evaluation showed no significant difference between the 2 groups before and after treatment, but the psychological condition of patients in both groups was significantly improved after treatment. Besides, patients in Group A were better in the improvement of constipation scale, and patients in Group B had a greater improvement in the pain scale. As for anorectal function, there was no significant difference before and after treatment, except for the squeeze duration before treatment. In the comparison pretreatment and post-treatment, patients in Group A had significant differences in resting (average), first defecation and squeeze (average), while patients in Group B had significant differences in resting (average) and first defecation.

Conclusions: Two endoscopic therapies were effective in treating internal hemorrhoids, with no significant difference in terms of treatment effect, symptom relief, complication rate, psychological condition, and anorectal function when compared between 2 groups. However, when compared within each group, the different methods had their own advantages in the evaluation of treatment effect and anorectal function.

Background: To investigate the microbiological contamination of endoscopes after endoscopic debridement of pancreatic encapsulated necrosis with multidrug-resistant bacterial infection by 2 different reprocessing methods of peroxyacetic acid and ethylene oxide.

Methods: Endoscopes with auxiliary water function after endoscopic debridement of pancreatic encapsulated necrosis and multidrug-resistant bacterial infection in a tertiary care hospital in Jiangxi Province were selected and divided into 2 groups by random number table method: group A was sterilized by peracetic acid immersion and group B was sterilized by ethylene oxide low temperature. The 3 channels of the endoscopes, namely, the working channel, the air/water channel, and the auxiliary water channel, were collected by the filter membrane method and sent to the laboratory for microbiological culture within 2 hours. The qualification rate, colony count, and isolation of bacteria were compared between the 2 groups of endoscopes.

Results: In this study, 78 endoscopes were collected, 39 each from group A and group B, with a total of 312 samples. The overall pass rate of group A and group B was 61.54% and 100%, respectively. The pass rate of group A working channel was 82.05%, the pass rate of air/water channel was 89.74%, the pass rate of auxiliary water channel was 74.36%, and the pass rate of all 3 channels in group B was 100%. The pass rate of group A working channel is 82.05%. The ranges of total bacterial colonies in the channel, air/water channel, and auxiliary water channel were 0 to 6 CFU/channel, 0 to 112 CFU/channel, and 0 to 23 CFU/channel, respectively. A total of 36 strains of bacteria were isolated, mainly multidrug resistant Pseudomonas aeruginosa , methicillin-resistant Staphylococcus aureus , and multidrug resistant Klebsiella pneumoniae . After transferring 15 failed endoscopes in group A to low-temperature sterilization with ethylene oxide, the microbiological surveillance pass rate reached 100%.

Conclusion: For endoscopes with pancreatic encapsulated necrosis and multidrug resistant bacterial infection endoscopic debridement, the ethylene oxide cryo-sterilization method is safer and more effective. Routine microbiological surveillance of endoscopes cannot be limited to the surveillance of working channels only, and endoscopes with auxiliary water function need to monitor auxiliary water channels to reduce the risk.

Objective: This study aims to assess the efficacy of transcystic duct gallbladder-preserving cholecystolithotomy by endoscopic retrograde cholangiopancreatography (TDGPCE) in patients diagnosed with cholecystolithiasis, both in the presence and absence of common bile duct stones (CBDS).

Methods: A total of 54 patients with cholecystolithiasis, including those with and without CBDS, who underwent TDGPCE between March 2021 and May 2024 at the Endoscopy Center of Shenzhen University General Hospital were enrolled in this study. Clinical data and follow-up results were documented for all patients.

Results: Gallbladder stones were successfully removed in 45 patients (83.3%) by TDGPCE. Comparisons of the success rate of stone removal, operative time, and full-covering metal stent (FCMS) placement time revealed no significant differences between patients with cholecystolithiasis, regardless of CBDS presence ( P >0.05). Post-ERCP pancreatitis (n=3, 6.7%) and hyperamylasemia (n=21, 46.7%) were resolved with subsequent interventions. Notably, the 3 patients who developed post-ERCP pancreatitis did not receive pancreatic duct stent insertion due to the presence of an accessory pancreatic duct. Concomitant CBDS did not correlate with an increased risk of post-ERCP pancreatitis or hyperamylasemia in patients undergoing TDGPCE ( P >0.05). During the follow-up period, among the patients (n=45) who underwent this procedure, one reported residual gallbladder stones, and 2 experienced recurrence of gallbladder stones.

Conclusion: TDGPCE is a safe and effective approach for the removal of gallbladder stones in patients with cholecystolithiasis, offering the advantage of preserving gallbladder function without the need for incisions to the abdominal wall or gastrointestinal tract.

Background: Obesity is a global health concern associated with multiple comorbidities, and bariatric surgery remains one of the most effective interventions for sustained weight loss and metabolic improvement. The Single Anastomosis Sleeve Ileal (SASI) bypass is a novel procedure that offers a simplified surgical approach while maintaining efficacy. However, despite its advantages, SASI bypass carries a risk of postoperative complications, including internal herniation-related bowel obstruction-a rare but potentially life-threatening condition requiring prompt recognition and intervention.

Method: We report 3 cases of internal herniation following SASI bypass, 2 performed robotically and 1 laparoscopically. Despite uneventful surgical procedures, all 3 patients developed postoperative internal herniation, with symptom onset ranging from 1 week to 16 months after surgery. A comparative summary of their clinical presentations and outcomes is provided in the accompanying table. Due to timely diagnosis and prompt surgical intervention, all patients had favorable outcomes. In addition, we compiled and edited a surgical video from the third case to illustrate the operative management of this complication.

Results: Computed tomography (CT) emerged as the gold standard for diagnosis, although immediate surgical exploration was necessary in cases of peritonitis or hemodynamic instability. Notably, 1 patient (Case 2) experienced rapid weight loss, a factor previously implicated as a potential risk for internal herniation. Petersen's defect was the most common herniation site in SASI bypass, resembling the pattern seen in One Anastomosis Gastric Bypass (OAGB) but differing from Roux-en-Y Gastric Bypass (RYGB), where multiple mesenteric defects increase the risk. While a longer biliopancreatic limb may predispose SASI and OAGB patients to herniation, consensus on routine defect closure remains lacking.

Conclusion: Internal herniation is a rare but serious complication of SASI bypass, with delayed diagnosis potentially leading to bowel ischemia or perforation. CT is essential for early detection, while timely surgical intervention is critical in symptomatic cases. The necessity of routine Petersen's defect closure remains debated, highlighting the need for further studies to determine the true incidence and optimal prevention strategies.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment for biliary obstruction, yet fails in 5% to 7% of cases, necessitating alternative therapeutic options like endoscopic ultrasound-guided biliary drainage (EUS-BD). With acute cholangitis posing significant morbidity and mortality risks, assessing the safety and efficacy of EUS-BD in these patients is vital. This is the first meta-analysis with a subgroup analysis assessing the outcomes of EUS-BD in patients with acute cholangitis secondary to biliary obstruction.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines, searching MEDLINE, Embase, Web of Science, Clinicaltrials.gov, and Cochrane databases until December 23, 2023. Studies involving adult patients undergoing EUS-BD for cholangitis were included. Outcomes assessed were pooled technical and clinical success rates, complications, and mortality. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was assessed using the I2 % statistics.

Results: Among the included 5 studies (109 patients), EUS-BD achieved a pooled technical success rate of 95.5% (95% CI: 91.0-98.5) and a clinical success rate of 92.1% (95% CI: 86.4-96.3), with low heterogeneity across studies ( I2 : 0.00% for both outcomes). The pooled complication rate was 12.2% (95% CI: 5.1-21.8, I2 : 37.46%), with predominantly mild and self-limiting complications.

Conclusion: EUS-BD demonstrated excellent pooled technical and clinical success rates, particularly when ERCP is not feasible in patients with acute cholangitis secondary to biliary obstruction. Most postprocedure complication rates are also mild and self-limiting making EUS-BD a possible alternative for the management of patients with cholangitis.

Background: Laparoscopic common bile duct exploration (LCBDE) is safe and efficacious. "Classic" LCBDE technique utilizes isolated choledochoscope-guided retrograde basketing; however, it is less effective than transcholedochal exploration. We report on the evolution of our LCBDE technique away from "classic" transcystic approach towards prioritizing antegrade clearance using a novel algorithm utilizing a variety of tools, which we term laparoscopic reverse cholangiopancreatography (LRCP).

Methods: We report an algorithm-driven LRCP technique for LCBDE that tailors intervention to the patient's anatomy and stone burden (size, location, number) seen on cholangiogram (IOC). For cystic ducts ≥4 mm, we use a choledochoscope-assisted technique versus a fluoroscopy-guided technique if <4 mm. For small stones, we use wire basketing (with the "classic" technique) or the "snow-plow" maneuver. For medium (≤10 mm) or multiple stones, we utilize sphincteroplasty plus "snow-plow" if needed. For large (>10 mm), we use laser or electrohydraulic lithotripsy. Fallback methods are ERCP or transcholedochal exploration.

Results: We retrospectively reviewed our 80 LCBDE cases at a single Veterans Affairs hospital: 50 cases in the "classic" phase and 30 subsequent cases using LRCP. Transcystic clearance was significantly higher for LRCP at 97% vs. 56% during the "classic" phase (χ2=15.14, P <0.001). There was zero utilization of choledochotomy during LRCP.

Conclusions: Algorithm-driven LRCP dramatically improved transcystic clearance success and reduced reliance on choledochotomy. Our algorithm serves as a decision aid, allowing surgeons to utilize a variety of available tools for LCBDE.