Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

Introduction: Many patients with cirrhosis develop posthepatectomy liver failure (PHLF). Factors associated with clinically relevant PHLF (CRPHLF) in cirrhosis with different remnant liver volume (RLV)-to-standard liver volume (SLV) ratios are unclear.

Aim: The study aimed to determine whether an RLV/SLV value of <40% is safe for hepatectomy in patients with cirrhosis.

Material and methods: Patients with cirrhosis were divided into an RLV/SLV <40% group (28 cases) and an RLV/SLV ≥40% group (39 cases) based on their RLV/SLV ratio. The incidence of CRPHLF and surgical complications in the 2 groups were analysed, and CRPHLF was determined according to the criteria of the International Study Group of Liver Surgery. Factors associated with CRPHLF were identified using multivariate logistic regression for all patients. We further performed the Hosmer-Lemeshow test and calculated the area under the receiver operating characteristic curve (AUC) to assess the overall model fit. All analyses were performed using SPSS 19.0 software.

Results: Patients who developed CRPHLF had a higher rate of severe complications (17.1%) than those who did not. Body mass index (BMI), prothrombin time (PT), RLV/SLV value, and blood transfusion were associated with CRPHLF in all patients with cirrhosis ( P <0.05). Clinically relevant PHLF was associated with PT in patients with RLV/SLV ≥40% and with BMI in patients with RLV/SLV <40% ( P <0.05). Model diagnostics suggested satisfactory calibration (Hosmer-Lemeshow P =0.436) and moderate discrimination (AUC=0.78) in the overall cohort. Patients with cirrhosis with an RLV/SLV value of <40% (and ≥30%) had the same complications or CRPHLF as patients with an RLV/SLV value of ≥40% ( P >0.05).

Conclusion: We found that a high PT was a risk factor in patients with RLV/SLV ≥40%, while a low BMI was a risk factor in those with RLV/SLV <40%. Increased surgical complications may not be associated with low RLV/SLV ratios, and hepatectomy may be safe in some patients with cirrhosis with RLV/SLV values <40% (and ≥30%).

Background: Inadequate management of pain, anxiety, and gastrointestinal function after laparoscopic cholecystectomy can lead to an increase in the incidence of nausea and vomiting, disruption of gastric functions, delayed postoperative recovery, prolonged hospital stay, increased risk of mortality, opioid use, and unwanted side effects. To evaluate the impact of manual and machine-based hand massage following laparoscopic cholecystectomy on pain, anxiety, and gastrointestinal function.

Methods: This randomized controlled trial study was conducted with 171 patients. Patients were divided into 2 intervention (manual hand massage and machine-based hand massage) groups (n=57), and a control group (n=57). Data were collected at 0, 4, and 8 hours postoperatively using the survey form, Numerical Rating Scale, State-Trait Anxiety Inventory, and Gastrointestinal Function Monitoring Form.

Results: The severity of pain in the manual hand massage group decreased statistically significantly after massage ( P <0.05). Anxiety levels in the intervention groups were lower at all time intervals postoperatively ( P <0.001). The severity of nausea in the massage groups was lower at 8 hours ( P <0.05). The number of bowel sounds at 8 hours in the massage groups showed a greater increase ( P <0.05).

Conclusion: Both manual and machine-based hand massage positively affected pain, anxiety, nausea intensity, and bowel sounds following laparoscopic cholecystectomy. Manual hand massage was more effective than machine-based hand massage in reducing pain intensity and increasing bowel sounds.

Objective: This study aimed to evaluate the clinical efficacy, technical characteristics, and impact on postoperative recurrence of the transabdominal preperitoneal (TAPP) approach combined with internal ring constriction for the treatment of giant inguinal hernias.

Materials and methods: Conducted as a single-blinded, single-center randomized controlled trial, the study compared TAPP with and without internal ring constriction. A total of 962 patients with inguinal hernias were recruited from January 2020 to October 2023. Based on the European Hernia Society classification, 779 patients with type I or II hernias were excluded, leaving 183 patients with type III inguinal hernias (inner ring defect ≥3 cm) for analysis. The experimental group (n=93) received TAPP combined with internal ring constriction, while the control group (n=90) underwent standard TAPP. Key outcomes assessed included operation time, intraoperative bleeding, postoperative pain, hospital stay duration, postoperative complications, and the 2-year recurrence rate.

Results: The experimental group had a significantly longer operation time than the control group (P<0.001). However, no significant differences were observed between the groups regarding intraoperative bleeding, hospital stay length, postoperative pain (measured by the visual analog scale on the first postoperative day), surgical site infection, seroma, scrotal edema, or vascular injury (all P values >0.05). Notably, neither group experienced scrotal hematoma or hydrocele. The experimental group demonstrated a significant reduction in the 2-year recurrence rate compared with the control group (P<0.05).

Conclusions: These findings suggest that TAPP combined with internal ring constriction is a valuable technique in managing giant inguinal hernias, offering a lower postoperative recurrence rate without increasing perioperative complications, postoperative pain, or hospital stay duration.

Background: Consuming only low-fiber food on the day before the procedure is recommended as standard practice for bowel cleansing in patients using polyethylene glycol (PEG). However, there have been few studies to date investigating the optimal dietary regimen for patients using the more cost-effective Sennoside A+B calcium before colonoscopy. The present study compares the quality of bowel preparation of patients following a clear diet and those following a low-fiber diet on the day before colonoscopy among patients using Sennoside A+B calcium.

Methods: This prospective, randomized, and investigator-blinded study was conducted between November 2023 and February 2024. Included in the study were 150 patients aged 18 years and over with a mean age of 55.6±14 years, with 75 patients assigned to the clear diet group and 75 patients to the low-fiber diet group. The assessment of colonoscopy cleanliness before colonoscopy was conducted using the Boston Bowel Preparation Scale (BBPS).

Results: None of the patients experienced intolerance. The mean overall total cleanliness score, measured using the BBPS, was 7.24±2.1, with 7.48 ± 2.1 in the low-fiber diet group and 7.0 ±2.1 in the clear liquid diet group. No significant difference in cleanliness was found between the 2 groups ( P =0.096).

Conclusion: Patients using cost-effective Senna for bowel cleansing before colonoscopy can safely consume low-fiber foods on the day before the procedure. In the present study, a clear diet offered no benefit over a more comfortable and better-tolerated diet in terms of colon cleanliness.

Purpose: Point-of-care (POC) diagnostic tools can support timely and efficient clinical decision-making. The introduction of a POC digital rectoscope has the potential to enhance colorectal surgical practice by enabling immediate bedside endoscopic evaluation in different settings.

Methods: This case series describes 5 cases, with video documentation illustrating the potential benefits of using a portable digital rectoscope in outpatient follow-up, inpatient postoperative care, and emergency settings.

Results: In a tertiary referral center, POC rectoscopy effectively supported the detection of anastomotic leakage and rectal perforation, response evaluation after neoadjuvant treatment for rectal cancer, and facilitated follow-up after treatment for anastomotic leakage.

Conclusions: POC digital rectoscopy shows promise in enhancing the diagnostic efficiency of colorectal care. Further studies are warranted to evaluate its clinical impact and cost-effectiveness for the illustrated indications.

Background: Bougie is critical for achieving the optimal sleeve size or pouch creation in metabolic and bariatric surgery (MBS). This study investigates the clinical application and challenges of specialized bougie in MBS within China, aims to identify targeted solutions, and seeks to guide clinical practice.

Methods: A survey questionnaire, developed in collaboration with MBS experts through a webinar, was distributed online to MBS centers across China from March 9 to 15, 2023. Statistical analysis was used to evaluate the survey responses.

Results: The survey collected 183 valid responses from 28 provinces, including autonomous regions and municipalities. Of these, 86.34% of centers reported using specialized bougie for MBS, with 79.23% using it frequently. Among those frequently using bougie, 40.51% reused bougie postdisinfection due to the high costs of new bougies. The most common bougie sizes used were 36Fr for laparoscopic sleeve gastrectomy and laparoscopic gastric bypass, with other sizes ranging from 30Fr to 38Fr. However, 41.53% of centers reported complications related to bougie use, with tension rupture and esophageal injury being the most frequent.

Conclusions: This nationwide survey offers insights into the clinical application and challenges of specialized bougie in Chinese MBS centers. There is a need for enhanced education, standardization, and training to mitigate complications and improve patient outcomes.

Introduction: Studies analyzing the factors associated with reintervention after endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) are limited. We aimed to analyze the incidence and predictors of reintervention in patients with malignant biliary obstruction undergoing EUS-CDS.

Methods: We retrospectively analyzed the data of patients with malignant distal biliary obstruction undergoing EUS-CDS from 8 tertiary care centers in India. The study's primary outcome was reintervention due to stent migration or blockage. The secondary outcomes included clinical success and adverse events. Multivariate analysis using the logistic regression model was used to identify the independent predictors of reintervention.

Results: A total of 134 patients were included in the study. The technical and clinical success rates were 97.8% (131/134) and 93.9% (123/131), respectively. Periprocedural adverse events (AE) were seen in 6% (8/134) cases. Over a median follow-up of 20 weeks, reintervention was required in 8.4% of the cases after a median interval of 11 weeks. On multivariate analysis, cholangitis at presentation (odds ratio [OR] 6.26) and the absence of coaxial stent with concomitant duodenal stent (OR: 7.41) were independent predictors of reintervention in the overall cohort. On subgroup analysis of patients undergoing EUS-CDS with self-expanding metallic stent (SEMS), the absence of a coaxial stent with concomitant duodenal stent (OR: 10.15) was an independent predictor of reintervention.

Conclusion: Reintervention on follow-up after EUS-CDS is required in around 8.4% of cases. The absence of coaxial stent with concomitant duodenal stent was an independent predictor of reintervention in the overall cohort as well as in those undergoing EUS-CDS with SEMS.

Objective: This study aimed to assess the outcomes of minimally invasive surgery (MIS) for colon cancer and analyze the impact of tumor localization on survival.

Patients and methods: A retrospective analysis was conducted on 842 consecutive patients who underwent curative MIS (laparoscopic and robotic) for stage I to III colon adenocarcinoma between 2001 and 2024. The surgical technique adhered to oncological principles, ensuring adequate resection margins and proper lymph node dissection. Patient characteristics, operative data, perioperative outcomes, histopathologic findings, and oncological outcomes were analyzed.

Results: The study included 842 patients (59.4% male, 40.6% female) with a median age of 60.3 years. Tumor localization was right colon in 29.5%, transverse colon in 6.5%, and left colon in 64% of cases. In our study, 814 cases (96.7%) were performed using laparoscopic surgery, while 28 cases (3.3%) were performed using robotic surgery. The mean operative time was 135 minutes, with a mean hospital stay of 6 days. Conversion to open surgery occurred in 3% of cases. The mean number of lymph nodes removed was 35 (range: 8 to 72). Pathologic examination revealed that 65% of cases were node-positive stage III. During a mean follow-up of 10 years, local recurrence (LR) was observed in 2.8% of patients, with no significant difference based on tumor localization. Distant metastases (DM) occurred in 12.7% of patients. The 10-year disease-free survival (DFS) rate for all patients was 75%, and the overall survival (OS) rate was 78.7%. The 10-year DFS rates for right colon, transverse colon, and left colon cancers were 74%, 71%, and 76%, respectively. Similarly, the OS rates for the same groups were 78.9%, 75%, and 79%, respectively. Statistical analysis revealed no significant differences in DFS ( P =0.851) or OS ( P =0.789) among the 3 tumor localization groups.

Conclusion: Our study demonstrated that MIS is a promising approach for achieving favorable long-term oncological outcomes in colon cancer patients. Consequently, MIS is established as the standard approach in colon cancer surgery. Although right colon tumors are often associated with poorer disease-free and overall survival rates, this study found no significant differences in DFS or OS among left, transverse, and right colon tumors.

Objective: The prevalence of gallbladder polyps is 0.3% to 9.5%. Gallbladder polyps are divided into polyps and pseudo polyps. We aim to determine the rate of polyps after histopathologic examination in patients who were operated on for gallbladder polyps and to choose the factors affecting the diagnosis of polyps.

Patients and methods: Patients who underwent cholecystectomy between January 2012 and January 2022 were analyzed retrospectively. Demographic data of the patients, anthropometric measurements, preoperative radiologic imaging methods, characteristics (size and number of polyps), and histopathologic results of the gallbladder after cholecystectomy were recorded. After histopathologic examination, the patients were grouped as gallbladder polyp and pseudo polyp and compared.

Result: A total of 162 (4.7%) patients were included in the study. 109 (67.3%) of the patients were in the polyp group, and 53 (32.7%) were in the pseudo polyp group. Polyp size and number were larger in the polyp group than in the pseudo polyp group and were odd in number ( P = 0.03, P < 0.001). The radiologic polyp size cut-off value to identify the polyp was >8 mm (sensitivity: 84.2%, specificity: 66.0%).

Conclusion: Gallbladder polyps are a common pathology. The distinction between true and pseudo polyp is critical. Therefore, it is essential to distinguish between polyps and pseudo polyps for cholecystectomy.

Introduction: The WIRELESS trial compared the postoperative analgesic effect of the bilateral transversus abdominis plane patient-controlled analgesia (TAP-PCA) with that of epidural patient-controlled analgesia (E-PCA) using ropivacaine 0.25%.

Methodology: A hundred patients aged between 18 and 85 years and planned for upper midline laparotomy (Class I and II wounds) under general anesthesia were randomized into TAP-PCA (50) and E-PCA (50) groups. The PCA pump used for the study was designed to deliver a baseline infusion rate of 5 mL/hour (0.25%). The patients were instructed to press the PCA button, as and when required to deliver an additional dose of 2 mL, with 15-minutes lockout period. Both groups received 1 g of paracetamol infusion every 8 hours. The pain score was evaluated at 3, 6, 12, and 24 hours and then every 12 hours till 72 hours postoperatively. The requirements of rescue analgesia (injection tramadol), out-of-bed mobilization, and recovery of bowel function were recorded. Drug-related side effects and catheter-related complications were also noted.

Results: Five (10%) patients in the TAP arm and 17 (34%) patients in the epidural arm could not complete the study due to complications/failure. The intention-to-treat analysis indicates that VAS scores were similar in both groups (47 in the epidural PCA group and 48 in the TAP-PCA group) at 3, 12, 24, 36, 48, 60, and 72 hours. Rescue analgesia (tramadol) was similar in both groups (0.21, 0.58 vs. 0.13, 0.44). There were no significant differences observed between the 2 groups in terms of out-of-bed mobilization and pulmonary complications. Nonetheless, the TAP arm showed the earlier passage of the first flatus and a shorter hospital stay compared with the epidural arm.

Conclusion: PCA through the TAP route is not inferior to the epidural route for managing postoperative pain. Because of fewer contraindications and complications, TAP-PCA can be considered an alternative to epidural PCA.