Surgical Endoscopy And Other Interventional Techniques最新文献

Background: The purpose of this study was to evaluate the surgical and oncological outcomes of robotic-assisted beyond-TME surgery for locally advanced rectal cancer.

Methods: Consecutive adult (≥ 18 years old) patients who underwent a robotic-assisted proctectomy beyond-TME planes for primary or recurrent rectal cancer at three Mayo Clinic (USA) hospitals from 2017-2023 were included. Patient demographics and tumor and disease characteristics were obtained by review of the electronic health record. Outcomes of interest included postoperative complications, hospital length of stay, and pathologic and oncologic outcomes.

Results: In total, 72 patients were included in the final cohort. Thirty-five (48.6%) patients underwent an extended resection without exenteration, while 22 (30.6%) underwent a multi-visceral en bloc exenteration; 20 (36.1%) patients underwent a lateral pelvic lymph node dissection, with or without a concomitant extended resection. Most cases had an advanced T-stage and an involved mesorectal fascia on pre-treatment MRI. The median operative time was 425.0 min (340.5-504.0) and the median estimated blood loss was 150.0 mL (75.0-277.5). Conversion to open surgery was needed in two (2.8%) cases. Nearly half the cohort (48.3%) experienced a postoperative complication and the median postoperative length of stay was 3.5 (3.0-7.0) days. Five cases had a positive margin, resulting in an R0 rate of 93.1%. None of the exenteration cases had a positive margin. After a median follow-up of 22.0 (13.0-45.7) months, 10 patients experienced a local recurrence (13.8%).

Conclusion: Robotic-assisted beyond-TME surgery can be performed safely with favorable postoperative clinical and oncologic outcomes.

Backgrounds: A growing number of studies have shown that bariatric surgery can cause changes in the body composition of patients. This meta-analysis aims to reveal changes in skeletal muscle mass 1 year after bariatric surgery and analyze the causes of changes in skeletal muscle in postoperative patients, to provide a more comprehensive clinical basis for preserving muscle mass in patients.

Methods: We systematically searched PubMed, Embase, Web of Science, and Cochrane databases, and included six studies. The search time limit was from establishing the databases to October 10, 2024. Data on weight, BMI, and skeletal muscle mass at 1-year follow-up after bariatric surgery were collected. Meta-analysis was conducted using Review Manager 5.2 statistical software.

Results: After analysis, the skeletal muscle mass decreased significantly from preoperative to postoperative 3 months, and the difference was statistically significant ([WMD = 3.30 kg, 95%CI (2.18, 4.41)], P < 0.00001). Skeletal muscle mass was not statistically significant from 3 to 6 months after surgery and 6 to 12 months after surgery.

Conclusion: The skeletal muscle mass of patients after bariatric surgery showed a downward trend within 1 year after surgery, especially in the first 3 months.

Background: Acute cholecystitis, primarily caused by gallstones, is a serious condition that may lead to severe complications. The optimal timing of surgery for acute cholecystitis is still under debate. Early cholecystectomy is generally preferred to prevent complications and improve postoperative outcomes. This study aimed to evaluate the impact of early, intermediate, and delayed laparoscopic cholecystectomy on postoperative quality of life (QoL) in patients with acute cholecystitis.

Methods: This retrospective study included 201 patients who underwent laparoscopic cholecystectomy for acute cholecystitis between May 2019 and February 2023. Patients were categorized into three groups based on the timing of surgery: early (within one week), intermediate (1-6 weeks), and delayed (after six weeks). The Gastrointestinal Quality of Life Index (GIQLI) was used to evaluate QoL six months postoperatively. Data on patient demographics, surgery timing, and cholecystitis severity (based on the Tokyo Guidelines) were analyzed using univariate and multivariate regression models.

Results: The mean age of patients was 56.0 ± 14.9 years, and 65.7% were female. Early cholecystectomy was performed in 30.8% of cases, intermediate in 16.9%, and delayed in 52.2%. The median GIQLI score was 116. Patients who underwent early surgery had significantly higher GIQLI scores compared to those in the intermediate group (p < 0.001). No significant difference was observed between early and delayed surgery (p = 0.199). Multivariate analysis showed that intermediate surgery negatively affected QoL (p < 0.001), while cholecystitis severity was also a significant factor (p = 0.006).

Conclusions: Early laparoscopic cholecystectomy significantly improves postoperative QoL compared to intermediate surgery. Delayed surgery provides similar QoL outcomes to early surgery. However, intermediate cholecystectomy may lead to poorer QoL due to heightened surgical complexity and increased complications. Early intervention should be prioritized to optimize patient outcomes.

Background: Recently, the application of double band ligation-assisted endoscopic submucosal resection (ESMR-DL) in the resection of rectal endocrine tumors ≤ 10 mm has shown promising prospects. However, the use of ESMR-DL has not been reported for gastric gastrointestinal stromal tumors (gGISTs). In this study, we aimed to compare the application of modified ESMR-DL with ESD in gGISTs (≤ 1.5 cm).

Methods: Data were retrospectively collected from 472 patients who underwent modified ESMR-DL or endoscopic submucosal dissection (ESD) for resection of gGISTs (≤ 1.5 cm). To overcome selection bias, a propensity score matching method was applied using four covariates for 1:1 matching: sex, age, tumor size, and tumor location. Clinical data, surgical status, and postoperative outcomes were compared between the two groups.

Results: Of the 472 patients, 78 (16.5%) received modified ESMR-DL and 394 (83.5%) received ESD; after matching, there were 78 patients in each group. There was no statistical difference in the baseline characteristics between the two groups after matching (p > 0.05). Compared to ESD, modified ESMR-DL resulted in shorter operation time, time to a liquid diet and postoperative hospitalization time, but had a higher incidence of intraoperative perforation (p < 0.05). There was no significant difference in the R0 resection rate of tumors, incidence of postoperative complications, and average hospitalization costs between the two groups after matching (p > 0.05). Univariate and multivariate analyses showed that the maximum dimension of the lesion (7 mm increments) and the surgical method were factors affecting procedure time, and the maximum dimension of the lesion (7 mm increments) and operator (novice vs instructor) were factors affecting intraoperative perforation in modified ESMR-DL (P < 0.05). During the follow-up, there were no recurrences or metastases of gGISTs in either group.

Conclusions: Modified ESMR-DL is noninferior to ESD with a similar complete resection rate. In addition, modified ESMR-DL had shorter procedure time and hospitalization time.

Background: Foot switches are commonly used to record gastrointestinal lesions. However, prolonged use of foot switches can cause unstable posture, leading to musculoskeletal disorders. Therefore, this study aimed to develop and evaluate the usability of a compact foot switch for reducing musculoskeletal disorders among endoscopists.

Methods: A new endoscopic foot switch was developed to reduce musculoskeletal disorders and was compared with a previous foot switch. Between January 1 and October 1, 2024, 50 expert endoscopists from five different centers analyzed its usability, postural stability, ability to reduce pain and work fatigue, and efficiency.

Results: Compared with the conventional foot switch, the new foot switch showed favorable outcomes in terms of musculoskeletal disease-related factors, with better results in the following areas: comport endoscopic examination (6.5 [6-7] vs. 2 [1-2], p < 0.001), stable posture (6 [6-6] vs. 2 [2-3], p < 0.001), relief of musculoskeletal disorders (6 [5-6] vs. 3 [2-3], p < 0.001), efficiency of examination (6 [6-7] vs. 3 [2-3], p < 0.001), and applicability to other equipment (6 [6-7] vs. 2 [2-3], p < 0.001).

Conclusions: We developed a new foot switch that can prevent musculoskeletal disorders among endoscopists. Further validation of its usefulness in various hospitals and users is required.

Background: Black patients undergo sacral neuromodulation for urinary incontinence less than White patients. There is less known about racial disparities in fecal incontinence.

Objective: To determine if racial disparities in fecal incontinence care exist, specifically sacral neuromodulation education.

Design: This was a retrospective cohort study of adults treated for fecal incontinence from 2011 to 2021 at an academic health center.

Settings: Medical records were queried to collect clinical variables, including diagnostic tests ordered, treatments offered or discussed, and specialties treating the patients' fecal incontinence.

Patients: The two cohorts were patients who identified as non-Hispanic Black or non-Hispanic White.

Main outcome measures: The primary outcome was the percent of patients with documentation of discussion of sacral neuromodulation.

Results: 180 Black patients and 360 age-matched White patients were included. 21.7% of patients with fecal incontinence had documented counseling about sacral neuromodulation which was significantly less frequent in Black patients (12.8% vs 26.1%, p < 0.001). However, among only patients with this counseling documented, there was no difference based on race (17.4% vs 21.3%, p = 0.679). Black patients were also less likely to receive referrals for pelvic floor physical therapy (52.2% vs 72.2%, p < 0.001), anorectal manometry (41.1% vs 51.9%, p = 0.018), sphincter imaging (1.1% vs 5.3%, p = 0.018), and defecography (7.2% vs 16.1%, p = 0.004). Patients seen by Urogynecology, Colorectal Surgery, and/or Urology were more likely to be counseled about sacral neuromodulation (48.4% vs 2.8%, p < 0.001). On multivariate logistic regression, Black race (OR 0.45 95% CI 0.25-0.81), male sex (OR 3.15 95% CI 1.33-7.41), and not seeing a surgical specialist (OR 0.03 95% CI: 0.01-0.06) were associated with no sacral neuromodulation counseling.

Limitations: Limitations include reliance on chart documentation for the primary outcome.

Conclusion: Racial differences in treatment of fecal incontinence exist between Black and White patients, including differences in counseling about sacral neuromodulation.

Background: Recurrence and postoperative pain are major concerns after laparoscopic surgery for inguinal hernia. Follow-up on all patients is difficult and time consuming for both the hospital and the patient. We conducted a patient-reported follow-up study to estimate the rate of recurrence and postoperative pain in our department.

Method: Patients undergoing the TAPP (TransAbdominal PrePeritoneal) procedure with a self-adherent mesh at Copenhagen University Hospital - North Zealand from 2016 to 2019 received an online survey about signs of recurrence, postoperative pain, and complications. Patients reporting signs of recurrence or pain were contacted and invited for a clinical examination if relevant. Forty-five randomly selected patients who did not report any symptoms of recurrence or pain were contacted by phone for validation.

Results: 871 patients received a questionnaire, and 546 responded, leaving a response rate of 62.7%. Median follow-up time was 34 months (IQR 23-47). The self-reported recurrence rate was 8.1% (95% CI: 6.0-11.0%). On examination, recurrence was diagnosed in 2.4% (95% CI: 1.4-4.1%) of the patients. When including the patients with self-reported recurrence who did not accept the offer of clinical examination, the recurrence rate was 3.8% (95% CI: 2.5-5.8%). Four patients (0.7%, 95% CI: 0.2-2.0%) underwent herniotomy for recurrence. The rate of chronic postoperative pain impairing daily activity was 0.5%.

Conclusion: We found an acceptable low rate of recurrence and postoperative pain compared to other studies. The patient-reported recurrence rate was significantly higher than the clinical recurrence rate after the examination, indicating that patient-reported recurrence seems to overestimate true recurrence after TAPP.

Background and aims: Laparoscopic common bile duct exploration (LCBDE) is a safe and effective method for the treatment of choledocholithiasis. However, there is still controversy in clinical practice over whether primary duct closure (PDC) or T-tube drainage (TTD) should be selected after choledochotomy. Therefore, this study aimed to compare the two methods of closing the common bile duct in order to identify the safer and more effective approach.

Approach and results: A retrospective analysis was conducted on data from 745 patients who underwent LCBDE at the Department of Hepatobiliary and Pancreatic Surgery, Zhongshan Hospital, Xiamen University, between January 2017 and December 2021. Using propensity score matching (PSM), 433 patients were selected and divided into two groups: the primary duct closure group (PDC group, 287 patients) and the T-tube drainage group (TTD group, 146 patients). The study compared preoperative baseline characteristics, Intraoperative conditions, and postoperative conditions between the two groups. The results showed that the PDC group had significantly shorter operative time and less intraoperative blood loss compared to the TTD group, along with a lower incidence of postoperative infections. Despite no significant differences between the two groups in terms of postoperative hospital stay, bile leakage, biliary stricture, residual stones, postoperative bleeding, and recurrence, the overall performance of the PDC group was superior to that of the TTD group.

Conclusion: The study concluded that primary duct closure (PDC) after LCBDE is safer and more effective than T-tube drainage (TTD), without increasing the risk of postoperative complications.

Background: Low muscle mass is negatively associated with survival in patients undergoing surgery for colorectal cancer. Current evidence is limited regarding whether the surgical approach for liver resection of colorectal metastasis impacts postoperative changes in body composition and whether preoperative body composition can impact complication rate and survival.

Method: This study included patients previously included in the randomized OSLO-COMET trail where patients was allocated to laparoscopic or open liver resection for colorectal liver metastasis. CT scans 0-3 months before and 2-6 months after liver resection were segmented with the artificial intelligence-based tool BodySegAI to measure skeletal muscle mass (SM), visceral adipose tissue (VAT), and inter- and intramuscular adipose tissue (IMAT). SM, VAT and IMAT was compared between the open and laparoscopic group and as predictors for 5-year survival and postoperative complications.

Results: This study included 216 patients, median age was 67, 127 (59%) were male, 91 (42%) had primary tumor in rectum and 86 (40%) had multiple liver metastasis. There was no significant difference in postoperative change in SM, VAT or IMAT between those undergoing laparoscopy or open surgery. In multivariate analysis, high preoperative IMAT was a predictor for increased risk of postoperative complications (HR (95% CI): 1.045 (CI 95%: 1.003-1.089), p = 0.034). Moreover, postoperative increase in IMAT was a negative predictor for 5-year survival (HR (95%CI):1.009 (1.003-1.016), p = 0.003).

Conclusion: Postoperative change in body composition did not differ between patients randomly assigned to open or laparoscopic liver resection for colorectal metastasis. High preoperative IMAT was associated with an increased risk of postoperative complications.