Journal of Minimal Access Surgery最新文献

Introduction: In laparoscopic inguinal hernia repair (LIHR), fixation means for meshes (FMMs) are commonly used to reduce hernia recurrence risk. Their use may result in post-operative pain (PP) and may even increase surgical time (ST). Recently, self-gripping meshes (SGMs) have been developed, which leave aside fixation devices; they could potentially reduce PP and even decrease ST. Our primary outcome was to compare ST, PP and recurrence rates in LIHR using SGM versus FMM.

Patients and methods: A comparative retrospective study with prospective case registry was conducted. All patients who underwent LIHR with transabdominal pre-peritoneal approach from January to December 2022 in a high-volume centre were analysed. Patients were divided into two groups according to the type of mesh used in surgery (SGM vs. FMM). Demographic variables, hernia type and size, mesh type and size, ST, PP, recurrence and other morbidities were compared between the groups.

Results: A total of 411 LIHRs were performed during the period, of which 283 were included in the study. Of these, 234 patients were repaired with FMM and 49 with SGM. ST had a statistically significant reduction in the SGM group ( P = 0.0004) with a mean time of 58.9 min (±13.6), compared to 68.1 min (±18.9) for the FMM group. A trend towards lower PP in the SGM group was noted ( P = 0.08). No recurrences were found in the SGM group with a median follow-up of 18 months (interquartile range: 3).

Conclusions: SGMs have proven to be a safe, efficient and fast for LIHR in our series. They are a feasible alternative for LIHR, reducing ST and potentially reducing PP. Prospective randomised trials are needed to confirm this trend, along with a longer follow-up period to determine potential advantages in terms of recurrences.

Abstract: Intrapancreatic accessory spleen (IPAS) is a rare condition resulting from the failure of embryological splenic buds to fuse. Found in approximately 1.1% to 3.4% of the population, IPAS can present significant diagnostic challenges, often mimicking pancreatic tumours such as pancreatic neuroendocrine tumours. We report two cases of IPAS, each illustrating different diagnostic approaches and outcomes. These cases highlight the importance of considering IPAS in differential diagnoses for hypervascular pancreatic tail lesions. Advanced imaging techniques such as magnetic resonance imaging, computerised tomography, technetium-99m scintigraphy and endoscopic ultrasound-guided fine-needle aspiration are critical in distinguishing IPAS from malignant conditions, potentially preventing unwarranted surgical interventions. Comprehensive diagnostic protocols combining multiple modalities are recommended to enhance diagnostic accuracy and optimise patient outcomes.

Abstract: Laparoscopic cholecystectomy (LC) is a widely performed procedure, but it can be complicated by iatrogenic bile duct injuries, leading to benign biliary strictures (BBS). This report details the case of a 38-year-old man with a Bismuth type IIIb BBS and an internal duodenal fistula following LC. He underwent a totally laparoscopic Roux-en-Y hepaticojejunostomy (RYHJ), a technically demanding procedure, particularly in the presence of complex biliary strictures. The surgery involved meticulous dissection and the creation of a wide hepaticojejunostomy. The patient had an uneventful recovery, with discharge on the post-operative day 4. At 18-month follow-up, he remains asymptomatic with normal liver function. This case demonstrates the feasibility and effectiveness of laparoscopic RYHJ in managing complex BBS, offering the advantages of minimally invasive surgery, including reduced post-operative pain and shorter hospital stay, while ensuring favourable long-term outcomes.

Abstract: Patients diagnosed with solitary non-parasitic splenic cysts were mainly described in the literature as case reports or case series. This study aims to analyse data from published articles about this condition. We performed a systematic review using the PRISMA protocol. PubMed/MEDLINE, Embase and the Google Scholar Library were searched up to the end of May 2024. Fifty-five patients were included in this study. 31 (56.36%) patients are female, and the mean age is 29.13 years. 32 (58%) patients experienced abdominal pain and 5 (9%) patients were asymptomatic. Sizes of the cysts varied between 67 and 250 mm. Most of the patients underwent laparoscopic fenestration of the cyst (54.55%), and all the pathological results were benign lesions. 3 minor complications (5.45%) were observed and recurrence of the cyst occurred in 3 patients (5.45%). Solitary non-parasitic splenic cysts are uncommon. They are benign lesions but can become symptomatic and therefore require surgery. Minimally invasive surgery is a safe option with a very low morbidity and mortality.

Background: Robot-assisted surgeries are increasingly used for the treatment of benign gynaecological conditions. However, their impact in cases of significantly enlarged uteruses remains uncertain. This study aims to investigate whether the weight of the uterus influences the surgical results of robotic hysterectomy.

Patients and methods: Ambispective analysis of 306 cases was performed, of which 265 cases were analysed retrospectively. The outcome measures included total operative time, including docking time, console time and vault closure time, complication rates and quality of life (World Health Organization Quality of Life Brief questionnaire) stratified based on uterine sizes into three groups by every 250 g.

Results: Of the 306 cases, 76.47% of cases ( n = 234) had uterine weight <250 g, 18.30% of cases ( n = 56) had uterine weight between 250 and 500 g, while 5.23% of cases ( n = 16) had a weight of uterine specimen >500 g. The total operative time was significantly lower in the <250 g group compared to >500 g (81.92 ± 22.81 vs. 111.88 ± 40.27 min; P = 0.003), contributed primarily by the console time. Although the need for post-operative blood transfusion was higher in the >500 g group, the overall complication rate between the three groups was similar. The three groups had comparable QOL through all four domains.

Conclusion: The present study underscores the influence of uterine weight on robotic hysterectomy outcomes, revealing increased operative times and post-operative haemoglobin drop for uteri over 500 g. Despite these challenges, complications were not significantly affected by uterine size.

Introduction: This retrospective study aims to compare the feasibility and efficacy of the modified Billroth-II with Braun (B-II Braun) reconstruction with the Roux-en-Y (R-Y) reconstruction following laparoscopic distal gastrectomy.

Patients and methods: Between January 2020 and December 2022, 213 patients underwent total laparoscopic distal gastrectomy (TLDG). Of these, 125 patients underwent B-II Braun reconstruction and 8 underwent R-Y reconstruction. Patient data were prospectively collected and retrospectively analysed.

Results: The modified B-II Braun reconstruction required shorter operative times compared to the R-Y approach (151.60 ± 12.50 vs. 182.50 ± 10.60; P = 0.0037), including anastomosis time (32.46 ± 1.55 vs. 48.80 ± 2.84; P = 0.016). At a 6-month short-term follow-up, endoscopic examination in the B-II Braun group revealed 27 cases of bile reflux and 15 cases (10.3%) of Grade 2 gastritis, with no cases of Grade 2 food residue. However, there was no statistically significant difference between the two groups in terms of food residue remaining in the residual stomach at 6 months ( P = 0.29), gastritis at 6 months ( P = 0.126) or bile reflux at 6 months ( P = 0.209).

Conclusion: For gastric cancer patients, TLDG with modified B-II Braun reconstruction is technically feasible. It offers an acceptable post-operative complication profile, shortens operative time, facilitates early post-operative recovery and effectively prevents bile reflux into the remnant stomach.

Introduction: Ventral hernia (VH) in patients with severe obesity poses a surgical challenge during bariatric surgery (BS). There is conflicting evidence regarding the optimal timing to perform a definitive VH repair (VHR). We present our experience in managing severely obese patients with VH.

Patients and methods: Sixty-seven severely obese patients with VH underwent a cross-sectional analysis of outcomes after BS and VHR. Outcomes were presented in terms of patients' demographics, BS performed, timing of VHR and recurrence rates.

Results: Sixty-seven patients were included in the study. Seven patients who presented with complicated hernia underwent a concomitant BS and VHR (Group 1) and the rest with uncomplicated hernia underwent a staged VHR (Group 2). The mean age of presentation was 45.2 (±11.5) years, with a female preponderance (male:female = 17.9:82.1). The mean defect size was 3.4 (1.6) cm. Majority of Group 1 patients underwent an anatomical repair while Group 2 patients underwent a mesh hernioplasty. The patients in Group 1 had a higher body mass index at the time of VHR (47.4 ± 12.7 vs. 33.7 ± 4.21 kg/m 2 ). The rate of recurrence was also higher in Group 1 compared to Group 2 (42.9% vs. 3.3%) at a mean duration of 10.3 and 12 months, respectively.

Conclusion: VHR in patients with severe obesity is challenging. The staged approach appears to be a safer option with acceptable recurrence rates compared to the concomitant approach. However, an individualised approach based on patient presentation should be followed for VHR in such patients.

Introduction: Colon and rectal surgery was amongst the earliest specialities to adopt robotic surgery, with Weber and Hashizume reporting the first operations for benign and malignant colorectal disease, respectively, in 2002. Although robotic-assisted surgery benefits from technical advantages that shorten the learning curve, it nonetheless presents a steep and extended learning curve.

Patients and methods: A prospective study was performed by a surgical team formed from two different departments in Bulgaria, using the da Vinci Si HD robotic system. The patients were divided into two groups: group I - the first 28 patients without indocyanine green (ICG) use and group II - the next 17 patients with ICG fluorescence imaging to assess bowel perfusion. Correlations between patient characteristics, operation duration, conversions, hospitalisation duration, complications, bleeding, reoperation, type of operation and ICG usage were assessed using multivariate analysis. This research aims to evaluate our learning curve, oncological safety and technical proficiency using the cumulative summation (CUSUM) method. To determine the CUSUM scores for each procedure index, the average console and docking time were taken into account. Subsequently, CUSUM plots were generated for the initial 45 cases.

Results: Forty-five patients were included: 32 men (71.1%) and 13 women (28.9%). The procedures performed included 37 anterior resections (82.2%) and 8 (17.8%) abdominoperineal excisions. The operative time was shorter in group II for both the docking and console times. The docking time in group I was 10 min (range, 4-30 min) compared with 9 min (ranging 5-20 min) in group II ( P = 0.691). The console time was 166 min in group I (ranging 45-300 min) and 147 min in group II (ranging 60-235 min) ( P = 0.020).

Conclusion: A significant reduction in console time was observed after the 28 th case. Anastomotic leaks were not observed in the ICG group. Despite our small patient cohort, we believe our institution contributes to the literature by describing our experience and the learning curve associated with robotic rectal resections.