Journal of Minimal Access Surgery最新文献

Background: Laparoscopic inguinal hernia repair (LIHR) has become increasingly popular, but recurrence remains a concern. This study introduces a novel tail-anchor mesh (TAM) fixation method for LIHR and evaluates the safety, feasibility and clinical outcomes of this technique in patients undergoing LIHR.

Patients and methods: Between June 2018 and June 2020, 412 patients with inguinal hernias were included in the study. LIHR with the TAM method was performed in 210 patients (Group A), whereas 202 patients underwent LIHR with conventional mesh fixation (Group B). Statistical analysis was used to compare clinical data between the two groups.

Results: The recurrence rate and incidence of seroma were significantly lower in Group A (0.48% and 1.90%, respectively) than in Group B (3.96% and 9.41%, respectively) ( P < 0.05). There were no significant differences between the groups in terms of demographic indicators, intraoperative blood loss, operation time, hospital stay or patient costs (all P > 0.05). Follow-ups at 24 and 53 months after discharge revealed no cases of wound infection, chronic pain or testicular atrophy in either group.

Conclusions: The TAM fixation method is a safe, feasible and reproducible technique for LIHR and offers superior outcomes compared with conventional mesh fixation, particularly in reducing recurrence and seroma formation.

Introduction: Primary ventral hernia remains a common presentation in surgical clinics with reported recurrence rates of 10%-20%. Intraperitoneal onlay mesh (IPOM) repair has been the widely accepted technique for laparoscopic management of ventral hernia. More recently, extended view totally extraperitoneal (eTEP) repair has emerged as a safe procedure in terms of reduced post-operative pain and faster recovery. Studies comparing IPOM with eTEP are limited. The present study was conducted to compare the two surgical techniques in terms of early outcomes in patients presenting with primary ventral hernia.

Patients and methods: A total of 30 patients with primary ventral hernias with defect size > 2 and up to 6 cm were randomised using computer-generated sequences into two groups. Operative time was used as the primary endpoint. Patients were followed up at 6 months, 1 year and 2 years postoperatively to look for recurrence, chronic pain and any other complications.

Results: Mean operative time in the IPOM group was significantly less than eTEP repair ( P < 0.001). Mean pain scores in the eTEP group at discharge, on day 1 and 1 week were significantly lower than corresponding scores in the IPOM group. The mean hospital stay (2.09 ± 0.30 days) in the eTEP group was less than the IPOM group (3.64 ± 1.56 days) ( P < 0.001). Return to work was also significantly earlier in eTEP (10.18 ± 1.07 days vs. 13.55 ± 2.16 [ P < 0.001]). No recurrence was recorded in 23 of 30 patients followed up till 2 years.

Conclusions: Operative time was significantly longer in the eTEP group, reaffirming the published data. Post-operative pain was significantly lower in patients undergoing the eTEP procedure up to 1 week. Consequently, hospital stay was also reduced and return to work was faster in these patients. Both procedures fared equally in terms of no recurrence with a 77% follow-up at 24 months.

Abstract: The synchronous occurrence of pancreatic neuroendocrine neoplasm (PNEN) and clear cell renal cell carcinoma (ccRCC) in one patient is extremely rare. Synchronous resection of both tumours is preferred over a two-stage procedure if possible. The robotic da Vinci Xi platform allows for multi-quadrant surgery with oncological outcomes comparable to those of laparoscopic or open surgery. We present the case report of an 80-year-old male who underwent synchronous resection of a PNEN in the tail of the pancreas and ccRCC in the left kidney. To the best of our knowledge, this is the first case report on this topic.

Background: Heterotopic pancreas (HP) is a rare congenital anomaly, characterised by ectopic pancreatic tissue lacking anatomical and vascular continuity with the main pancreas. Its clinical and radiological presentation often mimics gastrointestinal stromal tumours (GIST), making pre-operative diagnosis challenging. They are usually asymptomatic but can rarely present with symptoms like GI bleed.

Methods: This retrospective study analysed the four cases of HP in the gastroduodenal region, diagnosed over the past 4 years. All patients underwent minimally invasive surgical excision based on pre-operative suspicion of GIST. Clinical presentation, imaging findings, surgical approach and histopathological results were reviewed.

Results: The study included four male patients aged 18-62 years. The symptoms ranged from post-prandial abdominal pain and discomfort to asymptomatic incidental findings and haemoptysis. Contrast-enhanced computed tomography (CECT) revealed nodular lesions (1.6-2.7 cm) with exophytic or endophytic growth patterns, raising the suspicion for GIST. Robotic-assisted excision was performed in three cases and laparoscopic excision in one. Histopathological examination confirmed HP in all cases, classified as Heinrich type 1 or 2, with one case showing an additional adenomyoma.

Conclusion: HP should be considered in submucosal or intramural GI lesions, especially when mimicking GISTs or showing umbilication on endoscopy. Surgical resection is recommended for the symptomatic cases or diagnostic uncertainty, with minimally invasive approaches preferred. Our series highlights the first robotic excision of duodenal HP in the literature.

Introduction: The pathogenesis of diverticular disease varies significantly and so does its clinical presentation. The procedure for left-sided diverticular disease is standardised, but there is still no consensus on the level of arterial ligation. In 2021, our group initiated the Diverticular Disease Registry (DDR) Trial, a multi-institutional registry on diverticular disease. The aim of this study is to analyse patients enrolled in the DDR who underwent elective laparoscopic sigmoidectomy to determine if different arterial ligations result in differences in bowel function.

Patients and methods: Patients enrolled in the DDR from June 2021 to January 2024 were reviewed. Inclusion criteria included elective sigmoidectomy for diverticular disease, reported pre-operative bowel preparation and availability of data on the level of the arterial section. Patients were grouped according to the level of artery ligation: the superior haemorrhoidal artery transection (SHA-T) group and the superior haemorrhoidal artery preservation (SHA-P) group.

Results: A total of 242 patients were enrolled at 8 hospitals. One hundred and ten patients were included in the analysis. Hospital stay was shorter although not significantly in the SHA-P group compared to the SHA-T group (5 ± 2 vs. 6 ± 1.5; P = 0.062). The first flatus occurred earlier in the SHA-P group, approaching the level of significance (1 ± 0.5 vs. 2 ± 0.8; P = 0.057). Bowel function restored significantly earlier in the SHA-P group (2 ± 0.4 vs. 3 ± 2.1; P = 0.041).

Conclusions: Our study reported improved bowel function in patients undergoing SHA preservation during elective sigmoidectomy for diverticular disease.

Abstract: Gall bladder volvulus (GBV) is a rare surgical emergency characterised by torsion of the gall bladder on its mesentery, leading to potentially life-threatening consequences. The presentation of this condition often resembles that of typical calculous cholecystitis, requiringW a high level of clinical suspicion to diagnose and treat it promptly. It is essential to comprehend the clinical subtleties of GBV due to its infrequency and difficulties in diagnosis to prevent serious consequences. We present the case of an 86-year-old frail woman who presented to the emergency department with sudden-onset vomiting and acute abdominal pain. Imaging revealed a distended gall bladder with massive wall thickening and biliary tree dilation, suggestive of biliary obstruction due to gall bladder torsion. Emergent laparoscopic cholecystectomy was performed, revealing a torsed gall bladder with gangrene and intramural haemorrhage. Post-operative management included antibiotics, and the patient experienced an uneventful recovery. This case emphasises the need to consider GBV as a differential diagnosis for elderly patients experiencing acute abdominal symptoms. Advanced imaging modalities, such as magnetic resonance imaging, play an important role in detecting GBV preoperatively and aiding treatment planning. Surgical intervention remains the cornerstone of GBV treatment, necessitating precise surgical techniques to avoid complications. The rarity of GBV and its similarity to acute cholecystitis makes it difficult to diagnose. This case emphasises the significance of maintaining a high index of suspicion for GBV, especially in frail elderly patients.

Introduction: Laparoscopic ventral hernia surgery has become the standard of care for most surgeons, offering improved patient outcomes, shorter hospital stays, and fewer complications compared to open surgeries. However, the benefits of combining Intraperitoneal Onlay Meshplasty (IPOM) with other surgeries are rarely discussed and not commonly practiced. This study examines the safety of placing mesh after Total Laparoscopic Hysterectomy (TLH) based on a single center's retrospective experience of over 1,000 cases spanning 15 years.

Materials and methods: Data of all the patients who underwent concomitant TLH with IPOM were collected retrospectively. Details of the surgery, immediate post-op outcomes, long term follow ups with complications and recurrences were analysed.

Results: Between January 2006 and January 2021, we reviewed 1,273 cases, of which 1,058 met our inclusion and exclusion criteria. There were no open conversions. The mean patient age was 48.23 years with a standard deviation (SD) of 2.19. The mean BMI was 33.21 kg/m² with an SD of 1.83. The average defect size was 5.8 cm with an SD of 1.65. The mean operating time was 231 minutes with an SD of 10.15. The average hospital stay was 3.2 days with an SD of 0.84. There were no 30 day readmissions or mortality. Out of 1,058 cases, 782 patients had a minimum follow-up period of 2 years, conducted through telephone conversations or in-person hospital visits. An additional 155 patients had at least 1 year of follow-up, while 121 patients were lost to follow-up within the first year. The median follow-up duration for all patients was 2.8 years. 52 cases (4.9%) experienced postoperative seroma. We had only one case (0.094%) of mesh infection, which required mesh explantation. There were two instances of recurrence (0.189%): one patient underwent open repair after 24 months, and another underwent eTEP repair 32 months after the initial surgery. Both patients completed 1 year of follow-up post-second procedure and were doing well.

Conclusion: Meshes can be safely placed in a clean, contaminated environment alongside total laparoscopic hysterectomy, with the discretion of the operating surgeon considering his expertise and judgment. We can conclude that combining ventral hernia repairs with TLH is safe and feasible with acceptable morbidity.

Abstract: Prostate cancer is one of the most prevalent neoplasms among men, and radical prostatectomy is a common treatment. While urinary incontinence and erectile dysfunction are frequently discussed postoperative complications, the incidence of inguinal hernias (IHs) has received less attention. Retzius-sparing robot-assisted radical prostatectomy (RS-RALP) has emerged as a technique that may reduce the risk of IH compared to conventional approaches (C-RALP). We conducted a systematic review and meta-analysis following PRISMA guidelines to evaluate whether different surgical approaches influence the incidence of IHs. From 670 initially identified studies, four met the inclusion criteria. The meta-analysis showed that RS-RALP was associated with a significantly lower incidence of IH compared to C-RALP (odds ratio = 0.31; confidence interval = 0.18-0.55; P < 0.001). Preservation of the Retzius space appears to reduce the risk of postoperative IH, whereas reconstructive measures within this space do not seem to offer additional protection.