Journal of Minimal Access Surgery最新文献

Introduction: Gangrene/perforated appendicitis entails high rates of morbidity and mortality. The purpose of this study is to discuss the reliability, surgical management and post-operative complications of laparoscopic interventions in the treatment of perforated appendicitis.

Patients and methods: One hundred and ten patients (50 men and 60 women) diagnosed with perforated appendicitis based on history, physical examinations, laboratory and computed tomography findings between January 2016 and May 2022 were analysed retrospectively. Preoperative laboratory and radiological findings, surgical methods and post-operative complications were evaluated.

Results: Abdominal pain defence and rebound were present in all patients. In terms of radiological findings, intra-abdominal free fluid was present in all patients and abscess in 42. Post-operative abdominal surgical site infection developed in six patients. No intra-abdominal abscess or incisional hernia was observed during follow-ups.

Conclusion: As a diagnostic tool, permitting better visualisation of the abdominal cavity, entailing fewer post-operative complications and obviating the need for large incisions, laparoscopy can represent the approach of choice in the treatment of perforated appendicitis.

Background: Although fast-track treatment pathways are well established in colorectal surgeries, their role in oesophageal resections has not been well studied. This study aims to prospectively evaluate the short-term outcomes of enhanced recovery after surgery (ERAS) protocol in patients undergoing minimally invasive oesophagectomy (MIE) for oesophageal malignancy.

Patients and methods: We studied a prospective cohort of 46 consecutive patients from January 2019 to June 2022 who underwent MIE for oesophageal malignancy. The ERAS protocol mainly consists of pre-operative counselling, pre-operative carbohydrate loading, multimodal analgesia, early mobilisation, enteral nutrition and initiation oral feed. Principal outcome measures were the length of post-operative hospital stay, complication rate, mortality rate and 30-day readmission rate.

Results: The median (interquartile range [IQR]) age of patients was 49.5 (42, 62) years, and 52.2% were female. The median (IQR) post-operative day of intercoastal drain removal and initiation of oral feed was 4 (3, 4) and 4 (4, 6) days, respectively. The median (IQR) length of hospital stay was 6 (6.0, 7.25) days, with a 30-day readmission rate of 6.5%. The overall complication rate was 45.6%, with a major complication (Clavien-Dindo ≥3) rate of 10.9%. Compliance with the ERAS protocol was 86.9%, and the incidence of major complications was associated with failure to follow the protocol ( P = 0.000).

Conclusions: ERAS protocol in minimally invasive oesophagectomy is feasible and safe. This may result in early recovery with shortened length of hospital stay without an increase in complication and readmission rates.

Background: Minimally invasive surgery for groin hernia has expanded significantly over the last two decades and has demonstrated better outcomes in terms of pain and quality of life. A major contributing factor related to chronic post-operative inguinal pain (CPIP) is mesh fixation. An alternative to the standard fixation methods is the self-adhesive surgical mesh.

Patients and methods: Prospective data analysis was performed of all patients undergoing laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair in a single centre for the period 1 st January, 2022-15 th December, 2022. A standardised surgical technique was used with a lightweight self-adhesive mesh without additional fixation. The analysis has encompassed early and late post-operative complications as well as the assessment of pain with an emphasis on CPIP.

Results: The study enrolled 52 patients where a total number of 64 elective hernia repairs were performed: 92.2% ( n = 59) primary and 7.8% ( n = 5) recurrent. Fifty-one patients received post-operative follow-up: 100% at 1 month and 78.8% ( n = 41) at 3 months. The incidence of early postoperative complications was 7.7% ( n = 4): one patient developed a seroma, two patients - port site hematomas and one a transient subileus that were all managed conservatively. No patients suffered a recurrence. The average pain score according to the Visual Analogue Scale was 3.3 (0-8) at discharge, 0.6 (0-4) at 1 month and there was no incidence of CPIP after the 3 rd month.

Conclusion: Laparoscopic TAPP repair for inguinal hernia with a self-adhesive mesh is an adequate surgical technique with the potential to reduce CPIP, but more research is needed to evaluate this method.

Objective: The objective of this study was to explore the influence of traditional laparoscopic surgery and transumbilical single-port laparoscopic surgery on ovarian function in patients with benign ovarian tumours.

Materials and methods: Forty-four patients with benign ovarian tumours who were treated in our hospital from January 2020 to June 2021 were selected and randomly divided into two groups, with 22 cases in each group according to random number table. The conventional group was treated with conventional laparoscopic surgery, while the modified group was treated with transumbilical single-port laparoscopic surgery. The measurement method was t -test, and the enumeration method was two tests. The clinical operation-related indicators, ovarian function (follicle-stimulating hormone, E 2 and luteinising hormone), complication incidence, Visual Analogue Scale (VAS) and landscaping satisfaction scores of the two groups were compared.

Results: There were no significant differences in complications and operation duration between the two groups ( P > 0.05). After treatment, the ovarian function indexes and beautification satisfaction scores of the modified group were significantly superior to those of the conventional group ( P < 0.05). Besides, the intraoperative bleeding volume, post-operative exhaust time, hospital stay and three-dimensional VAS scores on day 1 and day 3 after surgery of the modified group were lower than those of the conventional group ( P < 0.05).

Conclusion: Transumbilical single-port laparoscopic surgery for benign ovarian tumours has a significant clinical effect, which can effectively reduce bleeding during the operation, improve ovarian function, relieve surgical pain, promote rapid post-operative recovery and improve patients' satisfaction with landscaping. It is worthy of clinical application.

Background: Incidental gall bladder cancer (IGBC) is often discovered unexpectedly in patients after cholecystectomy. Currently, magnetic resonance imaging (MRI) has been widely applied in the pre-operative diagnosis of gall bladder diseases as laparoscopic cholecystectomy developed into the preferred method.

Aims and objectives: This study aimed to evaluate the pre-operative MRI application and laparoscopic management in the IGBCs.

Materials and methods: Between January 2011 and January 2020, a total of 7917 patients with gall bladder diseases treated by laparoscopy were enrolled in this study.

Results: Amongst 49 patients diagnosed with IGBCs, the incidence of IGBCs in polypoid lesions, biliary pancreatitis, cholecystitis, cholecystocholedocholithiasis and gall bladder stones was 0.42%, 1.19%, 0.62%, 1.20% and 0.49%, respectively. MRI evaluation showed more remarkable pre-operative imaging as compared to ultrasonographic evaluation (40.8 vs. 26.5, P < 0.05). Furthermore, 14 patients were diagnosed with gall bladder cancer through intraoperative histological examination and 11 received laparoscopic extensive resection after cholecystectomy. MRI findings with diffuse thickening of the gall bladder detected IGBCs with 6.1% sensitivity, 96.02 specificity, 0.95% positive predictive values and 99.4% negative predictive values; diffuse thickening of the gall bladder with suspicion of malignancy detected IGBCs with 12.2% sensitivity, 99.1% specificity, 7.6% positive predictive values and 99.5% negative predictive values; focal thickening of the gall bladder detected IGBCs with 16% sensitivity, 99.8% specificity, 32% positive predictive values and 99.5% negative predictive values; moreover, suspicious lesion detected IGBCs with 6.1% sensitivity, 99.6% specificity, 8.8% positive predictive values and 99.4% negative predictive values.

Conclusions: Patients with biliary pancreatitis and cholecystocholedocholithiasis have a higher incidence of IGBC. MRI evaluation could provide more accurate information for the IGBCs, which should be recommended for patients accepting cholecystectomy. MRI findings exhibited an unsatisfactory sensitivity when detecting IGBCs, but they represented high specificity. Pre-operative MRI evaluation and intraoperative histological examination may help some IGBCs to achieve one-stage laparoscopic extensive resection.

Background: The present study was conducted to evaluate the impact of enhanced recovery after surgery (ERAS) pathway in patients undergoing laparoscopic adrenalectomy (LA) for primary and secondary adrenal disease, in reducing the length of primary hospital stay and return to daily activities.

Materials and methods: This retrospective study was carried out on 61 patients who underwent LA. A total of 32 patients formed the ERAS group. A total of 29 patients received conventional perioperative care and were assigned as the control group. Groups were compared in terms of patient's characteristics (sex, age, pre-operative diagnosis, side of tumour, tumour size and co-morbidities), post-operative compliance (anaesthesia time, operative time, post-operative stay, post-operative numeric rating scale (NRS) score, analgesic assumption and days to return to daily activities) and post-operative complications.

Results: No significant differences in anaesthesia time ( P = 0.4) and operative time ( P = 0.6) were reported. NRS score 24 h postoperatively was significantly lower in the ERAS group ( P < 0.05). The analgesic assumption in post-operative period in the ERAS group was lower ( P < 0.05). ERAS protocol led to a significantly shorter length of post-operative stay ( P < 0.05) and to return to daily activities ( P < 0.05). No differences in peri-operative complications were reported.

Discussion: ERAS protocols seem safe and feasible, potentially improving perioperative outcomes of patients undergoing LA, mainly improving pain control, hospital stay and return to daily activities. Further studies are needed to investigate overall compliance with ERAS protocols and their impact on clinical outcomes.

Objective: The aim of this study was to evaluate the effect of adding dexmedetomidine to ropivacaine on pain relief and quality of recovery in older patients undergoing open inguinal hernia repair surgeries.

Methods: This was a prospective and randomised clinical trial of 102 patients aged over 65 years who received an ultrasound-guided transversus open mesh herniorrhaphy abdominis plane (TAP) block with either 0.375% ropivacaine 20 ml (Group R, n = 47) or 0.375% ropivacaine combined with 1 μg/kg dexmedetomidine 20 ml (Group RD, n = 45) in the pre-anaesthesia care unit before elective open inguinal hernia surgeries. The primary outcome measure was Visual Analogue Scale (VAS) pain scores at rest and on movement at 2, 4, 8, 12 and 24 h and at 1 and 3 months' postoperatively. The secondary outcome measures were the incidence of post-operative delirium (POD), nausea and vomiting and the occurrence of side effects or complications on post-operative day 1.

Results: Group RD had lower VAS scores at rest and on movement at 8 and 12 h postoperatively and a lower incidence of POD on the post-operative day 1 than Group R. Transient bradycardia was more frequent in Group RD than in Group R, and side effects or post-operative complications were reported in either group.

Conclusion: The addition of dexmedetomidine to ropivacaine in a TAP block enhances postoperative analgesia during hospitalisation and improves the quality of recovery without affecting chronic pain in older patients undergoing open inguinal hernia repair surgery.

Abstract: Benign cystic mesothelioma is a very rare and uncommon lesion, first reported by Plaut in 1928. It affects young women of reproductive age. It is usually asymptomatic or has non-specific symptoms. Diagnosis remains difficult despite the evolution of imaging, and the histopathological study is the key examination to make the diagnosis. Surgery remains the only curative treatment, regardless of significant rate of recurrence, and until today, no consensus on the therapeutic strategy is established.