Journal of Minimal Access Surgery最新文献

Abstract: Feeding jejunostomy (FJ) is essential for patients with absolute dysphagia, providing a critical means of nutrition. Despite various techniques being described in the literature, there is no standardized, cost-effective approach for laparoscopic FJ. This study aims to describe a modified, simplified laparoscopic FJ technique and assess its safety, feasibility, and cost-effectiveness. A case series of 30 patients who underwent laparoscopic FJ between June and December 2022 was evaluated. The mean age of the patients was 29 ± 1.2 years, with an average operating time of 46.5 ± 9 minutes. Intraoperative blood loss was minimal, and there were no major complications during the hospital stay. Only one minor complication, catheter displacement, occurred during the 1-month follow-up. The average hospital stay was 2 ± 0.66 days. The cost of the procedure was compared to existing commercial kits in India, demonstrating significant savings. The findings suggest that the modified laparoscopic FJ technique is a safe, feasible, and cost-effective alternative, offering a simplified approach with minimal complications and a short hospital stay. Further studies with larger sample sizes and longer follow-up are needed to validate these results.

Abstract: A giant inguinoscrotal hernia extends below the level of the midpoint of the thigh, in an upright position. They are usually due to the neglect of the patient and fear of surgical intervention. Patients typically present with lower urinary tract symptoms, ulcers over the scrotum caused due to dribbling of urine and rarely with obstruction or strangulation. Here, we present a similar case of an uncomplicated giant inguinoscrotal hernia with a Tanaka index of 74% who was preoperatively optimised with BOTOX (BOtulinum TOXin-A) and pre-operative progressive pneumoperitoneum and was managed laparoscopically with enhanced totally extraperitoneal repair. This signifies the importance of optimisation of the patients, especially with loss of domain help in managing such cases without any resection of bowel or omentum. Moreover, this proper pre-operative optimisation also helped us in managing such a case laparoscopically.

Introduction: Ventral hernia repair techniques have evolved, with enhanced total extraperitoneal repair (eTEP) and intraperitoneal onlay mesh repair-plus (IPOM+) emerging as alternatives. While eTEP avoids complications such as adhesions and infections associated with intraperitoneal mesh placement, its effectiveness compared to IPOM+ remains debated. To compare the outcomes of eTEP and IPOM+ in primary midline ventral hernia repair, focusing on post-operative pain, complications and early recurrence rates.

Patients and methods: A randomised controlled study was conducted in a tertiary hospital in Delhi from August 2022 to February 2024. Forty-eight patients with primary midline ventral hernias (defect size: 2-6 cm) were randomised into eTEP ( n = 24) and IPOM+ ( n = 24) groups. Outcomes included operative time, pain scores (evaluated at 6 h, 24 h, 7 days, 1 month and 3 months), analgesic use, complications (seroma and surgical site infections) and recurrence rates.

Results: eTEP had significantly longer operative time (115.83 ± 36.30 min vs. 63.94 ± 10.94 min; P < 0.001) but significantly lower pain scores at 6 and 24 h ( P < 0.001). Analgesic requirements were reduced in the eTEP group, with only two patients requiring rescue analgesia compared to 20 in the IPOM+ group ( P < 0.001). No significant differences were observed in seroma rates, surgical site infections or recurrence at 3 months.

Conclusions: eTEP offers reduced early post-operative pain and lower analgesic use compared to IPOM+, with similar complication and recurrence rates. Despite longer operative times, eTEP provides a viable alternative for ventral hernia repair with potential quality-of-life benefits.

Objective: The choice of the stent for managing walled-off pancreatic necrosis (WOPN) is a topic of debate with varying reported outcomes between metal and plastic stents. The present meta-analysis aimed to compare the efficacy and safety of metal and plastic stents for the drainage of WOPN.

Patients and methods: A comprehensive search of literature from inception to December 2024 was done on three databases for randomised controlled trials comparing metal and plastic stents for drainage of WOPN. Risk ratios with 95% confidence intervals (CIs) were calculated for all the dichotomous outcomes. Continuous variables were analysed using mean difference (MD).

Results: A total of 821 records were identified, of which seven studies were included in the final analysis. The procedural duration was significantly lower with metal stents with an MD of-11.32 min (95% CI: -17.75--4.88). However, there was no difference between the two groups in terms of stent-related periprocedural adverse events, bleeding, serious bleeding, treatment success, need for necrosectomy, number of necrosectomies, number of reinterventions, need for percutaneous drainage, need for surgery, duration of hospitalisation, mortality, stent dysfunction, recurrence of WOPN, endocrine and exocrine insufficiency. The procedural costs were significantly higher for metal compared with plastic stents (MD 2.4 × 10 3 $, 95% CI: 1.2-3.7), with no significant difference in the overall cost.

Conclusion: Except for a significantly shorter procedural duration, metal stents do not offer any significant advantage over plastic stents for WOPN drainage. Further studies are required before routinely recommending metal stents for WOPN drainage.

Background: Recent years have seen an increase in gastric cancer incidence. The most effective method of treating gastric cancer is still surgical resection. Over the past few decades, minimally invasive surgery has rapidly developed, reducing post-operative complications and speeding up recovery. However, the technical difficulties, especially during anastomosis, hinder the widespread use of this advanced surgery. The aim of this study was to investigate the safety and efficacy of self-pulling and latter transection in totally laparoscopic total gastrectomy (SPLT-TLTG).

Patients and methods: A retrospective study compared the outcomes of laparoscopic-assisted total gastrectomy (LATG) and SPLT-TLTG in patients with gastric cancer. Eighty patients who underwent either LATG or SPLT-TLTG between January 2016 and June 2018 were included in the study. Clinical information was used to compare patients who underwent these surgeries.

Results: Compared to LATG, patients who received SPLT-TLTG surgery recovered faster than those who received LATG time (operation and digestive tract reconstruction), blood loss, rehabilitation, first flatus, oral food intake, average pain score and hospital stay were significantly shorter in the SPLT-TLTG group than in the LATG group ( P < 0.05). However, the two groups had no significant differences in LNs and baseline characteristics.

Conclusions: The findings of this study provide significant evidence in support of the use of self-pulling and the latter transection procedures in total laparoscopic gastrectomy.

Abstract: Pancreatico-pleural fistula (PPF) is sequelae of pancreatitis. It is more commonly seen in alcoholic pancreatitis with abdominal symptoms and signs. PPF presenting with respiratory symptoms and signs in the absence of abdominal signs is rare. Moreover, trivial trauma which went unrecognised in a 14-year-old child for 3 months resulting in PPF has not been reported in the literature. This chronic PPF results in the formation of adhesions between the lung and pleura. These adhesions result in the incomplete expansion of the lungs even after thoracocentesis. The present case highlights the significance of video-assisted thoracoscopic surgery in such cases with a review of diagnostic and management guidelines.

Abstract: The increasing prevalence of obesity has made managing metabolic-dysfunction-associated steatotic liver disease and metabolic-dysfunction-associated steatohepatitis (MASH) with cirrhosis a significant challenge. This report details the case of a 53-year-old woman with class-V obesity (body mass index: 63.9 kg/m²) and MASH-associated decompensated cirrhosis with portal hypertension who underwent robotic sleeve gastrectomy (SG) after preoperative optimisation. Initial management involved stabilisation of variceal bleeding, a very-low-calorie diet, beta-blockers and continuous positive airway pressure, leading to improved liver function and Child-Turcotte-Pugh class improvement from B to A. The robotic SG, performed with meticulous intraoperative techniques to minimise bleeding and good post-operative care, resulted in favourable outcomes, including significant weight loss (44.8% total body weight loss) and improved liver parameters at 18-months. This case highlights the feasibility of metabolic and bariatric surgery in carefully selected cirrhotic patients following comprehensive optimisation and multidisciplinary care.

Introduction: With the ever-increasing demand for laparoscopic hernia repair, it is important to scrutinise the benefit in terms of recurrence, pain and cosmesis with the open technique for small ventral hernias.The objective is to compare the outcomes of open and laparoscopic intraperitoneal onlay mesh (IPOM) repair for small ventral hernias (defect size <3 cm).

Patients and methods: A prospective analysis of patients who underwent surgical mesh repair for ventral hernias with defects smaller than 3 cm between January 2021 and September 2022. Ventral patch composite mesh (Ventralex™) and composite Prolene-cellulose mesh (Proceed™) were utilised. We collected and analysed patient characteristics, operative findings and post-operative data, including recurrence rates, pain scores and cosmetic satisfaction over a 12-month follow-up period.

Results: Among the 116 patients included in the study, 54 underwent laparoscopic IPOM repair, while 62 underwent open IPOM repair. The laparoscopic group had an average hernia defect size of 2.7 cm (±0.3), while for the open repair group, it was 2.4 cm (±0.4). The duration of open repair was notably shorter than that of laparoscopic repair (54 min [±16] vs. 94 min [±27]; P = 0.001). Postoperatively, there were significant differences between the groups in terms of VAS scale pain score on post-operative day 1 ([7 ± 2 vs. 4 ± 2]; P = 0.008). Eight cases developed surgical site infections requiring oral antibiotics in the open group, whereas the laparoscopic group had 3 cases ( P = 0.6).

Conclusion: Open IPOM repair can be considered as a favourable option for ventral hernias <3 cm when compared to laparoscopic IPOM repair, primarily due to its shorter operative time, ease of spinal anaesthesia, single incision, shorter learning curve and absence of risks associated with port-site hernias. Higher initial pain in the laparoscopic group can be attributed to the use of absorbable tacks and transfascial sutures. No discernible disparities were observed in terms of chronic pain or recurrence rates between these surgical approaches.

Introduction: Obturator hernia is a relatively rare type of abdominal external hernia.The diagnosis is often delayed because of its rarity and nonsepcific symptoms and signs.

Patients and methods: Retrospective study of 18 patients undergoing surgery for obturator hernia in a 11-year period.

Results: 15 female and 3 male patients were recorded. Low body mass index (BMI) was the common predisposing factor. Accurate preliminary diagnosis were made only in 8 patients with support of timely computed tomography (CT) scans. The rate of strangulated hernias was 33.33% (6/18)and intestinal resection was required in 4 cases. 11 patients underwent open surgery while 7 received laparoscopic surgery. Simple closure of the hernia defect or hight ligation was performed in 12, mesh repair in 6. No serious operative complications was observed.

Conclusions: Obturator hernia should be included in the differential diagnosis of intestinal obstruction of unknown origin, especially in elderly women with low BMI. Early surgical intervention is imperative to avoid intestinal resection and reduce complications. Laparoscopy has a tendency to rapid recovery but has its limits.