Journal of Minimal Access Surgery最新文献

Abstract: Laparoscopic pancreaticoduodenectomy (LPD) is a minimally invasive approach for pancreatic head and ampullary tumours, with pancreaticojejunostomy (PJ) critically influencing post-operative outcomes. This study aimed to compare a modified continuous single-layer PJ technique with the conventional two-layer method in LPD. A retrospective cohort study of 22 patients undergoing LPD compared the surgical outcomes between the modified group (n = 12) and the conventional group (n = 10). Baseline characteristics were well-matched between the two groups. The modified group demonstrated significantly shorter anastomosis time (19.08 vs. 23.1 min, P < 0.001) and lower abdominal infection rates (0 vs. 3 cases, P = 0.041). No significant differences were observed in clinically relevant post-operative pancreatic fistula or bleeding. Conclusively, the modified continuous single-layer PJ technique appears safe and feasible, offering efficiency advantages without compromising short-term outcomes. However, large-scale randomised controlled trials are warranted to validate safety, efficacy and long-term prognostic implications.

Introduction: The introduction of laparoscopy has revolutionised the field of surgery. Camera navigation is a pivotal factor for a successful laparoscopic surgery. Good camera assistance guides the operating surgeon towards a safe and successful surgery. Laparoscopic camera navigation is a complicated task, requiring specific psychomotor and visuospatial skills. This study aimed to find out whether the objective structured assessment of camera navigation skills (OSA-CNS) is an effective tool for assessment and feedback to the residents.

Patients and methods: This was a single-centre randomised study with a test group and a control group having surgical residents as participants. The sample size is 24, with 12 in each group. Residents were assessed based on the five key parameters of camera navigation skills by an expert surgeon and the operating surgeon. The test and control group scores were analysed along with the progress of the groups after each assessment. Each participant assisted in five laparoscopic cholecystectomies. Statistical tests were conducted using SSPN and R-code.

Results: After the assessment, the test group had improved scores compared to the control group, which was statistically significant (P < 0.001). The analysis of variance test of the groups revealed that the test group participant scores improved after each assessment (F = 23.45, P < 0.001). The residents opined that the objective assessment helped improve their navigation skills.

Conclusion: The data from our study showed that the OSA-CNS is a viable and reliable tool. This structured assessment helps to improve camera navigation and has great scope in the future with regard to surgical training.

Introduction: To compare short- and mid-term outcomes in patients undergoing laparoscopic extended-view totally extraperitoneal (eTEP) inguinal hernia repair using either self-gripping mesh or polypropylene mesh with absorbable tackers.

Patients and methods: A prospective, parallel-arm, double-blinded randomised controlled trial was conducted at a tertiary care centre between April 2023 and July 2024. Adults with primary unilateral uncomplicated inguinal hernias were randomly assigned to receive self-gripping or polypropylene mesh with tackers. Pain was assessed using the Visual Analogue Scale (VAS) at 12 h and on post-operative days 1, 2, 7, 30 and at 3 months. The secondary outcomes included short-term complications, chronic pain, recurrence and quality of life (QoL) using the HerQLes questionnaire. Data were analysed using t-tests or Mann-Whitney U-test for the continuous variables and Chi-square or Fisher's exact tests for the categorical variables. P < 0.05 was considered statistically significant.

Results: Sixty-two patients were randomised equally. The mean VAS score at 12 h was 4.68 ± 0.94 in the polypropylene mesh group versus 4.58 ± 0.92 in the self-gripping mesh group (P = 0.657). No statistically significant difference in pain was observed at any assessed time point. Chronic pain at 3 months was negligible (mean VAS <1), and no recurrences were detected. Short-term complications and quality-of-life scores (HerQLes) were comparable between the two groups.

Conclusions: Laparoscopic eTEP hernia repair with either self-gripping mesh or polypropylene mesh fixed with absorbable tackers yields similar short- and mid-term outcomes regarding post-operative pain, complications, recurrence and QoL. Both techniques are safe and effective for primary unilateral inguinal hernia repair.

Introduction: Post-operative mesh infection is a rare but serious complication of laparoscopic hernia surgery. In this study, we share our experience of post-laparoscopic hernia repair mesh infections, with a review of the literature and possible preventive steps that can be taken to for such a dreaded complication.

Patients and methods: This retrospective observational study was done from January 2014 to 30 June 2024. We reviewed the prospectively maintained data of all the patients who underwent laparoscopic inguinal hernia surgery. Thousand eight hundred and twenty patients underwent laparoscopic hernia repair, and we found case records of six patients who experienced surgical site infections (SSIs) following laparoscopic inguinal mesh hernioplasty.

Results: The rate of SSI or the mesh infection was 0.34% (6 cases). All were male with 4 of them in the age group between 51 and 60 years. One patient (16.66%) had undergone totally extraperitoneal repair, whereas 5 patients (83.33%) had undergone transabdominal preperitoneal repair. All the patients presented with mesh infection within the first 4 weeks of surgery. Three (50%) of patients presenting with post-mesh infection had different comorbidities. Four (66.6%) patients of post-laparoscopic inguinal hernia repair mesh infection underwent mesh explantation and the remaining 2 (33.33%) were treated conservatively.

Conclusion: Intra-abdominal abscess and mesh infection, though rare, are serious complications of laparoscopic hernia repair. Prevention remains the best approach, and the surgical team must ensure adherence to key preventive measures at each stage.

Background: This study evaluates the clinical efficacy of the endoscopic mini- or less-open sublay (EMILOS) technique with stapler-assisted fascial closure for ventral hernia repair.

Materials and methods: Twelve patients underwent EMILOS with stapler-assisted fascial closure between July 2022 and August 2024 with a mean follow-up of 12.4 months.

Results: The cohort (7 females and 5 males; mean age: 58.9 ± 16.3 years and body mass index: 27.8 ± 3.5 kg/m²) underwent repair for various ventral hernias (mean defect: 4.9 cm × 5.2 cm). The mean operative time was 95 min. Complications included seroma (17%), surgical site infection (8%) and small bowel obstruction requiring reoperation (8%). The hernia recurrence rate was 8%. Patients reporting excellent quality of life increased from 17% preoperatively to 50% postoperatively.

Conclusions: EMILOS with stapler-assisted closure offers a safe, efficient approach with favourable short-term outcomes, particularly for obese patients and medium-sized hernias. The technique combines enhanced visualisation with efficient fascial closure, yielding an 8% recurrence rate that compares favourably with alternatives. Larger studies with extended follow-up are needed to establish long-term efficacy.

Background: Perforation peritonitis remains a significant cause of morbidity and mortality in emergency surgical patients. Conventionally, open laparotomy has been the preferred approach. However, with advancements in minimally invasive techniques, laparoscopic management has emerged as a potential alternative. The study aims to assess the feasibility and effectiveness of laparoscopic surgery compared to open laparotomy in managing perforation peritonitis.

Patients and methods: A prospective observational study was conducted from January 2022 to May 2023 for patients diagnosed with perforation peritonitis. A total of 140 patients were recruited, 110 patients underwent laparotomy while 30 patients underwent laparoscopic management. Propensity score matching (PSM) in 1:1 ratio was applied to balance confounding variables, resulting in two matched groups of 28 patients each. Operative time, length of post-operative stay, post-operative Visual Analogue Scale score, morbidity and mortality rates were compared.

Results: The mean operative time was significantly longer in the laparoscopic group (217.43 ± 86.10 min) compared to the laparotomy group (182.46 ± 31.63 min; P = 0.049). However, patients in the laparoscopic group experienced a significantly shorter hospital stay (4.39 ± 2.04 days vs. 8.68 ± 3.45 days; P < 0.001) and lower post-operative pain scores at all time points (P < 0.012). The 30-day morbidity rate was lower in the laparoscopic group (10% vs. 32%), with fewer surgical site infections and reoperations.

Conclusion: Laparoscopy is a feasible and effective alternative to laparotomy in selected cases of perforation peritonitis, offering benefits such as reduced post-operative pain and shorter hospital stay. Despite technical challenges, improved surgical expertise and patient selection can enhance its role in emergency surgical settings.

Objective: The objective of the study was to compare the effects of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of early oesophageal cancer.

Subjects and methods: Eighty-six patients with early oesophageal cancer and precancerous lesions admitted to our hospital from November 2021 to December 2023 were randomly divided into a treatment group (ESD: 43 cases) and control group (EMR: 43 cases). The efficacy and safety of the two methods were compared.

Results: The operation time of ESD was 117.65 ± 19.98, which was longer than that of EMR group (P < 0.05). The hospitalization time of patients in the ESD group was shorter than that in the EMR group (7.51 ± 1.30 vs. 9.16 ± 2.01 days, P < 0.05). Comparable en bloc resection rate, complete resection rate, and curative resection rate of patients in the ESD group (100.0%, 95.35%, and 93.02%) and EMR group (100.0%, 93.02%, and 90.70%) were observed (P > 0.05). The incidence of postoperative complications in the ESD group was 4.65%, which was lower than 13.95% in the EMR group (P > 0.05). No recurrence or metastasis of the primary lesions occurred in both groups. Both groups were displaying better postoperative life quality comparing to that of pre-operation. The quality of life in the ESD group was significantly better than that of the EMR group (P < 0.05).

Conclusion: Compared with EMR, ESD showed better clinical effects, fewer postoperative complications and higher safety in treating early oesophageal cancer and precancerous lesions. However, the diameter of the lesion should be considered for an optimal surgical plan.

Objective: To establish a two-port minimally invasive laparoscopic cholecystectomy (LC) technique that minimises surgical scarring and alleviates post-operative pain.

Methods: A cohort study was conducted, enrolling patients meeting the inclusion criteria to undergo two-port minimally invasive LC. The outcomes were compared with those of patients who underwent conventional LC performed by other medical teams. The clinical and pathological data were collected. Visual Analogue Scale scores were used to assess incision pain on post-operative days 1 and 15. Statistical analyses were performed to compare pain scores between the groups.

Results: Between November 2020 and June 2021, 56 patients met the screening criteria and were enrolled in the study group. Of these, 42 patients successfully underwent two-port LC, while 14 cases were converted to conventional three-port LC. No post-operative complications, such as bleeding or bile leakage, occurred, and all patients were discharged without incident. On day 1 post-surgery, the average incision pain score in the two-port LC group was 1.4 ± 0.95, significantly lower than 1.8 ± 1.32 in the conventional LC group (P = 0.02). On day 15 post-surgery, 13 patients (23.2%) in the two-port LC group reported subxiphoid incision pain, compared to 63 patients (41.4%) in the conventional LC group.

Conclusion: For patients meeting indications for conventional LC, early implementation of two-port minimally invasive LC achieved a success rate of 75%. Compared to conventional LC, this technique did not significantly shorten operative time or reduce the complication rates. However, it decreased the number of incisions to two, reduced scar size from 10 mm to 3 mm and significantly alleviated post-operative pain. It is worthy of clinical application and promotion.

Introduction: A difficult laparoscopic cholecystectomy (LC), if not handled appropriately, can lead to devastating complications. We hereby describe our experience and outcomes of patients with difficult LC over the last two decades, with various bailout strategies to achieve a very low conversion rate and bile duct injury rate.

Patients and methods: This study was a retrospective analysis of patients labelled as difficult LC in a single surgical unit at a tertiary care teaching hospital from January 2004 to December 2020. The pre-operative, peri-operative and follow-up data of all these patients were obtained from a prospectively maintained electronic database.

Results: Between January 2004 and December 2020, 3726 patients underwent elective LC, of which 649 (17.4%) cholecystectomies were deemed difficult. Using the various bailout strategies, we were able to achieve a conversion rate of 4.9% and bile duct injury rate of 0.1% with an overall morbidity of 8%.

Conclusion: When a difficult situation occurs, the benefit of removing the complete gall bladder is outweighed by the risk of a major injury, so a bailout strategy needs to be used. The present series reiterates the use of bailout strategies to not only decrease conversion but also achieve a minimal BDI rate.

Introduction: Laparoscopic cholecystectomy is widely regarded as the standard treatment for symptomatic gall bladder diseases due to its minimally invasive nature and favorable recovery profile. However, hemorrhagic complications pose significant risks to patient safety and outcomes.

Patients and methods: This retrospective case series aimed to evaluate the incidence, risk factors and outcomes associated with intraoperative and post-operative hemorrhagic complications in patients undergoing cholecystectomy. Eighteen patients who experienced significant bleeding necessitating unplanned reoperations were included in the analysis. Data were collected encompassing demographic information, comorbidities, surgical details and post-operative outcomes.

Results: The study found that older age and higher body mass index (BMI) were strongly correlated with increased estimated blood loss, with each additional year of age increasing the odds of severe hemorrhage by 7% and each unit increase in BMI raising the odds by 15%. Patients with the American Society of Anesthesiologists classifications of 3-4 were 3.5 times more likely to experience severe bleeding. In addition, the use of anticoagulant or antiplatelet therapy was associated with a nearly six-fold increase in the risk of significant hemorrhage. The presence of adhesions or severe inflammation further doubled the risk of substantial blood loss. Hemorrhagic complications were associated with prolonged hospital stays, higher rates of blood transfusions and increased mortality.

Conclusion: These findings highlight the importance of pre-operative risk assessment and tailored surgical strategies to mitigate bleeding risks. Enhancing patient evaluation and optimizing surgical techniques are crucial for improving outcomes and ensuring patient safety in cholecystectomy procedures.