Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Background: Following the COVID-19 pandemic, antibiotic therapy has become the first-line treatment for acute appendicitis (AA) in many centers. Interval appendectomy (IA) is often needed later due to symptom recurrence. This paper aimed to report our experience with early, unplanned laparoscopic IA (LIA) over the past 2 years. Materials and Methods: All patients with previous AA initially managed with antibiotics who underwent LIA due to symptom recurrence over the period January 2022-March 2024 were enrolled. Parameters assessed included patients' characteristics and operative outcomes. Results: The patient cohort included 40 girls and 31 boys, with a median age of 13.3 years (range 9-17). All LIAs were accomplished laparoscopically without conversions or intraoperative complications. The median operative time was 27 minutes (range 15-48). The appendix was ligated using two endoloops in 28/71 (39.4%) and resected using an automatic stapler in 43/71 (60.6%). A retrocecal appendix was found in 25/71 (35%), and adhesions between the appendix and the surrounding tissues in 31/71 (43%). Parasitic helminths were found in the lumen of the appendix in 5/71 (7%). Meckel's diverticulum was negative in all cases. The median hospitalization was 32 hours (range 26-50). No postoperative complications occurred. Pathology confirmed intramural inflammation with peri-appendiceal fibrosis in all patients. Conclusions: Our study confirms that early laparoscopic appendectomy is a safe and feasible option after failed nonoperative management of complicated appendicitis. All procedures were completed laparoscopically without complications. Given the presence of adhesions and retrocecal appendix in many cases, further studies are needed to refine optimal treatment strategies and timing.

Background: The optimal surgical approach for complicated diverticulitis in the emergency setting remains controversial. This retrospective cohort study aimed to investigate the clinical outcomes associated with Hartmann's procedure (HP) and primary anastomosis (with and without ileostomy) in patients diagnosed with complicated diverticulitis. Methods: Data were collected from the American College of Surgeons-National Surgical Quality Improvement Program participant user files from 2016 to 2021. A total of 25,458 patients with acute diverticulitis and emergency surgery were included. The patients were categorized into three groups: those who underwent HP, those who underwent primary anastomosis with ileostomy and those who underwent primary anastomosis without ileostomy. The primary outcomes assessed were medical-related morbidity and anastomotic leak. Secondary outcomes included mortality, unplanned readmission, and length of in-hospital stay. Results: Compared to patients who underwent the primary anastomosis procedure, the HP group displayed significantly higher rates of medical-related morbidity, and higher mortality rates, even after multivariate adjustment and propensity score analysis. Patients who received the ileostomy exhibited a statistically significantly higher medical-related morbidity and unplanned readmission rates. However, aside from these outcomes, the two groups did not exhibit significantly different rates in any of the other outcomes studied, including anastomotic leak. In patients with septic shock, primary anastomosis without diverting loop ileostomy was associated with significantly lower unplanned readmission when compared with the ileostomy group. Conclusion: Primary anastomosis demonstrated superior outcomes when compared with HP, and there are potential benefits of avoiding a diverting loop ileostomy. Hemodynamical status was not associated with worse prognosis in the primary anastomosis group.

Background: Minimally invasive thyroidectomy has evolved to improve cosmetic outcomes while maintaining surgical safety. The axillo-breast approach is increasingly favored, yet standardized methods to enhance anatomical clarity and nerve preservation are limited. Objective: To describe the Axillo-Breast Lateral Entry (ABLE) technique for endoscopic hemithyroidectomy and introduce the Critical Landmark Exposure & Anatomical Recognition (CLEAR) concept for safer dissection. Materials and Methods: A retrospective review was conducted on 40 patients who underwent ABLE endoscopic hemithyroidectomy without intraoperative neuromonitoring between January 2023 and October 2025 at a tertiary centre in Northern India. Standard laparoscopic instruments and energy devices were used. Port placements followed ergonomic principles. The CLEAR view was applied to reliably identify key structures: recurrent laryngeal nerve (RLN), inferior thyroid artery (ITA), and parathyroid glands within a defined anatomical triangle. Results: All patients had benign nodules with a mean size of 4.4 ± 1.2 cm. The RLN was visually identified in 100% of cases. There were no instances of permanent vocal cord palsy or hypoparathyroidism. All patients were discharged by postoperative day one, with excellent cosmetic outcomes and no major complications. Conclusion: The ABLE technique is safe, reproducible, and ergonomically favorable, particularly for early-career surgeons. The CLEAR concept provides a consistent anatomical framework for preserving critical structures, especially when intraoperative neuromonitoring is not available. This approach may facilitate wider adoption of endoscopic thyroidectomy in resource-limited settings.

Introduction: The Allurion® gastric balloon (AGB) is an innovative option for treating overweight individuals and those with grade I obesity, or as a bridging treatment for bariatric surgery, or for patients who do not desire surgical intervention. This study aimed to evaluate the efficacy and safety of the AGB in a multicentric cohort. Materials and Methods: A retrospective analysis of consecutive cases treated with AGB (≥18 years old with body mass index [BMI] ≥27) was performed in eight centers in three countries in Latin America (Argentina, Chile, and Perú), between September 2021 and September 2022, with a 12-month follow-up. Results: In total, 402 patients were included (median BMI of 32.81 kg/m²). Mean total weight loss percentage was 8.3%, 11.6%, and 14.9% at 3, 6, and 12 months, respectively, with a follow-up of 93.03%, 75.37%, and 40.54%. The adverse event rate was 1.24% (n = 5). During the first 7 days, 34.58% (n = 139) experienced concomitant symptoms, and 1.99% (n = 8) asked for endoscopic balloon extraction because of intolerance. The complication rate was 6.46% (n = 26). Readmission index was 4.97% (n = 20), and reintervention was 2.23% (n = 9). Balloon elimination was experienced by 5.7% of patients in the first 14 days, 29.10% (n = 117) before the third month, and 62.68% (n = 252) after the 16th week. Early deflation rate was 2.73% (n = 11). Digestive track elimination was perceived by 26.61%. Conclusions: AGB is a safe and effective option for the treatment of overweight and obesity in Latin America. Lifestyle changes and continuous support with a multidisciplinary team are essential to achieving good mid- to long-term outcomes.

Objective: To identify the safest and most effective knot-tying sequences for cruroplasty after gastric sleeve surgery, aiming to reduce recurrence risk. Materials and Methods: A total of 38 knot-tying sequences were tested using a dynamometer and nonabsorbable sutures. These were divided into four groups: Silk 0 (8 sequences), Silk 2/0 (12), Nylon 1 (12), and Polypropylene 2/0 (14). Each sequence was randomly selected and evaluated based on the average tensile strength of 10 tied knots. Results: For Silk 2/0, the strongest sequences were H3H2a (46.39 N) and H2H1aH1aH1aH1a (45.89 N); the weakest were SSbSb (22.28 N) and SSbSbSb (24.18 N). For Silk 0, H3H2a (72.44 N) and H3H2s (70.48 N) were most resistant, while H1H1sH1sH1sH1s (56.6 N) had the lowest strength. With Nylon 1, H2H1sH1sH1sH1sH1s and H2H1aH1aH1aH1aH1aH1a had the highest strengths; SSbSbSb (29.38 N) was weakest. Polypropylene 2/0 sequences showed consistent strength, with H2H1aH1aH1aH1a (48.91 N) being the strongest. Conclusions: For Silks 0 and 2/0, at least three half-knots (H1H1H1) are recommended. Starting with a double knot (H2) offers no added benefit. Slip knots should include a minimum of five throws. For Nylon 1, six-throw sequences are optimal; fewer than four throws are not recommended. Polypropylene 2/0 showed uniform performance across sequences. Knot symmetry did not significantly affect strength in any group. All recommended sequences exceed the 43 N threshold needed to prevent cruroplasty dehiscence under normal intra-abdominal pressures.

Background: Obesity is a multifactorial disease that has had an increase in its prevalence. Its treatment requires a multidisciplinary team to prepare the patient for bariatric surgery. But not all patients are willing to undergo a surgical procedure. Other options to surgery were developed, such as the swallowable gastric balloon, a novel device that allows weight loss (WL) due to a restrictive function without anesthesia, endoscopy, or surgery and is completely ambulatory. Methods: A descriptive, retrospective, and observational study was presented. A total of 497 obese patients of both sexes, who underwent placement of a swallowable gastric balloon for WL, were included. The study was conducted at a single center between January 2020 and January 2024. Results: A total of 515 balloons were placed (497 patients). 71% were women. The mean age was 39 years. The mean body mass index was 31.7. The mean WL was 14.3%, with weight maintenance at 12 months in 86% of patients. A 100% success rate was obtained in its implantation. The adverse effects described were nausea and vomiting (22.9%), abdominal pain (33%), reflux (52%), headache (12%), and asthenia (24%). Complications reported included intolerance in 1.1%, hyperinflation in 0.3%, catheter breakage upon removal in 0.3%, and dehydration in 0.5%. No procedure-related mortality was reported. Conclusions: Swallowable gastric balloon is an excellent option for patients with overweight or grade I and II obesity.

Purpose: Esophageal squamous cell carcinoma (ESCC) located at the cervicothoracic junction (CTJ-ESCC), approximately 18-21 cm from the incisors, poses unique surgical difficulties given its proximity to the trachea and recurrent laryngeal nerves. This investigation evaluated a new approach that avoids cervical incisions by combining the EGIARADMT™ curvilinear stapling method with OrVil™-based three-dimensional suspension anastomosis (TriSAS) to achieve R0 resection. Methods: A retrospective analysis was performed on 11 consecutive cases of CTJ-ESCC treated between February 2019 and March 2024, with follow-up data available until February 2025. Results: All patients underwent R0 resection without cervical incisions, achieving a proximal margin of 1-4 cm. The median operative time was 350 minutes (range: 275-605) with a blood loss of 100 mL (range: 20-700). Lymphadenectomy resulted in a median of 21 nodes (range: 9-38) being retrieved. The median duration of hospitalization was 49 days (range: 42-67). There were no occurrences of anastomotic leaks, strictures, or recurrent laryngeal nerve injuries. Transient gastric stasis was observed in 18.2% of cases and resolved with conservative management. One postoperative mortality was attributed to pulmonary infection. The median overall and disease-free survival were 25 months. Conclusion: Integrating EGIARADMT curvilinear stapling with OrVil-TriSAS anastomosis enables cervical incision-free R0 resection for CTJ-ESCC, achieving precise oncologic control with functional preservation. Adjuvant therapy may further improve survival despite clear margins.

Background: Near-infrared spectroscopy (NIRS) has been developed to monitor cerebral oxygenation. Various studies have investigated its utility in measuring somatic tissue oxygenation and in noncardiac surgeries. Aims: The aim of this study was to determine the effect of pneumoperitoneum on the abdominal wall. Study Design: A prospective, case-control study. Methods: This study included 70 patients who had elective laparoscopic cholecystectomy. A regional oximetry sensor was placed on the anterior abdominal wall in all patients. Primary outcome measures included preoperative regional tissue saturation (rSO₂) values. For secondary outcome measures, we recorded visual analogue scale (VAS) scores and tramadol usage at postoperative hours 2, 6, 12, and 24: intraoperative end-tidal CO₂ values; peripheral oxygen saturation (spo2); and abdominal subcutaneous fat tissue thickness. Results: The initial rSO₂ value (T1: 75.6 ± 6.64) was significantly higher than those measured at the predetermined time intervals during pneumoperitoneum (T4: 73.4 ± 6.3, T5: 68 ± 8.9, T6: 68 ± 8.9, T7: 66.6 ± 9.4, T8: 65.81 ± 10.2, T9: 65.6 ± 8.8) (P < .05). The mean change in rSO₂ between preoperative measurements (T1) and mid-pneumoperitoneum measurements (T8) was -12.9 ± 11%. This change was found to be negatively correlated with postoperative VAS scores and 24-hour tramadol consumption amounts. Conclusion: The results of the present study show that changes in abdominal wall tissue oxygenation during pneumoperitoneum can be measured with NIRS.

Background: The prevalence of metabolic disorders and obesity is increasing worldwide. The underlying pathogenetic mechanisms include an imbalance of the autonomic nervous system secondary to a relative decrease of the parasympathetic vagal tone or increase of the sympathetic tone. Previous clinical experience with a surgically implanted gastric pacemaker for morbid obesity showed that augmenting the vagal tone effects satiety and weight control. The aim of this study was to assess the feasibility of endoscopic implantation of a brain-neuromodulator (BNM) within the proximal gastric wall. Methods: Experimental study testing the prototype of an original, self-powered BNM implanted in pigs through upper gastrointestinal endoscopy. The miniaturized electronic device, designed to deploy depolarization signals through the afferent fibers of the vagus nerve, was placed submucosally at the level of the proximal lesser gastric curve. The feasibility, biocompatibility, and biosafety of the procedure were evaluated radiologically, endoscopically, and at the time of the explant. Heart rate variability (HRV) was assessed at baseline and during and after the procedure to measure changes in the vagal tone. Results: The procedure was uncomplicated, and the BNM remained in a stable position at the level of the lesser gastric curve without notable side effects or device displacement as assessed radiologically and endoscopically. Compared to baseline measurements, post-procedural HRV consistently increased, confirming that signaling through the afferent vagal pathway has the potential to increase parasympathetic tone. Autopsy showed that the device was in the original position, embedded in the gastric wall and without any sign of transmural ulceration. Conclusions: This feasibility study shows that a miniaturized battery-free and catheter-free BNM can be placed endoscopically in the submucosal layer of the lesser gastric curve. The device was well-tolerated, biocompatible, and safe. Rigorous validation of the physiological endpoints and optimization of the stimulation parameters are necessary for future clinical application of BNM.