Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Background/Objectives: Advancements in surgical stapling devices play a crucial role in improving outcomes for bariatric procedures. This study evaluates the performance and safety of a new endoscopic stapler (EnDrive® Beluga^TM) regarding perioperative results across multiple bariatric surgery types. Methods: A retrospective analysis was conducted on 112 patients who underwent bariatric procedures using the Beluga stapler at two centers in the United Arab Emirates and Kenya over a 6-month period (June-December 2023). Procedures included laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB), and revisions. Perioperative outcomes, complications, and hemoglobin changes were assessed. Results: The cohort included 29 males and 83 females, with a mean age of 32.8 years and preoperative body mass index of 41.1 kg/m². Procedures performed were 88 primary LSG, 3 primary LRYGB, 12 primary OAGB-MGB, and 9 revision surgeries. No conversions, deaths, bleeding, or leaks occurred. Minor complications were observed in 4 patients. One patient required reoperation for intestinal obstruction. The mean hospital stay was 1.5 days. Hemoglobin levels showed minimal change from preoperative (12.8 g/dL) to postoperative day 1 (12.3 g/dL). Conclusions: The new Beluga endoscopic stapler demonstrated safe and effective performance across various bariatric procedures through this retrospective study, with low complication rates and minimal blood loss. Its enhanced articulation capabilities may offer advantages in specific cases. Further studies with larger groups, control groups, and longer follow-up periods are warranted to compare long-term outcomes with established stapling devices.

Background: A primary pull-through for Hirschsprung's disease (HD) requires confirmation of normal ganglionic bowel by intraoperative biopsies to determine the level of resection. Despite this, aganglionic bowel that is not fully resected (so-called "transition zone pull-throughs") is reported in 15%-19% of patients. We hypothesize that this may result from insufficient biopsies sent for intraoperative diagnosis. Methods: A new biopsy protocol has been developed in our institution for patients undergoing a laparoscopic-assisted endorectal pull-through for HD. Laparoscopic seromuscular biopsies are taken as per standard practice and are reported intraoperatively to identify the most distal site of ganglionic bowel. A 5 mm laparoscopic stapling device is used to divide the bowel at the proposed proximal resection margin and 2 cm distally. If there is any evidence of abnormality in the first doughnut, a second, more proximal doughnut is taken. Results: Between 2015 and 2020, 21 patients underwent a primary laparoscopic endorectal pull-through for HD using the doughnut biopsy protocol. Sixteen patients were male. The mean patient age at the time of surgery was 3 months (range 1-6 months), and the mean weight at the time of surgery was 6.5 kg (range 4.1-8.54 kg). In all 21 cases, initial laparoscopic biopsies were reported showing normal ganglionic bowel; in two cases (10%), the laparoscopic doughnut influenced the proximal resection margin. In both cases, aganglionic tissue was identified intraoperatively in the doughnuts, and a second, more proximal doughnut was sent. No patients had transition zone resections on final histology (mean clear margin 45.55 mm, range 11-72 mm). Conclusions: In conclusion, intraoperative frozen sections taken from doughnuts of bowel retrieved using 5 mm laparoscopic stapling devices are safe and have resulted in a 0% rate of transition zone pull-throughs while reducing the potential of spillage of enteric contents. We would recommend this protocol for all patients undergoing primary endorectal pull-throughs.

Purpose: Surgery for choledochal cysts (CDC) in children younger than 6 months is relatively rare. We report our experience and compare the results between Da Vinci robot-assisted hepaticojejunostomy (RAHJ) and laparoscopic-assisted hepaticojejunostomy (LAHJ) in children younger than 6 months to treat CDC. Methods: A retrospective study was conducted on all children under 6 months of age who underwent RAHJ or LAHJ at the Children's Hospital, Zhejiang University School of Medicine, from July 2018 to November 2023. Results: We reviewed 34 patients who underwent RAHJ surgery and 50 patients who underwent LAHJ surgery (P = .243). RAHJ group of the median operation time was 182 minutes (range 161-221), and LAHJ group was 168 minutes (range 143-191) (P = .02). The RAHJ group had a significantly shorter median postoperative hospital stay of 9 days (range 7-10) than the LAHJ group, 11 days (range 10-14), p < .001. The median hospitalization cost in the RAHJ group was significantly higher than that in the LAHJ group (75,474 CNY versus 28,984 CNY, p < .01). The median follow-up time was 18 months in the RAHJ group and 48 months in the LAHJ group (p < .01). All patients in the RAHJ group recovered well and were discharged. One patient in the LAHJ group developed biliary fistula 21 days after surgery and recovered well after reoperation. Conclusions: For children under 6 months old, on the basis of no consideration of cost, RAHJ has fast postoperative recovery and fewer postoperative complications, which is more recommended.

Introduction: The traditional method of performing open common bile duct exploration (OCBDE) was replaced by a less invasive procedure known as laparoscopic common bile duct exploration (LCBDE) in elective surgery. But at present, the application of this technique is considered novel and controversial to treat acute cholangitis (AC). The aim of our systematic review was to investigate the safety and efficacy of laparoscopic surgery in patients with AC. Methods: Studies containing information on patients diagnosed with AC who underwent LCBDE were included. A search for relevant articles was carried out, in the Cochrane Library, PubMed, and Google Scholar databases. All studies included in the systematic review were assessed using the Newcastle-Ottawa Quality Assessment Scale. Results: A total of 10 studies were included. Seven were retrospective and three were prospective. Only one was a randomized controlled trial. There were three studies that compared elective LCBDE and emergency LCBDE. Two studies compared between primary closure and T-tube drainage. Two other studies focused on the comparison between LCBDE and OCBDE. One study examined the comparison of LCBDE and endoscopic retrograde cholangiopancreatography. Another study addressed the issue of conversion in LCBDE. One study compared early and delayed LCBDE. Conversion rates ranged from 0% to 16.92%. Morbidity ranged from 0% to 26.3%, and mortality ranged from 0% to 3.07%. There was no difference in terms of retained, residual, or recurrent stones, bile leak, hemorrhage, and postoperative pancreatitis, and this, comparing the different groups of patients. Bile duct and intestinal injuries as well as biliary stricture were not common. The average length of hospital stays was approximately 5.86 days, ranging from 2 to 11.12 days. Conclusion: The one-stage urgent LCBDE, while subject to debate, proves to be a secure, feasible, approach for managing nonsevere AC.

Background: Laparoscopic sleeve gastrectomy (SG) is a commonly performed bariatric procedure. At our institution, two vessel sealing devices, Thunderbeat^® (Olympus) and Maryland LigaSure™ (Covidien) are utilized for intraoperative dissection. Methods: A retrospective review of all patients who underwent primary SG from July 2013 through August 2022 was performed to evaluate postoperative bleeding (POB) rates between the two devices. The primary outcome measured was POB as defined by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), with secondary outcomes including reoperation, source of bleed, and overall safety. Results: A total of 8157 underwent SG. Average BMI and age were 43.2 kg/m² and 37.1 years, respectively. A total of 6600 (80.9%) were female. Thunderbeat^® was utilized in 5143 (63%) cases and Maryland LigaSure™ was used in 3014 (37%) cases. There was no significant difference in overall bleeding between the Thunderbeat^® (18/5143, .35%) and the Maryland LigaSure™ (19/3014, .63%; P = .0689). However, there was a difference noted when comparing reoperation for bleeding between Thunderbeat^® (9/5143, .17%) and Maryland LigaSure™ (13/3014, .43%; P = .0291). Furthermore, the location of bleeding in the reoperations was more common from the cut edge of the mesentery compared to the staple line with the Maryland LigaSure™ versus the Thunderbeat^® (P = .038). Conclusions: The Thunderbeat^® device is comparatively more hemostatic than the Maryland LigaSure™ for SG. The location of postoperative bleed may be related to vessel sealing devices used.

Background: Percutaneous cholecystostomy (PC) rates have substantially increased in England over the past two decades. However, its utilization and clinical outcomes at a local level are not well documented or understood. This study aimed to characterize the cohort of patients who underwent PC and resulting clinical outcomes at a tertiary center for hepatobiliary and emergency general surgery. Methods: This is a retrospective cohort study of patients treated between 2012 and 2020 at a single center. A subgroup analysis was conducted to compare outcomes between Tokyo grade 2 and Tokyo grade 3 patients. Results: In the 73-patient cohort, a 57.1% increase in PC was observed between 2012 and 2020. Compared to the gold-standard Tokyo guidelines, 36 patients (49.3%) met the criteria for PC. Postprocedural complications occurred in 50 patients (68.5%), including PC tube dysfunction (27.4%), intra-abdominal abscess (20.5%), external bile leak (8.2%), and biloma (5.5%). Recurrent biliary infection developed in 30 patients (41.1%). Twenty-seven patients (37%) underwent emergency reinterventions due to acute cholecystitis recurrence. Twenty patients (27.4%) required radiological reintervention. Seven patients (9.6%) required emergency cholecystectomy, and ten patients (13.7%) underwent an elective cholecystectomy. Overall, 36 patients (49.3%) died during the follow-up period. Five patients (6.8%) died during index admission. Subgroup analysis demonstrated a higher rate of complications in the Tokyo grade 3 subgroup of 82.8% vs. 59.1% (P = .04). Patients from this subgroup were also more likely to require emergency additional abscess drainage (17.2% vs. 2.3%, P = .034). There was no significant difference in the number of emergency cholecystectomies performed between groups. Patients from the Tokyo grade 2 subgroup were more likely to have an elective cholecystectomy in the future (20.5% vs. 3.4%, P = .044). Conclusions: PC was overperformed in our patient cohort, and was associated with high postprocedure morbidity and mortality. Clinicians should be discerning in patient selection criteria for PC.

Background: Appropriate surgical techniques for controlling bleeding and preserving residual liver function are key to the success of laparoscopic liver resection. This study aims to evaluate the application effect of intraoperative ultrasound in the Pringle maneuver of laparoscopic liver resection. Materials and Methods: Between January 2022 and June 2023, 100 patients underwent laparoscopic liver resection and were randomly allocated to receive application of intraoperative ultrasound for Pringle maneuver (intraoperative ultrasound group, n = 50) or conventional Pringle maneuver (conventional group, n = 50). Intraoperative blood loss, blood transfusion, operation time, hepatic portal block time, complications (bile leakage, hemorrhage, ascites, and posthepatectomy liver failure), and hospital stay were compared between groups, along with the alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TB) levels at postoperative days 1, 3, and 7. Results: The operation time, postoperative ALT, AST, and TB levels on postoperative days 1, 3, and 7, complications (bile leakage, hemorrhage, ascites, and posthepatectomy liver failures), and hospital stay were comparable between groups. Compared with the conventional group, the intraoperative ultrasound group had significantly less intraoperative blood loss (P = .015), lower blood transfusion rate (P = .035), and less hepatic portal block time (P = .012). Conclusions: Applying intraoperative ultrasound in laparoscopic liver resection for hepatic pedicle occlusion is a safe, simple, and effective method.

Background: Cholelithiasis and inguinal hernias are common surgical conditions that often coexist. Laparoscopic techniques are increasingly used for both cholecystectomy and inguinal hernia repair. This study aimed to systematically review the available evidence on the safety and efficacy of simultaneous laparoscopic cholecystectomy (LC) and laparoscopic inguinal hernia repair (LIHR). Methods: A systematic search of the PubMed/MEDLINE and Google Scholar databases was performed for articles published until March 2024 using specific keywords. Studies meeting predetermined inclusion and exclusion criteria were analyzed. Results: Ten studies comprising 199 patients were included in the review. The mean operative time for combined LC and LIHR ranged from 55 to 157 minutes, with an average hospital stay between 1 and 4 days. The overall complication rate was 22%, with seroma/hematoma formation (6.5%) being most common. There were no reported mortalities or cases of mesh infection. Discussion: This review suggested that simultaneous LC and LIHR is a safe and effective option for patients with both conditions. The combined procedure offers potential benefits such as reduced hospital stay, faster recovery, and cost savings. Although the optimal sequence of surgical procedures for LIHR and LC remains debatable, the risk of mesh infection appears to be minimal.

Background: Laparoscopic procedure for rectal prolapse has extend throughout the world as a minimally invasive treatment. Various techniques have been reported regarding the use of mesh, fixation, and rectal mobilization. However, a standard technique has not been established yet. Method: The original procedure of laparoscopic ventral mesh rectopexy was modified as described below. The posterior rectal cavity was dissected in proximity to the levator ani, and the lateral ligament was partially divided. After mobilization of the rectum, trimmed polypropylene mesh was placed on the ventral side of the upper rectum and fixed. The mesh was fixed in a semi-spiral shape along the long axis of the intestinal tract. Results: Fifteen patients underwent this procedure. The length of rectal prolapse were 5 (4-30) cm. The grade of rectal prolapse according to the Oxford Grading System was V in all patients. The median operative time and blood loss were 176 (range: 100-252) minutes and 0 (0-43) mL, respectively. No postoperative complications were observed in any of the patients. One patient experienced recurrence (6.7%). The remaining 14 patients did not experience recurrence during the follow-up period, which had a median of 54.5 months (range: 6-119 months). Conclusion: This modified laparoscopic semi-spiral mesh rectopexy may be considered for the surgical treatment of rectal prolapse.

Background: Laparoscopic cholecystectomy is one of the most common surgical procedures. Several techniques of ligating the cystic duct have been compared in randomized trials, but data on comparative effectiveness are missing. Our aim was to systematically review the literature and, if appropriate, synthesize the available evidence. Methods: A systematic search of PubMed, Scopus, Ovid, and Cochrane Library was conducted to identify randomized studies comparing different ligation techniques of the cystic duct in laparoscopic cholecystectomy. Network meta-analysis synthesized evidence from all available techniques. Techniques compared were metal (MC), absorbable (AC), or polymer clips (PC), suture ligation (SL), and ultrasonic shears (US). Results: Twenty-three randomized studies with 2851 patients were included in our study. A well-connected network was formed for bile leak and a star-shaped network for operative time, with MC as the common comparator. No difference was found when SL, AC, US, or PC were compared for bile leak. Operative time was statistically significantly reduced when US were compared to MC (mean difference [MD] = -14.32 [-19.37, -9.28]), SL MD = -20.16 (-10.84, -29.47), and AC MD = -18.32 (-1.25, -35.39). The remaining techniques had similar operative times. PC had the highest probability of being the best technique P = 41.8, and SL had the highest probability P = 46.1 of being the second best for bile leak. US had a 98.1% chance of being the best technique for operative time. Conclusions: Given that all techniques demonstrate similar efficacy, the decision should be based on cost, familiarity with the technique, and environmental factors.