Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Background: Laparoscopic sleeve gastrectomy (LSG) is an effective surgical intervention for obesity, but managing complications post LSG remains crucial. Given the global prevalence of obesity, innovative approaches are needed to improve patient outcomes. Objective: This scoping review aimed to comprehensively map the existing literature on innovative approaches for managing complications in adult patients undergoing LSG to treat morbid obesity. This management strategy may include surgical techniques, perioperative care, nutritional support, or other relevant strategies. Methods: A systematic search of PubMed and Scopus databases was conducted to identify relevant studies. The prespecified inclusion criteria were applied through a two-stage screening process. Studies involving adult patients who underwent LSG for morbid obesity (body mass index > 35) and those investigating interventions related to complications were included. The scoping review process adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The results were summarized using a narrative approach. Results: This review included 31 studies with 4547 participants, showing diverse study designs, patient demographics, and surgical locations. Among them, 6 were case reports, 18 were randomized controlled trials, and 7 were retrospective studies. Complications of LSG include staple-line leaks, stenosis, hemorrhage, infection, gastric volvulus, and nutrient malabsorption. Innovative interventions, such as staple-line reinforcement, plication methods, and the Over-the-Scope Clip system, have been investigated for effective management. Conclusion: This scoping review provides valuable insights into innovative interventions for managing complications post LSG. This review highlights the need for further research to explore long-term outcomes, compare different interventions, and address the existing gaps in the literature.

Objective: To assess both the clinical effectiveness and practical experience of utilizing laparoscopic methods for addressing direct inguinal hernia in the pediatric population. Method: The study collected clinical data from 10 pediatric patients with direct inguinal hernia treated at the Children's Hospital of Anhui Province from July 2014 to July 2023. Among them, there were 8 males and 2 females, with an average age of 43.4 ± 22.0 months. All were initially diagnosed with indirect inguinal hernia before surgery. During the laparoscopic procedures, direct hernia was confirmed. Two cases had undergone open hernial sac high ligation surgery due to misdiagnosis as indirect hernia, resulting in recurrent groin bulges postoperatively. For these cases, laparoscopic direct hernia neck ligation with reinforcement and repair using the inner side of the umbilical ligament was performed. Results: All 10 cases of pediatric patients underwent surgeries smoothly without any need for open conversion. The average surgical duration was 29.8 ± 15.0 minutes, with minimal intraoperative bleeding. Patients were discharged on the first day postoperatively, and no significant surgery-related complications were observed. During the 12-month follow-up period, it was noted that the scar at the umbilical ring was superficial and inconspicuous. There were no occurrences of hernia recurrence, testicular retraction, or atrophy. Conclusion: Laparoscopic treatment for pediatric direct inguinal hernia has demonstrated favorable therapeutic outcomes, ensuring a safe surgical process, rapid recovery, and a low postoperative recurrence rate. The laparoscopic approach, specifically utilizing direct hernia neck ligation with reinforcement and repair using the inner side of the umbilical ligament, proves to be a secure and effective treatment for pediatric direct inguinal hernia. It can be considered as a conventional treatment method.

Background: The concept of preoperative prehabilitation has garnered attention as a means to manage the comorbidities of patients undergoing ventral hernia repair (VHR). In this regard, some comorbidities have been studied as potential risk factors for postoperative complications following VHR, such as diabetes, immunosuppression, and smoking. However, evidence regarding the impact of sarcopenia, defined by reduced muscle mass and highly associated with frailty syndrome, remains a gap. We aimed to perform a systematic review and meta-analysis analyzing the impact of sarcopenia on VHR outcomes. Methods: Cochrane Central, Embase, PubMed, MEDLINE, and Web of Science were searched for studies analyzing the impact of sarcopenia on VHR from inception until April 2024. Outcomes assessed were recurrence, surgical site occurrences (SSO), surgical site infection (SSI), and hospital length of stay (LOS). Data analysis was done using RStudio 4.1.2 Software. Results: The initial search yielded 263 results, of which 172 were screened after the exclusion of the duplicates. The full-text review was done for eight studies, of which three were included after applying the eligibility criteria. Our sample comprised 275 patients, of which 79 (28,7%) presented with sarcopenia. All included studies used radiological muscle findings to define sarcopenia. Our analysis showed no differences in recurrence rates between patients with sarcopenia and controls (risk ratios [RR]: 1.24; 95% confidence interval [CI]: 0.79-1.94; P = .35). Furthermore, no differences were found in SSI (RR: 0.7; 95% CI: 0.39-1.25.; P = .23). Interestingly, a higher SSO rate was noted for patients without sarcopenia (95% CI: 0.35-0.96; P = .04). No differences were found in LOS (mean difference 4.7 hours; 95% CI: -0.67 to 10.1; P = .4). Conclusion: Our analysis showed no differences were found in recurrence, SSI, and LOS following VHR in patients with sarcopenia. Furthermore, there was a reduced SSO for patients with sarcopenia.

Background: The incidence of multiple magnetic foreign body (MMFB) ingestion in children is rising, which poses a serious risk for gastrointestinal tract injury. In the current study, the clinical characteristics were analyzed to enhance awareness among parents and caregivers, treatment experiences were summarized and discussed, and optimal treatment plans were identified. Methods: A retrospective analysis was performed on 130 pediatric patients with MMFB ingestion at the Children's Hospital Affiliated with Zhejiang University School of Medicine, between June 2016 and June 2023. The clinical data, treatment details, and patient prognosis were systematically collected. Results: Forty-one patients were managed conservatively, while 89 patients underwent open surgery. Among the 44 patients who were treated with laparoscopic surgery, conversion to laparotomy was necessary in 28. The risk of gastrointestinal perforation was higher in symptomatic children than in asymptomatic children (chi-square value: 37.156; P < .001). Perforations were mainly observed in the small intestine. The median length of hospital stay was 10 days in the cohort of 16 children who underwent laparoscopic surgery successfully, which differed from the group of 28 children who were converted to a laparotomy (10 days [interquartile range, or IQR: 9-12.75 days] versus 12 days [IQR: 10-15.75 days]; P < .05). Conclusions: The ingestion of MMFBs in children can lead to severe injuries, underscoring the importance of early detection and treatment. Tailored clinical management strategies should be implemented based on individual conditions, while prompt and effective interventions can minimize harm. Therefore, we propose a comprehensive framework for individualized treatment processes.

Introduction: In the field of abdominal wall hernias, several innovative procedures have been developed, including the extended/enhanced-view totally extraperitoneal (eTEP) hernia repair technique. Initially introduced for laparoscopic hernia repair by J. Daes, it was subsequently applied to ventral hernia repair (VHR) and incisional hernia repair (IVHR) by I. Belyansky et al. This article presents the midterm experience and outcomes of our center's experience with the endoscopic technique based on the principles of eTEP during IVHR and VHR. Method: A review was conducted of a prospectively collected database of abdominal wall hernia. Patients who underwent eTEP VHR or IVHR between October 2018 and February 2021 were identified. Results: A total of 51 patients underwent an eTEP-RS or eTEP-TAR procedure, with a 24-month follow-up period. Of the 51 patients included in the study, 43 underwent eTEP-RS treatment, while 8 required an additional transversus abdominis release (3 unilaterally). One patient developed a large hematoma necessitating reoperation and drainage via the eTEP approach. Seven patients developed seromas, which were treated conservatively, while 2 patients experienced surgical site infections, which were managed with a single-use negative pressure wound therapy system. Two patients exhibited recurrence at sites above the epigastric edge of the mesh. Conclusion: Moreover, the advancement of minimally invasive surgical techniques for abdominal wall reconstruction has rendered the eTEP approach a viable option for both primary and incisional VHR, with promising midterm outcomes.

Objective: To compare the clinical outcomes between total transanal endorectal pull-through (TTEPT) and laparoscopic-assisted transanal endorectal pull-through (LTEPT) in children with rectosigmoid Hirschsprung's disease. Methods: A retrospective study was conducted to compare patients with rectosigmoid Hirschsprung's disease who underwent TTEPT or LTEPT at Beijing Children's Hospital between January 2016 and June 2021. Clinical details were collected from medical records. Patients' parents completed the Krickenbeck questionnaire to evaluate the long-term bowel function (age >4 years) by telephone. A literature search was conducted by using the National Center for Biotechnology Information (NCBI) PubMed database. We combined data from our data with eligible articles and performed a meta-analysis. Result: From our data, there was no difference in the incidence of postoperative complications or long-term bowel function between the patients undergoing TTEPT and LTEPT. A meta-analysis, including five published articles and our data, was performed with a total of 414 patients (n = 236 with TTEPT and n = 178 with LTEPT). For postoperative complications, there were no significant differences between TTEPT and LTEPT for the incidence of HAEC (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.45-1.80; P = .77) or anastomotic leak (OR, 2.52; 95% CI, 0.40-15.80; P = .32). Regarding bowel function outcomes, the incidence of soiling (OR, 1.77; 95% CI, 0.84-3.71; P = .13) and constipation (OR, 1.20; 95% CI, 0.54-2.64; P = .66) were also similar for the two approaches. Conclusion: There was no significant difference in postoperative complications and bowel functional outcomes in patients with rectosigmoid HD undergoing TTEPT or LTEPT. Levels of Evidence: III.

Background: With the rising demand for minimally invasive and cosmetically appealing surgeries, transumbilical single-incision laparoscopic cholecystectomy (SILC) has been increasingly adopted, albeit in a limited number of medical centers. Our team has successfully executed transumbilical SILC for benign gallbladder diseases. This study retrospectively analyzed and compared the efficacy of transumbilical SILC with that of conventional laparoscopic cholecystectomy (CLC). Methods: We analyzed data from 358 cases of laparoscopic cholecystectomy performed at Shanghai East Hospital of Tongji University between January 2021 and October 2023. Of these, 186 cases underwent SILC (observation group), while 172 cases underwent CLC (control group). We compared patient demographics, perioperative outcomes, and satisfaction with incision scars. Primary outcomes included surgical efficacy and safety, whereas secondary outcomes encompassed postoperative hospitalization duration, pain levels, hospital costs, and scar satisfaction. Results: No significant differences were observed in patient demographics between the two groups. Both the SILC and CLC groups exhibited similar operative times (39.56 ± 14.55 minutes versus 41.82 ± 16.13 minutes, P = .164) and intraoperative blood loss (11.34 ± 3.90 mL versus 11.28 ± 3.87 mL, P = .885). The single-incision approach led to earlier postoperative bowel function recovery (22.03 ± 3.60 hours versus 24.17 ± 3.22 hours, P < .01), lower 24-hour postoperative pain scores (2.06 ± 0.84 versus 2.35 ± 0.72, P < .01), shorter postoperative hospital stays (2.88 ± 0.86 days versus 3.33 ± 0.96 days, P < .01), comparable hospitalization costs (3411.67 ± 790.86$ versus 3494.50 ± 558.76$, P = .257), and better Scar Cosmesis Assessment and Rating scores (1.78 ± 0.70 versus 2.17 ± 0.89, P < .01). Patient satisfaction was higher with the single-incision technique (8.52 ± 0.79 versus 7.80 ± 0.75, P < .01). Both groups experienced one case of incision infection (SILC 0.54%, CLC 0.58%), and there was one case of postoperative bile leakage in the CLC group (0.58%). However, the difference in complications was not statistically significant (P > .05). Conclusion: Transumbilical SILC demonstrates safe and effective near-term efficacy, offering benefits such as reduced postoperative pain and improved cosmetic outcomes, which support its clinical adoption.

Introduction: To assess the medium-term weight loss and maintenance of lean body mass (ideal weight/weight loss maintenance) following the Roux-en-Y gastric bypass (RYGB) surgical procedure with or without the use of a rigid gastric ring. Method: An observational cohort study with a retrospective approach was conducted to evaluate the effectiveness of RYGB with and without a band in patients with morbid obesity. The outcomes were assessed by analyzing data obtained from medical records, including pre- and postoperative data. Results: A total of 239 patients who underwent surgery between 2001 and 2018 were included, with 150 undergoing RYGB without a ring and 89 using a ring. The group subjected to the intervention with a rigid ring showed a significantly higher average body mass index loss than the ringless group (coefficient -2.45; 95% confidence interval [CI]: [-3.92 to -0.97], P < .001) at 1 year. After a follow-up period of 5 years, the use of a gastric ring was still associated with significant improvement in weight loss, even after multivariate adjustment (coefficient 6.62, 95% CI: [+ 4.30 ± 8.95], P < .001). Less than 5% of patients needed gastric band removal during the follow-up period. Conclusion: In this retrospective cohort of 239 patients, using a ring in RYGB was associated with a significant increase in weight loss and maintenance of lean body mass.

Background: In laparoscopic surgery, a 30° lens is frequently used to obtain a wider field of view. However, it is difficult for inexperienced surgeons to maintain the horizontal state of the image in laparoscopic camera navigation (LCN). If there is a great deviation in the camera's horizontal axis, it may result in ambiguous anatomical recognition, which could impair patient safety. Scientific assessment of the degree of camera's horizontal axis deflection in camera holders with differing proficiencies is necessary for improving novice surgeons' fundamentals of laparoscopic surgery. This study aims to develop an evaluation and training system based on the deflection angle (refers to the change in the angle of the camera axis from its preset vertical position) and assess its potential value in the training and clinical application of laparoscopic surgery. Methods: A total of 15 postgraduates without laparoscopic surgery experience and 15 skilled senior attending physicians with an experience in more than 50 cases of laparoscopic surgery were recruited. The participants completed an LCN exercise. An inclinometer module was used to measure the camera's horizontal axis deflection angle and the difference in the deviation angle was compared between the two groups. Results: A deflection angle greater than ±15° was found in 57.98% and 31.76% of participants in the novice group and skilled group, respectively, whereas a deflection angle greater than ±30° was found in 18.4% and 7.58% of participants in the novice group and the skilled group, respectively. The thresholds (we designate 15°, 30°, 45°, and 60° as the checkpoints) for all angles were significantly different for the two groups. Conclusions: There was a significant difference in the technique of maintaining the camera's horizontal axis within an acceptable range between the novice and the skilled participants. Training that focuses on this deflection angle may be helpful for novice camera holders.