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Barbed Versus Conventional Sutures in Laparoscopic-Assisted Colorectal Surgery: A Systematic Review and Meta-Analysis. 腹腔镜辅助结直肠手术中的倒刺缝合与传统缝合:系统综述与元分析》。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-09 DOI: 10.1089/lap.2024.0324
Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Eric Pasqualotto, Caio Mendonça Magalhães, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga

Background: Minimally invasive surgery is the preferred method for treating colorectal disease. Laparoscopic suturing is complex, and barbed sutures (BS) can improve the process by eliminating the need for surgical knots and constant traction on the suture line. This study compares intraoperative and postoperative outcomes in patients undergoing laparoscopic-assisted colorectal surgery (LCS) with anastomosis using BS and conventional sutures (CS). Methods: PubMed, Scopus and Cochrane Library were systematically searched for studies comparing BS to CS in patients undergoing LCS. Continuous outcomes were compared using mean differences (MDs), and odds ratios (ORs) were computed for binary endpoints with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.2.3. Results: A total of four studies comprising 285 patients were included, of whom 143 patients (50.17%) underwent BS. Compared with CS, BS significantly reduced the total operative time (MD -16.25 minutes; 95% CI: -25.94, -6.56; P < .01; I2 = 0%). However, there were no significant differences between groups in the occurrence of intraoperative complications (OR .74; 95% CI: .26-2.12; P = .58; I2=0%), anastomotic leakage (OR 1.00; 95% CI: .14-7.26; P = 1.00), and Clavien-Dindo ≥III complications (OR 1.80; 95% CI: .41-7.95; P = .44, I2 = 0%). Conclusion: In this meta-analysis, BS significantly reduced the operative time in the anastomotic closure compared to CS in LCS. Furthermore, there were no significant differences between the groups in anastomotic leakage, intraoperative complications, and severe postoperative complications.

背景:微创手术是治疗结直肠疾病的首选方法。腹腔镜缝合是复杂的,而倒钩缝合(BS)可以通过消除手术结和对缝合线的持续牵引来改善这一过程。本研究比较了腹腔镜辅助结直肠手术(LCS)与BS缝合和常规缝合(CS)吻合患者的术中和术后结果。方法:系统检索PubMed、Scopus和Cochrane图书馆中比较LCS患者BS与CS的研究。使用平均差异(md)比较连续结果,并计算具有95%置信区间(ci)的二元终点的优势比(ORs)。采用I2统计量评估异质性。采用R软件4.2.3进行统计分析。结果:共纳入4项研究,共285例患者,其中143例(50.17%)患者接受了BS。与CS相比,BS显著缩短了总手术时间(MD -16.25 min;95% ci: -25.94, -6.56;P < 0.01;I2 = 0%)。但术中并发症发生率组间比较差异无统计学意义(OR .74;95% ci: 0.26 -2.12;P = .58;I2=0%),吻合口漏(OR 1.00;95% ci: 0.14 -7.26;P = 1.00), Clavien-Dindo≥III并发症(OR 1.80;95% ci: 0.41 -7.95;P = 0.44, i2 = 0%)。结论:在本荟萃分析中,与LCS中的CS相比,BS明显减少了吻合口闭合的手术时间。两组间吻合口漏、术中并发症及术后严重并发症发生率无显著差异。
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引用次数: 0
Does Prior Lower Abdominal Surgery Prevent Laparoscopic Hernia Repair (Totally Extraperitoneal or Transabdominal Preperitoneal)? A Prospective Observational Study. 以前的下腹部手术是否会阻止腹腔镜疝修补术(完全腹膜外或经腹膜前)?前瞻性观察研究。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-09 DOI: 10.1089/lap.2024.0349
Nevin Sakoglu, Turgut Donmez

Objective: Totally extraperitoneal (TEP) surgeries were considered contraindicated in patients who underwent lower abdominal surgery until recently. However, in recent surgeries, it has been reported that they can be performed safely in those cases. Our aim in this study is to investigate the effectiveness of laparoscopic hernia repair methods in patients who have and have not had lower abdominal surgery before. Patients and Method: This study was a prospective observational study between May 2018 and May 2023. Two hundred eighty-eight patients were included in the study. The operation was started with the TEP technique in all patients. Patients, classified in two groups who had not previously undergone abdominal surgery (n = 216) (Group I) and who had surgery (n = 72) (Group II). Demographic characteristics of patients, intraoperative and postoperative complications were determined. In addition to descriptive statistical methods (mean, standard deviation), Shapiro-Wilk normality test, independent t test, and chi-square test were used to evaluate the data. Logistic regression analysis was performed to determine the factors affecting the presence of Previous Surgery and Peritoneal Tear. Results were evaluated at the significance level of P < .05. Results: Two hundred fifty-nine patients were operated with TEP method. TEP method was converted to transabdominal preperitoneal (TAPP) in 9 patients from Group I and 20 patients from Group II. Intraoperative and postoperative complications were recorded. Conclusion: With increasing experience in laparoscopic hernia surgery, it is now possible to perform hernia surgeries with preperitoneal (TEP) and abdominal approaches (TAPP) in patients who have previously undergone lower abdominal surgery.

目的:直到最近,完全腹膜外(TEP)手术一直被认为是下腹部手术患者的禁忌症。然而,在最近的手术中,有报道称在这些病例中可以安全地进行 TEP 手术。本研究的目的是探讨腹腔镜疝修补术在接受过和未接受过下腹部手术的患者中的有效性。患者和方法:本研究是一项前瞻性观察研究,时间为 2018 年 5 月至 2023 年 5 月。研究共纳入 288 名患者。所有患者均采用 TEP 技术开始手术。患者分为两组,之前未接受过腹部手术的患者(n = 216)(第一组)和接受过手术的患者(n = 72)(第二组)。确定了患者的人口统计学特征、术中和术后并发症。除描述性统计方法(均值、标准差)外,还使用了 Shapiro-Wilk 正态性检验、独立 t 检验和卡方检验来评估数据。为确定影响既往手术和腹膜撕裂的因素,进行了逻辑回归分析。结果以 P < .05 为显著性水平。结果259 名患者采用 TEP 法进行了手术。第一组的 9 名患者和第二组的 20 名患者将 TEP 法改为经腹腹膜前 (TAPP)。记录了术中和术后并发症。结论:随着腹腔镜疝气手术经验的不断增加,现在已经可以为之前接受过下腹部手术的患者实施腹膜前(TEP)和腹腔入路(TAPP)疝气手术。
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引用次数: 0
Identifying Responsible Factors for Poor Surgical Visibility in Pediatric Laparoscopic Fundoplication: A Retrospective Single-Center Study. 确定儿童腹腔镜下手术可视性差的主要因素:一项回顾性单中心研究。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-05 DOI: 10.1089/lap.2024.0254
Yohei Sanmoto, Yudai Goto, Kouji Masumoto

Background: Laparoscopic fundoplication is commonly performed in patients with neurological impairment. However, these patients often have spinal deformities that can complicate achieving a clear surgical view. This study aimed to identify factors associated with poor visibility in pediatric laparoscopic fundoplication. Methods: Operative videos, medical records, and radiographs of patients who underwent laparoscopic fundoplication between 2015 and 2023 were retrospectively reviewed. The videos were reviewed by two pediatric surgeons and classified into good or poor visibility groups. Age, sex, height, weight, history of abdominal surgery, lordosis, operative time, blood loss, and intraoperative complications were compared between the two groups. Lordosis was evaluated using the sagittal view of computed tomography images, and the anterior vertebral depth and abdominal thickness were measured to calculate the ratio. Results: Forty-one patients were included in this study. Based on the video review, the patients were classified into good (20 patients) and poor (21 patients) visibility groups. The median age, height, and weight were 6 years, 110 cm, and 16.1 kg, respectively. In the poor visibility group, 23.8% of patients had a history of abdominal surgery (P = .048). Additionally, the anterior vertebral depth to abdominal thickness ratios at the first and third lumbar vertebrae were significantly lower in the poor visibility group (P = .016 and P = .0018, respectively). There were no significant differences in the operative time, blood loss, or intraoperative complications between the two groups. Conclusions: Lordosis and a history of abdominal surgery may be risk factors for poor visibility in pediatric laparoscopic fundoplication.

背景:腹腔镜下颅底复制术常用于神经功能障碍患者。然而,这些患者通常有脊柱畸形,这使得获得清晰的手术视野变得复杂。本研究的目的是确定儿童腹腔镜手术中能见度低的相关因素。方法:回顾性分析2015 - 2023年腹腔镜下盆底复制术患者的手术录像、病历和x线片。这些视频由两名儿科外科医生审阅,并分为能见度好和能见度差两组。比较两组患者的年龄、性别、身高、体重、腹部手术史、前凸、手术时间、出血量及术中并发症。使用计算机断层图像矢状面评估前凸,并测量前椎体深度和腹部厚度以计算比值。结果:41例患者纳入本研究。根据视频回顾,将患者分为可视性好组(20例)和可视性差组(21例)。年龄、身高和体重的中位值分别为6岁、110 cm和16.1 kg。能见度低组23.8%的患者有腹部手术史(P = 0.048)。此外,可视性差组第一和第三腰椎前椎体深度与腹部厚度之比显著低于对照组(P = 0.016和P = 0.0018)。两组手术时间、出血量、术中并发症无显著差异。结论:前凸和腹部手术史可能是儿童腹腔镜下翻底术可视性差的危险因素。
{"title":"Identifying Responsible Factors for Poor Surgical Visibility in Pediatric Laparoscopic Fundoplication: A Retrospective Single-Center Study.","authors":"Yohei Sanmoto, Yudai Goto, Kouji Masumoto","doi":"10.1089/lap.2024.0254","DOIUrl":"https://doi.org/10.1089/lap.2024.0254","url":null,"abstract":"<p><p><b><i>Background:</i></b> Laparoscopic fundoplication is commonly performed in patients with neurological impairment. However, these patients often have spinal deformities that can complicate achieving a clear surgical view. This study aimed to identify factors associated with poor visibility in pediatric laparoscopic fundoplication. <b><i>Methods:</i></b> Operative videos, medical records, and radiographs of patients who underwent laparoscopic fundoplication between 2015 and 2023 were retrospectively reviewed. The videos were reviewed by two pediatric surgeons and classified into good or poor visibility groups. Age, sex, height, weight, history of abdominal surgery, lordosis, operative time, blood loss, and intraoperative complications were compared between the two groups. Lordosis was evaluated using the sagittal view of computed tomography images, and the anterior vertebral depth and abdominal thickness were measured to calculate the ratio. <b><i>Results:</i></b> Forty-one patients were included in this study. Based on the video review, the patients were classified into good (20 patients) and poor (21 patients) visibility groups. The median age, height, and weight were 6 years, 110 cm, and 16.1 kg, respectively. In the poor visibility group, 23.8% of patients had a history of abdominal surgery (<i>P</i> = .048). Additionally, the anterior vertebral depth to abdominal thickness ratios at the first and third lumbar vertebrae were significantly lower in the poor visibility group (<i>P</i> = .016 and <i>P</i> = .0018, respectively). There were no significant differences in the operative time, blood loss, or intraoperative complications between the two groups. <b><i>Conclusions:</i></b> Lordosis and a history of abdominal surgery may be risk factors for poor visibility in pediatric laparoscopic fundoplication.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Out-of-Hours Laparoscopic Appendectomy: A Risk Factor for Postoperative Complications in Acute Appendicitis? 非工作时间腹腔镜阑尾切除术:急性阑尾炎术后并发症的危险因素?
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-04 DOI: 10.1089/lap.2024.0268
Hanbaro Kim, Byung Mo Kang

Background: The surgical environment can influence the clinical outcomes of procedures and patient conditions. This retrospective study aimed to evaluate how surgical timing affects short-term outcomes in emergency laparoscopic appendectomy for acute appendicitis. Methods: A total of 647 patients with acute appendicitis who underwent emergency laparoscopic appendectomy at Chuncheon Sacred Heart Hospital between January 2018 and June 2021 were included in this study. The study cohort was divided into the following two groups based on the timing of surgery: work hours and out-of-hours (weekends, holidays, or weekday nights). Clinical outcomes were then compared between the groups. Results: Work-hour and out-of-hours appendectomies were performed in 282 and 365 patients, respectively. Baseline characteristics and types of appendicitis were similar between the groups (complicated appendicitis: 26.6% in the work-hours group versus 30.4% in the out-of-hours group, P = .288). Operation times were comparable (35.10 minutes versus 34.33 minutes, P = .620), with no cases requiring conversion to open appendectomy in either group. The overall rate of 30-day postoperative complications did not differ significantly between the groups (7.8% versus 10.4%, P = .849). The severity of postoperative complications, categorized by the modified Clavien-Dindo classification, did not show significant differences between the groups (P = .849). In addition, the time to functional recovery was similar in both groups. Conclusions: The clinical outcomes of out-of-hours laparoscopic appendectomy were similar to those of procedures performed during working hours. Therefore, scheduling emergency surgery can be determined based on the patient's condition and the hospital's capacity to manage acute appendicitis.

背景:手术环境可以影响手术的临床结果和患者的情况。本回顾性研究旨在评估手术时机如何影响急性阑尾炎急诊腹腔镜阑尾切除术的短期预后。方法:本研究纳入2018年1月至2021年6月在春川圣心医院行急诊腹腔镜阑尾切除术的急性阑尾炎患者647例。研究队列根据手术时间分为以下两组:工作时间和非工作时间(周末、节假日或工作日晚上)。然后比较两组之间的临床结果。结果:工作时间阑尾切除术282例,非工作时间阑尾切除术365例。两组之间阑尾炎的基线特征和类型相似(复杂阑尾炎:工作时间组26.6%,非工作时间组30.4%,P = 0.288)。手术时间具有可比性(35.10分钟vs 34.33分钟,P = 0.620),两组均无病例需要转行开腹阑尾切除术。两组术后30天并发症的总发生率无显著差异(7.8% vs 10.4%, P = 0.849)。术后并发症严重程度采用改良Clavien-Dindo分类,两组间无显著差异(P = .849)。此外,两组的功能恢复时间相似。结论:非工作时间腹腔镜阑尾切除术的临床效果与工作时间手术相似。因此,急诊手术的安排可以根据患者的病情和医院处理急性阑尾炎的能力来确定。
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引用次数: 0
Do Abdominoplasties in Patients with Prior Sleeve Gastrectomy Impact De Novo Gastroesophageal Reflux Disorder and the Need for Conversion to Roux-en-Y Gastric Bypass? 曾接受过袖状胃切除术的患者进行腹壁成形术会影响新发胃食管反流病和转为鲁克-全-Y 胃旁路术的需要吗?
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 Epub Date: 2024-10-30 DOI: 10.1089/lap.2024.0313
Robin Berk, Diego L Lima, Michelle Park, Joaquin Serra, Cristian Echeverri, Rebeca Dominguez-Profeta, Matthew Wynn, Diego Camacho

Introduction: The sleeve gastrectomy (SG) often requires conversion to Roux-en-Y gastric bypass (RYGB) due to gastroesophageal reflux disorder (GERD). Many postbariatric patients seek body-contouring surgery such as abdominoplasty to remove unwanted skin and fat. Although the number of abdominoplasties performed in postbariatric patients is increasing each year, the number of conversion surgeries is increasing in accordance. This study evaluates the impact of abdominoplasties in patients with prior SG on the development of GERD and the need for conversion to RYGB. Methods: A retrospective study was conducted with 630 patients who underwent conversions from SG to RYGB at our institution between January 2014 and December 2023. Outcomes were stratified for comparison between patients with GERD as an indication for conversion and patients with inadequate weight loss as an indication for conversion. Between the two groups we compared the number of patients with post-SG abdominoplasty and the number of hiatal hernias (HH) seen during conversion surgery. A logistic regression analysis was performed to identify factors independently associated with GERD. Results: There was a statistically significant higher number of abdominoplasties in patients who underwent conversion to RYGB for GERD (29 patients, 8.6%) compared to inadequate weight loss (12 patients, 4.1%), P value .034. However, these patients also had statistically significantly more HH (98 patients, 28.9%) compared to patients with inadequate weight loss as an indication for conversion (46 patients, 15.8%), P value <.001. In the logistic regression comparing these two variables, only the presence of HH seen during surgery was found to be a significant predictor of GERD (odds ratio 2.7, confidence interval 1.7-4.1, P < .001). Conclusion: Our data shows that abdominoplasty surgery does not directly influence the development of GERD in post-SG patients. However, the presence of HH in this population significantly impacts the development of GERD, often necessitating conversion to RYGB.

导言:袖带胃切除术(SG)通常因胃食管反流障碍(GERD)而需要转为 Roux-en-Y 胃旁路术(RYGB)。许多减肥后的患者会寻求腹部整形等塑身手术来去除多余的皮肤和脂肪。虽然为减肥后患者实施腹部整形手术的数量每年都在增加,但转换手术的数量也在相应增加。本研究评估了曾接受过 SG 的患者腹部整形手术对胃食管反流病的发生和转为 RYGB 的必要性的影响。方法:本研究对 2014 年 1 月至 2023 年 12 月期间在我院接受 SG 转 RYGB 手术的 630 名患者进行了回顾性研究。我们对以胃食管反流为转流指征的患者和以体重减轻不足为转流指征的患者的结果进行了分层比较。在两组患者中,我们比较了SG术后腹壁成形术患者的人数和转换手术中出现的食管裂孔疝(HH)的数量。我们进行了逻辑回归分析,以确定与胃食管反流病独立相关的因素。结果:与体重减轻不足(12 名患者,4.1%)相比,因胃食管反流而接受 RYGB 转换手术的患者(29 名患者,8.6%)进行腹壁整形手术的次数明显较多,P 值为 0.034。然而,这些患者的 HH(98 名患者,28.9%)也明显高于以体重减轻不足为转归指征的患者(46 名患者,15.8%),P 值 P <.001)。结论我们的数据显示,腹部整形手术不会直接影响 SG 术后患者胃食管反流病的发生。然而,该人群中存在的 HH 会显著影响胃食管反流病的发展,往往需要转为 RYGB。
{"title":"Do Abdominoplasties in Patients with Prior Sleeve Gastrectomy Impact De Novo Gastroesophageal Reflux Disorder and the Need for Conversion to Roux-en-Y Gastric Bypass?","authors":"Robin Berk, Diego L Lima, Michelle Park, Joaquin Serra, Cristian Echeverri, Rebeca Dominguez-Profeta, Matthew Wynn, Diego Camacho","doi":"10.1089/lap.2024.0313","DOIUrl":"10.1089/lap.2024.0313","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The sleeve gastrectomy (SG) often requires conversion to Roux-en-Y gastric bypass (RYGB) due to gastroesophageal reflux disorder (GERD). Many postbariatric patients seek body-contouring surgery such as abdominoplasty to remove unwanted skin and fat. Although the number of abdominoplasties performed in postbariatric patients is increasing each year, the number of conversion surgeries is increasing in accordance. This study evaluates the impact of abdominoplasties in patients with prior SG on the development of GERD and the need for conversion to RYGB. <b><i>Methods:</i></b> A retrospective study was conducted with 630 patients who underwent conversions from SG to RYGB at our institution between January 2014 and December 2023. Outcomes were stratified for comparison between patients with GERD as an indication for conversion and patients with inadequate weight loss as an indication for conversion. Between the two groups we compared the number of patients with post-SG abdominoplasty and the number of hiatal hernias (HH) seen during conversion surgery. A logistic regression analysis was performed to identify factors independently associated with GERD. <b><i>Results:</i></b> There was a statistically significant higher number of abdominoplasties in patients who underwent conversion to RYGB for GERD (29 patients, 8.6%) compared to inadequate weight loss (12 patients, 4.1%), <i>P</i> value .034. However, these patients also had statistically significantly more HH (98 patients, 28.9%) compared to patients with inadequate weight loss as an indication for conversion (46 patients, 15.8%), <i>P</i> value <.001. In the logistic regression comparing these two variables, only the presence of HH seen during surgery was found to be a significant predictor of GERD (odds ratio 2.7, confidence interval 1.7-4.1, <i>P</i> < .001). <b><i>Conclusion:</i></b> Our data shows that abdominoplasty surgery does not directly influence the development of GERD in post-SG patients. However, the presence of HH in this population significantly impacts the development of GERD, often necessitating conversion to RYGB.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"1094-1098"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prolonged Umbilical Port Insertion Time Increases the Incidence of Umbilical Surgical Site Infection in Laparoscopic Percutaneous Extraperitoneal Closure for Inguinal Hernia in Children. 儿童腹腔镜经皮腹膜外疝气闭合术中,脐孔插入时间延长会增加脐孔手术部位感染的发生率。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 Epub Date: 2024-10-17 DOI: 10.1089/lap.2024.0172
Shohei Yoshimura, Kengo Hattori, Emi Tsuji, Jiro Tsugawa, Eiji Nishijima

Introduction: Umbilical surgical site infection (U-SSI) is the most common complication of laparoscopic percutaneous extraperitoneal closure (LPEC) for the treatment of inguinal hernia in children. Prolonged operative time is known to increase the risk of SSI in general pediatric surgery; however, the association between prolonged operative time and post-LPEC U-SSI is unclear. The present study aimed to elucidate the association between umbilical port insertion time and the incidence of U-SSI. Materials and Methods: The present study included all patients <16 years of age who underwent LPEC for the treatment of inguinal hernia between June 2018 and May 2023 at our institution. Those who underwent umbilical hernia repair or other procedures were excluded. We retrospectively collected and analyzed the following: patient demographics; operative data; and U-SSI data. The cutoff value for the umbilical port insertion time was determined using receiver operating characteristic analysis, and the incidence of U-SSI was compared based on the cutoff value, determined to be 8 minutes. Results: A total of 232 patients (133 boys; mean age, 4.6 ± 3.3 years) were eligible for the present study, 7 (3.0%) of which developed superficial incisional post-LPEC U-SSI within a median of 7.5 [4-19] days. The incidence of U-SSI was 20.0% in the long (≥8 minutes) versus 2.3% in the short (<8 minutes) umbilical port insertion time group (P = .03). Conclusion: Prolonged umbilical port insertion time (≥8 minutes) increases the incidence of post-LPEC U-SSI during the treatment of inguinal hernia in children.

导言:脐部手术部位感染(U-SSI)是腹腔镜经皮腹膜外闭合术(LPEC)治疗儿童腹股沟疝最常见的并发症。众所周知,手术时间延长会增加普通儿科手术中发生 SSI 的风险;然而,手术时间延长与 LPEC 术后 U-SSI 之间的关系尚不清楚。本研究旨在阐明脐孔插入时间与 U-SSI 发生率之间的关系。材料和方法:本研究包括所有患者:共有 232 名患者(133 名男孩;平均年龄为 4.6 ± 3.3 岁)符合本研究的条件,其中 7 名患者(3.0%)在中位 7.5 [4-19] 天内发生了 LPEC 术后浅表切口 U-SSI。长时间(≥8 分钟)U-SSI 发生率为 20.0%,而短时间为 2.3%(P = 0.03)。结论:在治疗儿童腹股沟疝的过程中,延长脐孔插入时间(≥8 分钟)会增加 LPEC 术后 U-SSI 的发生率。
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引用次数: 0
Which is a Better Predictor for the Safety and Efficacy of Retrograde Intrarenal Surgery; Stone Size or Volume? A Study of RIRsearch Study Group. 结石大小和体积哪个更能预测逆行肾内手术的安全性和有效性?RIRsearch研究小组的一项研究。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 DOI: 10.1089/lap.2024.0145
Cenk Murat Yazıcı, Duygu Sıddıkoğlu, Oktay Özman, Önder Çınar, Hacı Murat Akgül, Hakan Çakır, Cem Başataç, Eyüp Burak Sancak, Hüseyin Ateş, Barbaros Başeskioğlu, Bülent Önal, Haluk Akpınar

Objective: To compare the predictive effects of stone size and volume on the efficacy and safety of retrograde intrarenal surgery (RIRS) and to determine the cutoff values of stone volume for prediction of RIRS efficacy and safety. Methods: Patients who underwent RIRS between 2017 and 2021 in six referral centers were retrospectively included in the study. The database of the RIRsearch group, which was formed prospectively, was used for this retrospective analysis. The surgical results and complications of RIRS were evaluated according to stone size and stone volume and compared between these groups. Results: A total of 1128 patients were included. Operation time, intraoperative complication rate, and postoperative complication rate increased significantly as stone size and stone volume increased (P < .05). Stone size and volume were significant indicators for stone-free rates, but pairwise comparison showed that stone volume was a significantly better predictor of surgical success compared with stone size (P < .001). Stone size was not sufficient to predict postoperative complications, whereas stone volume predicted these complications with low performance. Conclusions: Stone volume was a better predictor for surgical success than stone size, and it was as reliable as stone size in predicting postoperative complications.

目的比较结石大小和体积对逆行肾内手术(RIRS)疗效和安全性的预测作用,并确定预测 RIRS 疗效和安全性的结石体积临界值。方法研究回顾性纳入了2017年至2021年间在6个转诊中心接受RIRS的患者。本次回顾性分析使用了前瞻性成立的RIRsearch小组的数据库。根据结石大小和结石体积评估 RIRS 的手术效果和并发症,并在各组之间进行比较。结果共纳入 1128 例患者。随着结石大小和体积的增加,手术时间、术中并发症发生率和术后并发症发生率均显著增加(P < .05)。结石大小和结石体积是无结石率的重要指标,但配对比较显示,结石体积比结石大小更能预测手术成功率(P < .001)。结石大小不足以预测术后并发症,而结石体积预测并发症的能力较低。结论:结石体积比结石大小更能预测手术的成功率,在预测术后并发症方面,结石体积与结石大小一样可靠。
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引用次数: 0
A Data-Driven Approach to Inguinal Hernia Repairs in Infants and Children. 婴幼儿腹股沟疝气修补的数据驱动方法。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 Epub Date: 2024-10-14 DOI: 10.1089/lap.2024.0101
Zane J Hellmann, Matthew P Shaughnessy, Matthew A Hornick, Robert A Cowles, Daniel G Solomon

Introduction: Laparoscopic inguinal hernia repair has become increasingly popular in children. The laparoscopic technique inherently assesses the contralateral processus vaginalis, reducing the risk of metachronous contralateral hernias. We hypothesized that primary laparoscopic repair would be associated with lower rates of subsequent hernia repair in the youngest patients, in whom metachronous contralateral hernias are most common. Materials and Methods: The Pediatric Health Information System database was queried for patients 0-15 years old, who underwent inguinal hernia repair between 2016 and 2022. The primary outcome was the need for subsequent hernia repair. Current Procedural Terminology (CPT) and ICD-10 procedure codes were used to determine laparoscopic versus open repair. Patients were excluded if the only recorded code was for recurrent hernia or if both laparoscopic and open codes were present for the same procedure. Results: A total of 109,456 patients were included in the study, with 20,338 patients (18.58%), undergoing laparoscopic inguinal hernia repair initially, and 2535 patients (2.32%) requiring a second hernia repair. Patients 6 months old and younger undergoing unilateral laparoscopic repair were less likely to require subsequent surgery (OR 0.82, 95% CI = 0.69-0.96). Across all ages, open bilateral repair less often required subsequent repairs (OR 1.93, 95% CI: 1.48-2.51). Conclusion: Laparoscopic unilateral inguinal hernia repair decreases the need for subsequent surgical repair in infants 6 months and younger. No difference was detected in older patients. Open repair of bilateral hernias decreases the need for a second hernia operation in all age groups, suggesting that open repair is more durable.

简介腹腔镜腹股沟疝修补术在儿童中越来越受欢迎。腹腔镜技术本身可评估对侧阴道突,从而降低对侧疝的风险。我们假设,在年龄最小的患者中,初次腹腔镜修补术与较低的后续疝修补率相关,而在这些患者中,并发对侧疝最为常见。材料与方法:在儿科健康信息系统数据库中查询了2016年至2022年期间接受腹股沟疝修补术的0-15岁患者。主要结果是是否需要进行后续疝修补术。当前程序术语(CPT)和 ICD-10 程序代码用于确定腹腔镜修复术与开腹修复术。如果记录的唯一代码是复发性疝气,或同一手术既有腹腔镜代码又有开腹代码,则排除患者。结果:共有 109,456 名患者纳入研究,其中 20,338 名患者(18.58%)首次接受腹腔镜腹股沟疝修补术,2535 名患者(2.32%)需要进行第二次疝修补术。接受单侧腹腔镜修复术的 6 个月及以下患者需要再次手术的可能性较低(OR 0.82,95% CI = 0.69-0.96)。在所有年龄段中,接受开放式双侧修复术的患者较少需要进行二次修复(OR 1.93,95% CI 1.48-2.51)。结论腹腔镜单侧腹股沟疝修补术可减少 6 个月及以下婴儿后续手术修补的需求。年龄较大的患者没有发现差异。双侧疝气的开放式修补术可减少所有年龄组患者第二次疝气手术的需求,这表明开放式修补术更耐用。
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引用次数: 0
Learning Curve of Robotic-Assisted Low Anterior Resection for Low and Mid Rectal Cancer. 机器人辅助低位前切除术治疗中低位直肠癌的学习曲线。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 Epub Date: 2024-08-21 DOI: 10.1089/lap.2024.0221
Nir Horesh, Roi Anteby, Mai Shiber, Yaniv Zager, Marat Khaikin

Objective: The aim of our study was to assess the learning curve of robotic assisted low anterior resection with diverting loop ileostomy (LARDLI) for low and mid rectal cancer performed by novice in robotic-assisted surgery colorectal surgeon in a public hospital with limited access to the robotic platform. Methods: A retrospective analysis of all low and mid rectal cancer robotic-assisted operations was conducted. All procedures were performed by a single surgeon with a once per week access to the Da Vinci® Si™ Surgical System, Intuitive Surgical Inc. Demographic, clinical, and pathological data were reviewed. The cumulative sum (CUSUM) analysis was utilized to analyze learning curve for operative time. Results: A total of 107 consecutive patients who underwent LARDLI for lower and mid rectal cancer between November 2011 and July 2020 were included in the analysis. The median patients' age was 65 (range, 32-85) years, 72% were males (n = 77), and 91% (n = 97) received neoadjuvant therapy. Median operative time was 295.5 (range, 180-551) minutes. The conversion rate was 3.7% (n = 4). Median length of hospital stay was 6 (range, 1-41) days. There were 35 (32.7%) postoperative complications, of these 7 (6.5%) were major complications (≥Grade 3, according to the Clavien-Dindo classification). There was only one intraoperative complication (.9%). CUSUM analysis showed that the learning curve was 49 cases to achieve a plateau. Conclusions: The learning curve of robotic assisted low anterior resection for lower and mid rectal cancer for a novice in robotic surgery colorectal surgeon with limited access to the robotic platform is 49 cases. Surgeon and operative team dedication, alongside sufficient hospital support, may lower the number of cases of the learning curve.

研究目的我们的研究旨在评估机器人辅助低位前切除术(LARDLI)治疗中低位直肠癌的学习曲线,该手术由一家公立医院的机器人辅助手术新手结直肠外科医生完成,但其使用机器人平台的机会有限。方法:对所有中低位直肠癌机器人辅助手术进行回顾性分析。所有手术均由一名外科医生完成,该外科医生每周可使用一次 Intuitive Surgical 公司的达芬奇 Si™ 手术系统。对人口统计学、临床和病理学数据进行了审查。采用累积总和(CUSUM)分析法来分析手术时间的学习曲线。结果共有 107 名在 2011 年 11 月至 2020 年 7 月期间接受 LARDLI 手术治疗的中下部直肠癌患者纳入分析。患者的中位年龄为65岁(32-85岁),72%为男性(77人),91%(97人)接受了新辅助治疗。手术时间中位数为295.5分钟(180-551分钟)。转化率为3.7%(n = 4)。中位住院时间为6天(1-41天)。术后并发症有35例(32.7%),其中7例(6.5%)为主要并发症(根据克拉维恩-丁多分类法,≥3级)。术中并发症只有 1 例(0.9%)。CUSUM分析显示,学习曲线为49例达到高点。结论:对于机器人手术新手和机器人平台使用受限的结直肠外科医生来说,机器人辅助中下段直肠癌低位前切除术的学习曲线为49例。外科医生和手术团队的专注以及医院的充分支持可降低学习曲线的病例数。
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引用次数: 0
Early Versus Delayed Laparoscopic Cholecystectomy, after Percutaneous Gall Bladder Drainage, for Grade II Acute Cholecystitis TG18 in Patients with Concomitant Cardiopulmonary Disease. 对于合并心肺疾病的 II 级急性胆囊炎 TG18 患者,经皮胆囊引流术后早期腹腔镜胆囊切除术与延迟腹腔镜胆囊切除术的对比。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 Epub Date: 2024-09-05 DOI: 10.1089/lap.2024.0233
Mohamed Wael, Mostafa Seif, Mohamed Mourad, Hashem Altabbaa, Ibrahim Mabrouk Ibrahim, Mostafa Refaie Elkeleny

Background: The advancement in medical care has led to an increase in patients with acute cholecystitis (AC) and cardiopulmonary comorbidities referred for surgery. Grade II AC, according to Tokyo Guidelines in 2018 (TG18), is characterized by severe local inflammation with no systemic affection. The optimal treatment for patients with high-risk grade II AC has not yet been clearly established, which is still a dilemma. For these patients, laparoscopic cholecystectomy (LC), despite being the only definitive treatment, is still a challenge. The introduction of percutaneous cholecystostomy as a temporary minimally invasive alternative technique allows an immediate gallbladder decompression with a rapid clinical improvement. However, the next step after percutaneous transhepatic gall bladder drainage (PTGBD) in these high-risk patients is still a debate, with no definitive consensus about the ideal treatment of choice as well as its optimal timing. In our study, we followed a treatment algorithm for high-risk patients that involved early gallbladder decompression by PTGBD, followed by LC at different intervals once the patient is considered fit for surgery. Method: A retrospective study of 58 patients with high-risk grade II AC with cardiopulmonary comorbidity from our medical records was included. They were managed initially with PTGBD, an LC was then performed either within 7 days after drain insertion (early group, 26 patients), while an LC was performed later for the remaining patients within 6-8 weeks after PTGBD (late group, 32 patients). The results of the two groups were analyzed. Result: Procalcitonin and C-reactive protein were significantly higher in the late group. No significant difference was found between both groups with regard to operative time, PTGBD-related complications, and major perioperative complications. Timing after PTGBD did not affect the incidence of operative complications. Total hospital stay was significantly shorter in the early group. Conclusion: PTGBD is a safe initial intervention for high-risk patients with AC with a low morbidity and high success rate. Urgent LC after PTGBD can be performed safely for well-selected high-risk patients with the timing of surgery is personalized according to each patient's clinical situation. Early LC (after PTGBD) has the advantage of shorter hospital stay, low cost, as well as avoiding the risk of biliary complications and mortality if waiting a delayed surgery with no significant difference in morbidity compared with late LC.

背景:随着医疗水平的提高,急性胆囊炎(AC)和心肺合并症患者转诊手术的人数不断增加。根据《2018 年东京指南》(TG18),II 级 AC 的特点是局部炎症严重,但无全身感染。对于高风险的 II 级 AC 患者,最佳治疗方法尚未明确确立,这仍是一个难题。对这些患者而言,腹腔镜胆囊切除术(LC)尽管是唯一明确的治疗方法,但仍是一项挑战。经皮胆囊造口术作为一种临时的微创替代技术,可以立即进行胆囊减压,并迅速改善临床症状。然而,这些高危患者在接受经皮经肝胆囊引流术(PTGBD)后的下一步治疗仍存在争议,对于理想的首选治疗方法及其最佳时机仍未达成明确共识。在我们的研究中,我们采用了一种针对高危患者的治疗算法,即通过经皮经肝胆囊引流术(PTGBD)进行早期胆囊减压,然后在患者被认为适合手术后的不同时间段进行LC治疗。方法:我们对病历中 58 例合并心肺疾病的高危 II 级 AC 患者进行了回顾性研究。这些患者最初均接受 PTGBD 治疗,然后在插入引流管后 7 天内进行 LC(早期组,26 例患者),而其余患者则在 PTGBD 术后 6-8 周内进行 LC(晚期组,32 例患者)。对两组患者的结果进行了分析。结果晚期组患者的降钙素原和 C 反应蛋白明显升高。两组在手术时间、PTGBD 相关并发症和主要围手术期并发症方面无明显差异。PTGBD术后的时间并不影响手术并发症的发生率。早期组的总住院时间明显较短。结论:PTGBD是针对高危AC患者的一种安全的初始干预措施,发病率低,成功率高。对于经过严格筛选的高危患者,PTGBD 后的紧急 LC 可以安全实施,手术时机可根据每位患者的临床情况进行个性化选择。早期胆道造影(PTGBD 术后)具有住院时间短、费用低的优点,而且与晚期胆道造影相比,在发病率方面无明显差异,避免了延迟手术带来的胆道并发症和死亡风险。
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引用次数: 0
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Journal of Laparoendoscopic & Advanced Surgical Techniques
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