Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Background: Severe gastroesophageal reflux disease (GERD) following sleeve gastrectomy (SG) remains a major therapeutic challenge in bariatric surgery. The gold-standard surgical approach is represented by the conversion to Roux-en-Y gastric bypass (RYGB), which carries a significant risk of long-term complication rate. The present study evaluates the efficacy and safety of an alternative procedure-the Round Ligament Cardiopexy (Rampal Technique, RLC)-in patients with severe, invalidating reflux following SG.

Methods: This is a single-center, retrospective study reviewing all patients who underwent Rampal cardiopexy for severe reflux after SG between June 2020 and October 2024. Demographic data, clinical characteristics, pre- and postoperative findings, and quality-of-life outcomes (Reflux-Qual® Simplified, RQS®) were collected. The primary endpoint was improvement in reflux and regurgitation symptoms; secondary endpoints included morbidity and mortality.

Results: Six female patients (mean age: 40.8 ± 15.7 years) were included, with a mean interval of 6 ± 3 years between SG and CR. All procedures were completed laparoscopically. A significant improvement in reflux symptoms was observed postoperatively (P = .02), with complete resolution of regurgitations and marked reduction of acid reflux. RQS® scores improved from 21 ± 4.6 to 15.7 ± 7.5 (P = .52). No mortality occurred. Early morbidity was 33% (two transient dysphagias), and late morbidity was 17% (one stricture requiring dilation).

Conclusion: The Rampal cardiopexy could represent a safe, effective, and minimally morbid alternative to conversion to RYGB for refractory reflux following SG. Additional further evaluation in larger, prospective studies is needed to confirm its long-term benefits. This technique should be better known among bariatric surgeons to expand the therapeutic options for managing post-sleeve GERD.

Introduction: Red cell distribution width (RDW) has recently emerged as a potential biomarker reflecting nutritional and inflammatory status in surgical oncology. While anastomotic leakage (AL) remains a devastating complication after right hemicolectomy for colorectal cancer, the predictive role of RDW in this setting has not been clearly established. This study aimed to evaluate the prognostic significance of RDW in predicting AL and postoperative outcomes after right hemicolectomy.

Methods: This retrospective study included 234 patients who underwent right or extended right hemicolectomy for colorectal cancer between June 2020 and May 2025 at a tertiary referral center. Demographic, surgical, histopathological, and laboratory data were analyzed. Postoperative complications were graded according to the Clavien-Dindo classification.

Results: AL occurred in 3.4% of patients; however, RDW was not an independent predictor. Patients with elevated RDW-fL values (>46.1 fL) were significantly older and had higher American Society of Anesthesiologists' (ASA) scores, lower preoperative hemoglobin and albumin levels, and higher C-reactive protein levels. They also demonstrated shorter overall survival (47.7 versus 59.2 months, P = .027). High RDW-fL was independently associated with major postoperative complications and failure to complete adjuvant therapy.

Conclusion: Preoperative RDW did not predict AL but was strongly associated with postoperative complications, adverse survival, and incomplete adjuvant treatment. RDW may serve as a simple, cost-effective biomarker for perioperative risk stratification in colorectal cancer surgery.

Background: Postoperative leakage at the esophagogastric anastomosis is a well-recognized and significant complication following esophagectomy. In the past, treatment options were largely confined to either conservative, nonsurgical management or removal of the gastric conduit with construction of a cervical esophagostomy. Over the last decade, the development of endoluminal stents and endoscopic clipping techniques has provided a less invasive alternative, enabling effective closure of leaks without the need for further surgery and preserving the continuity of the reconstructed esophagus.

Methods: This report presents our initial clinical experiences with the combined use of stents and clips. It also reviews up-to-date evidence on patient selection, available stent designs, treatment success rates, procedure-related considerations, and the anticipated role of endoscopic approaches in managing postoperative esophagogastric anastomotic leakage.

Results: We report 3 cases who underwent endoscopic management for esophagogastric anastomotic leak with a combination of stent and clips. The success of the procedure was determined on the extent of the defect and source management, which frequently necessitated concurrent drainage and antibiotic therapy.

Conclusions: Conservative approaches have become increasingly significant in the treatment of anastomotic leaks following esophageal surgery. Our experience demonstrates that some challenging cases can be treated with a combination of endoscopic therapy methods.

Aim: This study aims to perform a comprehensive systematic review and meta-analysis to evaluate the impact of anticoagulation (AC) therapy on clinical outcomes during ventral hernia repair (VHR).

Materials and methods: A thorough online search was conducted using PubMed, Cochrane, and Embase databases. Studies comparing the use of AC therapy following VHR were included. The results analyzed were bleeding-related reoperation, hemorrhagic/thrombotic complications, length of stay, and transfusion rates. Statistical analysis was performed with Review Manager 5.4 using a random-effects model.

Results: From 1278 records, 4 studies were included, encompassing 41,868 patients (anticoagulants use = 4804; no AC = 32,649), with 25% on anticoagulant therapy submitted to minimally invasive surgery (MIS). Additionally, 90% of patients using anticoagulants underwent mesh placement. Overall analysis showed increased hemorrhagic/thrombotic complications (risk ratios [RR]: 2.3; 95% confidence interval [CI]: 1.13-4.8; P = .02), bleeding-related reoperation (RR: 6.5; 95% CI: 4.3-9.9; P < .00001), and longer hospital stays (mean difference: 1.69 days; 95% CI: .66 to 2.72 days; P = .001) in patients using anticoagulant medications. However, there was no increased risk of transfusion (RR: 2.14; 95% CI: 0.58-7.95; P = .26) between groups.

Conclusions: The use of anticoagulant therapy following VHR is associated with increased hemorrhagic/thrombotic complications, bleeding-related reoperations, prolonged hospitalization, and similar transfusion rates. Further research is still required to validate these findings and explore the impact of MIS on anticoagulated patients following VHR.

Large hepatic cysts can cause abdominal pain, pressure symptoms, or liver dysfunction. Although laparoscopic fenestration is the standard surgical approach, recurrence remains a concern. As laparoscopic hepatectomy techniques have advanced, we have adopted laparoscopic left lateral segmentectomy as a curative treatment for symptomatic cysts located in the left lateral segment. Between 2018 and 2023, 4 patients underwent laparoscopic left lateral segmentectomy for symptomatic hepatic cysts at our institution. All procedures were performed using five ports. Cystic fluid was aspirated as much as possible, and hepatic transection was conducted under the total Pringle maneuver using ultrasonic dissectors. Small vessels were sealed, while larger vessels and Glissonean pedicles were clipped or divided with linear staplers. Resected specimens were retrieved via an extended umbilical incision. Surgical and postoperative parameters were analyzed to evaluate the safety and efficacy of the procedure. The cohort included 1 male and 3 female patients, with a mean age of 63 years. Presenting symptoms included abdominal pressure (3 cases) and epigastric pain (1 case). The mean maximum cyst diameter was 16.3 cm, and the average aspirated volume was 950 mL. The mean operative time was 232 minutes, and the mean blood loss was 48 g. No postoperative complications were observed. The average postoperative hospital stay was 6 days. All patients experienced symptom resolution without delayed complications during follow-up. Laparoscopic left lateral segmentectomy might be a safe and curative surgical option for symptomatic hepatic cysts located in the left lateral segment.

Background: Sleeve gastrectomy has become the most commonly performed bariatric procedure worldwide, yet staple line complications including bleeding and leakage remain significant concerns. The EnDrive Zero stapler features an innovative 4 × 2 configuration with B-Duo reinforced design, theoretically offering superior mechanical integrity and enhanced hemostasis compared with conventional staplers. Methods: Fourteen pigs underwent laparoscopic gastric stapling using either the EnDrive Zero test device (n = 6) or a conventional control stapler (n = 6). Gastric stapling was performed along the greater curvature under acute hypertension induced by epinephrine (8 μg/kg) to simulate demanding clinical conditions. Primary outcomes included intraoperative hemostasis scores, staple line integrity, and ex vivo burst pressure testing. Animals were followed for 28 days with comprehensive clinical, hematological, and histopathological evaluation. Results: Both devices achieved excellent hemostatic control with no significant differences in bleeding scores (stomach vessels: 2.3 ± 0.8 versus 1.7 ± 0.8, P = .183; gastric tissue: 1.3 ± 0.5 versus 1.1 ± 0.4, P = .552). All animals survived 28 days without adverse events, demonstrating 100% anastomotic success and complete healing. However, ex vivo burst pressure testing revealed significantly superior mechanical integrity for the test device (251.3 ± 15.6 mmHg versus 226.3 ± 16.3 mmHg, P = .013), representing an 11% improvement. Histopathological examination showed minimal tissue reactivity in both groups with no significant differences. Conclusion: The EnDrive Zero 4 × 2 stapler demonstrated hemostatic performance equivalent to conventional staplers while providing significantly superior mechanical strength in gastric stapling. This enhanced burst pressure, combined with the theoretical hemostatic advantages of four-row stapling, may offer additional safety margins against both bleeding and leak complications in sleeve gastrectomy, warranting clinical investigation in bariatric surgery.

Background: Primary hyperhidrosis is a debilitating condition characterized by excessive focal sweating, most commonly affecting the axillae, palms, and soles, for which surgical intervention provides a durable solution in patients refractory to medical management. Methods: We present our outpatient surgical technique for video-assisted thoracoscopic sympathectomy (VATS) using a two-port, 3-mm incision approach and evaluate its efficacy and outcomes. A case series of 33 consecutive patients undergoing outpatient VATS sympathectomy between 2016 and 2023 was reviewed, with 9 patients excluded for lack of postoperative follow-up. All procedures were performed with electrocautery at the third and fourth ribs posteriorly (T3 and T4). Results: The technique demonstrated consistent efficacy in symptom resolution with short operative times, low postoperative pain, and rapid recovery. Mean operative time was 22.0 ± 3.7 minutes, with same-day discharge achieved in all patients. The average pain score at discharge was 2.0 ± 2.6, and no intraoperative or immediate postoperative complications occurred. Symptom severity scores improved across all regions, most notably in the palms (8.8 ± 2.1 to 1.3 ± 2.1, P < .001) and axillae (7.1 ± 2.9 to 2.2 ± 2.3, P < .001), with improvement also observed in plantar sweating (8.6 ± 2.0 to 4.8 ± 3.0, P < .001), while facial sweating showed a modest, nonsignificant change (2.3 ± 2.8 to 1.5 ± 2.2, P = .21). At 2-4 weeks, complication rates, including compensatory hyperhidrosis and pneumothorax, were comparable to conventional methods. Conclusion: This minimally invasive two-port VATS sympathectomy with 3-mm incisions appears safe, effective, and patient-centered, supporting its use as a surgical approach for primary hyperhidrosis.

Background: This study aimed to evaluate the safety and clinical efficacy of self-expelling biliary stents in elderly patients undergoing laparoscopic and cholangioscopic procedures for gallbladder and common bile duct (CBD) stones. Methods: Clinical data from 220 geriatric patients treated at Yixing People's Hospital from January 2019 to April 2025 for primary CBD stones were retrospectively analyzed. All patients underwent laparoscopic common bile duct exploration (LCBDE) with intraoperative placement of a 6F self-expelling J-stent under cholangioscopic guidance, followed by primary duct closure using 4-0 polyglycolic acid sutures. Both the safety and effectiveness of the treatment were observed. Outcomes included operative metrics, bile leakage rates (International Study Group for Liver Surgery criteria), and stent expulsion time. Results: All procedures were completed laparoscopically without conversion. Mean operative time was 95.3 ± 15.2 minutes, with blood loss of 35.0 ± 8.66 mL. Stents were spontaneously expelled within 4.4 ± 1.3 days. Postoperative liver function (alanine transaminase/aspartate transaminase) and inflammatory markers (interleukin-6) improved significantly (all P < .001). Complications included wound infection (2.2%, n = 5) and bile leakage (0.4%, n = 1). Hospital stay was shorter (5.2 ± 0.6) days compared with historical T-tube drainage (TTD) cohorts. Conclusion: For elderly patients, self-expelling biliary stents have shown promising therapeutic results when used during LCBDE. Elderly patients benefit from the stents' adequate biliary drainage and decompression, which promotes an early recovery following surgery. Its "no-tube" strategy may reduce TTD-related burdens. In the future, multicenter prospective randomized controlled trials will be needed to confirm its superiority.

Introduction: Laparoscopic gastrostomy (LG) tube placement is a minimally invasive technique increasingly used in pediatric patients requiring long-term enteral nutrition. While various approaches exist, technique standardization remains limited. This study aims to describe our institution's standardized LG technique and evaluate its surgical outcomes. Methods: We conducted a retrospective review of pediatric patients who underwent LG tube placement at a tertiary care center between August 2017 and September 2022. All procedures were performed using a uniform laparoscopic technique involving a purse-string suture and multiple fascial anchoring sutures. Clinical and perioperative data, including patient demographics, operative time, and time to first feed, were analyzed. Statistical analyses included Spearman correlation and Mann-Whitney U tests. Results: Twenty-five patients (56% female) with a median age of 48 months (range: 7-204 months) underwent LG placement. Neurological impairment was present in 76% of cases. The median operative time was 71 minutes, and the median time to first feed was within the same postoperative day. Notably, no patients experienced intraoperative or postoperative complications. There were no conversions to open surgery, no aborted procedures, and no requirement for postoperative anti-reflux surgery. Mann-Whitney U analysis showed no statistically significant differences in operative time or time to first feed based on neurological status (P = .086 and P = .568, respectively). Conclusion: Our standardized LG technique is safe, reproducible, and effective, with no complications and favorable outcomes across pediatric subgroups. This approach may offer a reliable alternative to percutaneous endoscopic gastrostomy or open gastrostomy placement in children.

Introduction: Esophagojejunal anastomotic leak is a serious complication following total gastrectomy for gastric cancer. Self-expanding metallic stents placed endoscopically offer a minimally invasive treatment option for managing this complication. While sarcopenia has been linked to adverse postoperative outcomes in various surgical fields, its impact on the success of endoscopic treatment for anastomotic leakage remains unclear. This study investigates whether sarcopenia predicts endoscopic treatment failure in patients with esophagojejunal leakage after total gastrectomy. Materials and Methods: A retrospective review was conducted of patients who underwent laparoscopic total gastrectomy and Roux-en-Y esophagojejunostomy due to gastric adenocarcinoma at our institution between January 2020 and May 2025. Among the 241 patients who underwent surgery during the specified period, 31 patients who developed esophagojejunal anastomotic leakage and were treated with self-expanding metallic stents were included in the study. Preoperative sarcopenia was assessed using the total psoas index, measured at the L3 vertebra level on computed tomography images. Patients were divided into two groups based on the presence of sarcopenia, and the clinical success of stent treatment was compared with postoperative outcomes. Results: The study cohort consisted of 31 patients with a median age of 59 years (interquartile range: 51-67). Sarcopenia was detected in 29% (n = 9) of the study population. The overall clinical success rate of stenting was 67.7%, and this rate was significantly lower in the sarcopenia group (33.3% versus 81.8%; P = .009). The length of hospital stay was significantly longer in sarcopenic patients (37.8 ± 21.3 days versus 25.2 ± 10.3 days; P = .033), but there was no statistically significant difference between the groups in terms of intensive care unit admission duration (5.89 ± 5.58 days versus 2.95 ± 3.08 days; P = .069). Conclusions: Preoperative sarcopenia is associated with lower clinical success rates in endoscopic stent treatment of esophagogastric anastomotic leakage after gastric cancer surgery.