Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

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.

Purpose: This study aims to explore the influence of human immunodeficiency virus (HIV) infection on the prognosis of patients with hepatocellular carcinoma (HCC). Methods: According to the search strategy, we searched all relevant articles in the three databases (PubMed, Embase, and the Cochrane Library) up to February 18, 2024. All data available for analysis were extracted. Continuous variables were expressed as mean difference (MD) with standard deviation (SD). The categorical variables were expressed as odds ratio (OR) with 95% confidence intervals (CIs). Forest plots were used to illustrate the analysis results, and funnel plots were used to assess publication bias. Results: The study included a total of 4544 subjects. HIV patients were significantly younger compared to those without HIV (MD = -16.13, 95% CI = -17.24 to -15.01, I² = 91, P < .01), but there were no significant differences in other relevant clinical characteristics between the groups. Survival analysis indicated that HIV patients exhibited a poorer long-term prognosis compared with HIV-negative patients (HR = 0.71, 95% CI = 0.63 to 0.79, I² = 29%, P < .01). Conclusion: HIV infection, which compromises immune function and liver health, predisposes individuals to earlier onset of HCC and is associated with a poorer prognosis.

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.

Introduction: Retroperitoneal approach for robotic partial nephrectomy (PN) has been shown to offer shorter operative times and hospital stays without differences in complication rates compared with the transperitoneal approach. The single-port (SP) system may be better suited than multiport (MP) for challenges with the retroperitoneal approach such as narrow access geometry. We evaluated if the adoption of SP PN increased the utilization of retroperitoneal approach. Methods: We retrospectively reviewed an IRB-approved multi-institutional database of all PN from 2013 to 2023. The date of the first SP PN split the cohorts before and after SP adoption. The percentage of retroperitoneal and transperitoneal approach cases overall and for SP and MP was determined before and after adoption. Joinpoint analysis assessed changes in rates of the retroperitoneal approach. Logistic regression compared patient and tumor characteristics with retroperitoneal approach PN before and after adoption of SP. Results: Overall 1959 patients were evaluated, of which 654 were performed prior versus 1305 after SP adoption. There was an increased percentage of retroperitoneal approach after adoption, with 7.3% (48/654) before compared with 24.8% (324/1305) after adoption. The percentage of the retroperitoneal approach for SP PN was 52.8% (134/254), increasing over time with 75% (24/32) of SP in 2023 performed with a retroperitoneal approach. Conclusion: The retroperitoneal approach was used more frequently than the transperitoneal approach in the SP cohort. The adoption of SP increased the incidence of the retroperitoneal approach.

Background: Laparoscopic surgery is recommended as the standard approach for bilateral inguinal hernia repair. There are few studies in the literature comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic total extraperitoneal (TEP) approaches for bilateral inguinal hernia repair. This study aimed to compare the surgical outcomes and effectiveness of laparoscopic TAPP and laparoscopic TEP methods applied in bilateral inguinal hernia repair. Methods: A total of 100 patients operated on for bilateral inguinal hernia by applying laparoscopic TAPP and laparoscopic TEP methods from January 2016 to March 2023 were included in the study. The patients were randomized equally in two groups. Postoperative follow-up results were statistically analyzed in terms of recurrence rate, swelling in the incisions, scrotal edema and swelling, suture dehiscence, and the average time to return to work. Results: In bilateral inguinal hernia patients operated with laparoscopic TAPP method compared with bilateral inguinal hernia patients operated with laparoscopic TEP method, postoperative recurrence rate was significantly lower (2% versus 16%), swelling in the incision sites was significantly less (4% versus 24%), and the average time to return to work was significantly shorter (3.6 ± 2.3 versus 6.3 ± 5.8) (P < .05). Scrotal edema and swelling and suture dehiscence results did not show significant differences between the two approaches (P > .05). Conclusions: Both methods are widely used in bilateral inguinal hernia repairs. Postoperative results revealed that the laparoscopic TAPP method with less postoperative recurrence rate and less swelling in the incision sites, and shorter average time of the patients to return to work appears to be superior to the laparoscopic TEP method.

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.

Introduction: In the past, most patients with acute cholecystitis (AC) were treated conservatively. However, strong evidence from various studies has shown that laparoscopic cholecystectomy (LC) is safe and should be the primary treatment for AC. However, this may not be the case for all AC grades. This study aimed to compare two recommended approaches for grade II AC as outlined in the Tokyo guidelines TG18, focusing on early operative outcomes. Methods: We conducted a retrospective review of medical records for all patients diagnosed with grade II AC. The study compared patients who underwent early LC (group A, n = 130) with those who initially received percutaneous cholecystostomy (PC) followed by LC (group B, n = 90). Results: Both groups had similar Tokyo classification parameters. However, there were significant differences in baseline data, operative challenges, and postoperative complications. Cholecystostomy-related complications were observed in seven patients. The conversion rate for was 25% for group A and 5% for group B. The incidence of intraoperative biliary injury was 10% for group A and 2.2% for group B. In group A, 92% of patients with biliary injury and 80% of those who required conversion to open surgery had evidence of localized inflammation around the gallbladder. Conclusion: For selected patients with grade II AC and higher risks, PC placement can be beneficial in preventing life-threatening consequences. The study suggests a 2-month interval between PC and subsequent LC. Overall, performing LC after PC was found to be easier than early LC. Local inflammatory changes, including empyema, were associated with higher complication rates in the early LC group.

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.