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Minimally Invasive Transhiatal Esophagectomy Using Antegrade Inversion Technique in Esophageal Cancer: 10-Year Experience from a Tertiary Care Center. 使用前向倒转技术的微创经食管癌食管切除术:一家三级医疗中心的十年经验。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 Epub Date: 2024-10-23 DOI: 10.1089/lap.2024.0297
Thitiporn Chobarporn, Alia Qureshi, John G Hunter, Stephanie G Wood

Background: Esophageal cancer surgery aims for curative intent but carries high complication rates. Transthoracic esophagectomy is the dominant approach, however, transhiatal esophagectomy (THE) offers selective advantages in certain clinical scenarios. Minimally invasive THE (MI-THE) is an evolving technique with limited data. Methods: This retrospective study reviewed 38 patients with esophageal cancer who underwent MI-THE using "Antegrade Inversion Technique" between 2013 and 2023 at a tertiary care center. Perioperative outcomes were analyzed. Data were presented as mean with standard deviation, median with interquartile range, and percentages. Results: Most patients (86.8%) had early-stage cancer. Median operative time was 375 minutes, hospital stay was 8 days, and intensive care unit stay was 3 days. All patients achieved a negative resection margin. Pleural effusion (57.9%) was the most common complication, followed by pneumothorax (31.6%) and surgical site infection (15.8%). Anastomotic leak rate was 13.2%. There was no mortality. Conclusions: MI-THE appears safe and feasible with encouraging perioperative outcomes, particularly for early-stage disease and high-risk patients. While potentially offering advantages over open THE, further research is needed to definitively establish its role compared to traditional approaches.

背景:食管癌手术以治愈为目的,但并发症发生率很高。经胸食管切除术是最主要的方法,但经食管裂孔食管切除术(THE)在某些临床情况下具有选择性优势。微创食管切除术(MI-THE)是一种不断发展的技术,但数据有限。方法:这项回顾性研究回顾了一家三级医疗中心在 2013 年至 2023 年期间使用 "前向反转技术 "进行 MI-THE 手术的 38 例食管癌患者。对围手术期的结果进行了分析。数据以平均值(含标准差)、中位数(含四分位距)和百分比表示。结果大多数患者(86.8%)为早期癌症。手术时间中位数为 375 分钟,住院时间为 8 天,重症监护室住院时间为 3 天。所有患者的切除边缘均为阴性。胸腔积液(57.9%)是最常见的并发症,其次是气胸(31.6%)和手术部位感染(15.8%)。吻合口漏率为13.2%。无死亡病例。结论MI-THE似乎安全可行,围手术期效果令人鼓舞,尤其是对于早期疾病和高风险患者。与开放式THE相比,MI-THE具有潜在的优势,但要明确其与传统方法相比的作用,还需要进一步的研究。
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引用次数: 0
Is Endoscopic Resection Essential for Patients with Type 1 Gastric Neuroendocrine Tumor? 1 型胃神经内分泌肿瘤患者是否必须进行内镜下切除术?
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 Epub Date: 2024-11-07 DOI: 10.1089/lap.2024.0154
Omer Akay, Mert Guler, Husnu Sevik, Yesim Cokay Abut, Cihad Tatar, Ufuk Oguz Idiz

Background: The gastric neuroendocrine tumor (g-NET) is now more frequently diagnosed due to the widespread use and advancement of endoscopy. In our study, we aimed to discuss the superiority, if any, between the watch-and-wait approach and endoscopic treatment methods for the controversial management of type 1 g-NETs, as well as to evaluate their long-term outcomes. Materials and Methods: The data of 81 patients who underwent gastroscopy due to complaints related to the upper gastrointestinal system and were diagnosed with type 1 g-NET as a result of biopsy taken from suspicious stomach lesions were examined. After exclusion criteria, 48 patients were included in the study. Patients were categorized into two groups: the watch-and-wait group, where no invasive procedure was performed, and the group that underwent any form of endoscopic resection. Results: Thirty-seven patients were followed up regularly without any treatment. Eleven patients were followed up after endoscopic resection (endoscopic submucosal dissection-endoscopic mucosal resection). Endoscopic resection was performed in 5 of 37 patients with tumor size <10 mm and in 6 of 11 patients with tumor size between 10 and 20 mm. The median follow-up duration for all patients was 5 years, during which no instances of metastasis, tumor progression, or mortality were observed in any patient, regardless of whether they underwent endoscopic resection or not. Conclusion: This outcome prompts a questioning of the necessity for invasive treatment methods such as endoscopic resection, which comes with a relatively high cost and the potential for complications, in this particular patient group.

背景:由于内镜的广泛应用和发展,胃神经内分泌肿瘤(g-NET)的诊断率越来越高。在我们的研究中,我们旨在讨论观察等待法和内镜治疗法在治疗 1 型 g-NET 的争议中是否存在优越性,并评估其长期疗效。材料与方法:研究对象为因上消化道系统相关症状而接受胃镜检查的 81 名患者,这些患者通过对可疑胃部病变进行活检被确诊为 1 型 g-NET 。经过排除标准筛选后,48 名患者被纳入研究。患者被分为两组:观察等待组(不进行侵入性手术)和接受任何形式内镜切除术的一组。研究结果37 名患者在未接受任何治疗的情况下接受了定期随访。11名患者接受了内镜下切除术(内镜下粘膜下剥离术-内镜下粘膜切除术)。37 例患者中有 5 例进行了内镜下切除,肿瘤大小得出结论:这一结果促使人们质疑是否有必要采用内镜切除等侵入性治疗方法,因为在这一特殊患者群体中,内镜切除的费用相对较高,而且有可能出现并发症。
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引用次数: 0
Robotic-Assisted Versus Laparoscopic Approach for Treatment of Acute Cholecystitis in Children. 治疗儿童急性胆囊炎的机器人辅助方法与腹腔镜方法。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 Epub Date: 2024-10-17 DOI: 10.1089/lap.2023.0524
Wendy Jo Svetanoff, Karen Diefenbach, Jennifer H Aldrink, Marc P Michalsky

Introduction: Laparoscopic cholecystectomy (Lap-C) is the standard of care for patients requiring cholecystectomy in the acute setting. Although robotic-assisted cholecystectomy (RA-C) performance has increased, utilization in the acute setting has not been widely reported. We describe the feasibility of RA-C for pediatric patients undergoing acute inpatient cholecystectomy. Methods: A single institutional retrospective review of patients receiving RA-C while admitted for acute cholecystitis and/or choledocholithiasis (June 2017-June 2022) was compared with a matched cohort who underwent traditional multiport Lap-C (June 2021-June 2022). Demographic, perioperative, and postoperative data were analyzed. Results: Fifty patients were included: 25 each in the RA-C and Lap-C groups. Fifty-four percent were female; 66% were non-Hispanic white. Median age (15.7 years [interquartile range, IQR 14.7, 17.3] versus 15.3 years [IQR 14.5, 16.9], P = .91) and preoperative weight (92.6 kg [IQR 60, 105.9] versus 72.3 kg [IQR 61.6, 85.6], P = .15) were similar between the RA-C and Lap-C groups, respectively. No differences were observed in median operating time (89 minutes [IQR 76, 103] versus 88 minutes [IQR 77, 137], P = .70), postoperative length of stay (22.5 hours [21.4, 24.9] versus 20.6 hours [18.0, 25.1], P = .06), or 30-day complications (12% versus 16%, P = .69). Although opioid utilization (.23 milliequivalents/kilogram [MME/kg] [IQR .03, .30] versus .03 MME/kg [0, .09], P = .02) was higher in the RA-C cohort overall, no differences were detected during an analysis of the most recent 2 years (P = .96). Conclusion: RA-C in the acute setting can be performed safely in the pediatric population with comparable procedural times as well as perioperative and 30-day outcomes.

导言:腹腔镜胆囊切除术(Lap-C)是急诊胆囊切除术患者的标准治疗方法。虽然机器人辅助胆囊切除术(RA-C)的性能有所提高,但在急诊环境中的使用情况尚未得到广泛报道。我们对接受急性住院胆囊切除术的儿科患者使用机器人辅助胆囊切除术的可行性进行了描述。方法:对因急性胆囊炎和/或胆总管结石入院时接受 RA-C 的患者(2017 年 6 月至 2022 年 6 月)与接受传统多孔腹腔镜胆囊切除术的匹配队列(2021 年 6 月至 2022 年 6 月)进行单一机构回顾性审查。对人口统计学、围手术期和术后数据进行了分析。结果共纳入 50 名患者:RA-C组和Lap-C组各25人。54%为女性;66%为非西班牙裔白人。RA-C组和Lap-C组的中位年龄(15.7岁[四分位间距,IQR 14.7,17.3]对15.3岁[IQR 14.5,16.9],P = .91)和术前体重(92.6公斤[IQR 60,105.9]对72.3公斤[IQR 61.6,85.6],P = .15)分别相似。在中位手术时间(89 分钟 [IQR 76, 103] 对 88 分钟 [IQR 77, 137],P = .70)、术后住院时间(22.5 小时 [21.4, 24.9] 对 20.6 小时 [18.0, 25.1],P = .06)或 30 天并发症(12% 对 16%,P = .69)方面未观察到差异。虽然阿片类药物的使用量(0.23 毫当量/千克 [MME/kg] [IQR 0.03, 0.30] 与 0.03 毫当量/千克 [0, 0.09],P = 0.02)在 RA-C 组群中总体较高,但在最近两年的分析中未发现差异(P = 0.96)。结论:急性期的 RA-C 可以在儿科人群中安全进行,手术时间、围手术期和 30 天结果相当。
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引用次数: 0
Predictors of Persistent Prostate-Specific Antigen Persistence after Radical Prostatectomy. 前列腺根治术后前列腺特异性抗原持续存在的预测因素
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 Epub Date: 2024-10-17 DOI: 10.1089/lap.2024.0275
Chenhao Guo, Kangwei Zuo, Qi Zhao, Yongjuan Zhang, Nan Jiang, Suoshi Jing, Qiaokai Yang, Xiumei Li, Panfeng Shang, Weiping Li

Objective: To investigate the predictors of persistent prostate-specific antigen (PSA) after radical prostatectomy (RP). Methods: From January 2019 to December 2022, 212 patients with prostate cancer who underwent RP were retrospectively analyzed. According to the PSA value at 4-8 weeks postoperatively, the patients were divided into the PSA <0.1 ng/mL group (n = 142) and PSA ≥0.1 ng/mL group (n = 70). Logistic regression was used to analyze the independent risk factors of persistent PSA, and the logistic regression equation was established to predict the probability of persistent PSA. Results: Total PSA (tPSA) levels at diagnosis >49.73 ng/mL, free PSA (fPSA) levels at diagnosis >2.07 ng/mL, or clinical T stage >T3a were independent risk factors for PSA persistence after RP. Conclusion: Patients with tPSA at diagnosis >49.73 ng/mL, fPSA at diagnosis >2.07 ng/mL, and T3b prostate cancer showed strong associations with persistent PSA.

目的研究根治性前列腺切除术(RP)后前列腺特异性抗原(PSA)持续存在的预测因素。研究方法回顾性分析2019年1月至2022年12月期间接受前列腺癌根治术的212例前列腺癌患者。根据术后4-8周的PSA值,将患者分为PSA n = 142组和PSA≥0.1 ng/mL组(n = 70)。采用逻辑回归分析PSA持续存在的独立危险因素,并建立逻辑回归方程预测PSA持续存在的概率。结果诊断时总PSA(tPSA)水平>49.73纳克/毫升、诊断时游离PSA(fPSA)水平>2.07纳克/毫升或临床T分期>T3a是RP后PSA持续存在的独立危险因素。结论诊断时 tPSA >49.73 纳克/毫升、诊断时 fPSA >2.07 纳克/毫升和 T3b 型前列腺癌患者与 PSA 持续存在密切相关。
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引用次数: 0
Telescopic Dissection as a Cost-Effective Alternative to Balloon Trocar for Preperitoneal Dissection in Total Extraperitoneal Inguinal Hernia Repair. 在全腹膜外腹股沟疝修补术中,用伸缩式剥离器替代球囊套管进行腹膜前剥离具有成本效益。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-12-01 Epub Date: 2024-09-05 DOI: 10.1089/lap.2024.0223
Burak Dinçer, Sinan Ömeroğlu, İsmail Ethem Akgün

Background: Total extraperitoneal (TEP) approach is one of the commonly used minimally invasive method in inguinal hernia repair. There are limited data that compares the results of the telescopic dissection and balloon trocar for preperitoneal dissection. In our study, we aimed to retrospectively evaluate the TEP cases performed at our center and compare the results of these two techniques. Methods: TEP cases performed between 2020 and 2024 were evaluated. Strangulated and recurrent hernia cases were excluded. Telescopic dissection and balloon trocar techniques were compared in terms of conversion, postoperative pain, complications, and recurrence. Results: A total of 177 patients were included. Telescopic method was used in 122 cases, while a balloon trocar was used in 55 cases. The median age was 50 years (range: 20-86), and 163 patients (92%) were male. Bilateral inguinal hernia was present in 61 patients (35%). The median operative time was 100 minutes (IQR: 80-120 minutes). Conversion was required in a total of 3 cases (1.5%); specifically, the transabdominal preperitoneal method was employed in 2 cases, and Lichtenstein-style anterior approach hernia repair was performed in one case. Between the telescopic dissection and balloon trocar groups, no significant differences were observed in operation time (P = .407), conversion rates (P = .228), postoperative pain scores (P = .505, P = .264, P = .681, P = .743), complication rates (P = .205), or recurrence rates (P = .311). Conclusions: The results of using a balloon trocar and telescopic dissection in inguinal hernia repair with TEP are similar, and telescopic dissection could be a cost-effective alternative to the balloon trocar.

背景:全腹膜外(TEP)方法是腹股沟疝修补术中常用的微创方法之一。目前比较腹膜前剥离的伸缩式剥离和球囊套管的结果的数据有限。在我们的研究中,我们旨在回顾性评估在本中心实施的 TEP 病例,并比较这两种技术的效果。方法:对 2020 年至 2024 年期间实施的 TEP 病例进行评估。排除了绞窄性疝和复发性疝病例。从转归、术后疼痛、并发症和复发等方面比较了伸缩式剥离和球囊套管技术。结果:共纳入 177 名患者。122例使用了伸缩式方法,55例使用了球囊套管。中位年龄为 50 岁(范围:20-86 岁),163 名患者(92%)为男性。61例患者(35%)存在双侧腹股沟疝。手术时间中位数为 100 分钟(IQR:80-120 分钟)。共有 3 例患者(1.5%)需要进行转换手术,其中 2 例采用了经腹腹膜前法,1 例采用了 Lichtenstein 式前路疝修补术。在伸缩剥离组和球囊套管组之间,手术时间(P = .407)、转换率(P = .228)、术后疼痛评分(P = .505、P = .264、P = .681、P = .743)、并发症发生率(P = .205)和复发率(P = .311)均无明显差异。结论:在使用 TEP 进行腹股沟疝修补术时,使用球囊套管和伸缩式剥离器的效果相似,伸缩式剥离器可能是替代球囊套管的一种经济有效的方法。
{"title":"Telescopic Dissection as a Cost-Effective Alternative to Balloon Trocar for Preperitoneal Dissection in Total Extraperitoneal Inguinal Hernia Repair.","authors":"Burak Dinçer, Sinan Ömeroğlu, İsmail Ethem Akgün","doi":"10.1089/lap.2024.0223","DOIUrl":"10.1089/lap.2024.0223","url":null,"abstract":"<p><p><b><i>Background:</i></b> Total extraperitoneal (TEP) approach is one of the commonly used minimally invasive method in inguinal hernia repair. There are limited data that compares the results of the telescopic dissection and balloon trocar for preperitoneal dissection. In our study, we aimed to retrospectively evaluate the TEP cases performed at our center and compare the results of these two techniques. <b><i>Methods:</i></b> TEP cases performed between 2020 and 2024 were evaluated. Strangulated and recurrent hernia cases were excluded. Telescopic dissection and balloon trocar techniques were compared in terms of conversion, postoperative pain, complications, and recurrence. <b><i>Results:</i></b> A total of 177 patients were included. Telescopic method was used in 122 cases, while a balloon trocar was used in 55 cases. The median age was 50 years (range: 20-86), and 163 patients (92%) were male. Bilateral inguinal hernia was present in 61 patients (35%). The median operative time was 100 minutes (IQR: 80-120 minutes). Conversion was required in a total of 3 cases (1.5%); specifically, the transabdominal preperitoneal method was employed in 2 cases, and Lichtenstein-style anterior approach hernia repair was performed in one case. Between the telescopic dissection and balloon trocar groups, no significant differences were observed in operation time (<i>P</i> = .407), conversion rates (<i>P</i> = .228), postoperative pain scores (<i>P</i> = .505, <i>P</i> = .264, <i>P</i> = .681, <i>P</i> = .743), complication rates (<i>P</i> = .205), or recurrence rates (<i>P</i> = .311). <b><i>Conclusions:</i></b> The results of using a balloon trocar and telescopic dissection in inguinal hernia repair with TEP are similar, and telescopic dissection could be a cost-effective alternative to the balloon trocar.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"1084-1087"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134308","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
Short-Term Efficacy of LCBDE+LC Versus ERCP/EST+LC in the Treatment of Cholelithiasis Combined with Common Bile Duct Stones: A Retrospective Cohort Study. LCBDE+LC与ERCP/EST+LC治疗胆石症合并胆总管结石的短期疗效:一项回顾性队列研究。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-11-12 DOI: 10.1089/lap.2024.0345
Fuguo Liu, Lunhe Ye, Yongkun Wang, Zinan Zhao, Muladili Mutailipu, Xujing Wang, Qiqi Zhang, Bo Chen, Ran Cui

Background: Minimally invasive treatments for cholelithiasis have gained popularity. The complexity of diagnosing and treating choledocholithiasis offers multiple surgical options, including laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+LC) and endoscopic retrograde cholangiopancreatography and/or endoscopic sphincterotomy plus laparoscopic cholecystectomy (ERCP/EST+LC). Objective: To compare outcomes in patients with typical signs, symptoms, laboratory, and imaging features of cholelithiasis combined with common bile duct stones, we retrospectively analyzed the short-term outcomes of LCBDE+LC and ERCP/EST+LC. Methods: We analyzed 318 patients with gallbladder stones treated between January 2022 and May 2024. Of these, 152 underwent LCBDE+LC, and 166 underwent ERCP/EST+LC. We compared patients' baseline characteristics, perioperative outcomes, and short-term complications between the two groups. The primary outcome was the effectiveness of choledochal stone removal, while secondary outcomes included length of stay, hospitalization costs, and patient satisfaction. Results: Patients' baseline characteristics were similar between the LCBDE+LC and ERCP/EST+LC groups. Stone clearance rates were comparable (97.37% versus 95.18%, P = .306), with a slight advantage in the LCBDE+LC group. The length of hospitalization was significantly shorter in the LCBDE+LC group (6.49 ± 1.18 days versus 6.77 ± 1.11 days, P < .05). The LCBDE+LC group also had lower total hospitalization costs ($5188.78 ± 861.26 versus $6498.76 ± 1190.58 P < .01). Additionally, the incidence of pancreatitis was lower in the LCBDE+LC group (0.66% versus 6.02%, P < .01). There were no significant differences between the groups in other short-term complications such as abdominal infection, cholangitis, biliary bleeding, or bile leakage. Postoperative follow-up indicated higher patient satisfaction and acceptance in the LCBDE+LC group (SSQ-8, 85.84 ± 4.31 points versus 81.20 ± 4.54 points, P < .01). Conclusion: Our findings suggest that the LCBDE+LC holds promise as a safe and efficacious approach for the management of cholelithiasis combined with common bile duct stones. However, further prospective clinical trials are essential to corroborate these results and confirm their broader applicability.

背景:胆总管结石的微创治疗越来越受欢迎。胆总管结石诊断和治疗的复杂性提供了多种手术选择,包括腹腔镜胆总管探查加腹腔镜胆囊切除术(LCBDE+LC)和内镜逆行胰胆管造影术和/或内镜括约肌切开术加腹腔镜胆囊切除术(ERCP/EST+LC)。目的为了比较具有典型症状、体征、实验室和影像学特征的胆石症合并胆总管结石患者的治疗效果,我们回顾性分析了LCBDE+LC和ERCP/EST+LC的短期治疗效果。方法:我们分析了 2022 年 1 月至 2024 年 5 月间接受治疗的 318 例胆囊结石患者。其中152人接受了LCBDE+LC治疗,166人接受了ERCP/EST+LC治疗。我们比较了两组患者的基线特征、围手术期结果和短期并发症。主要结果是胆总管结石取出的有效性,次要结果包括住院时间、住院费用和患者满意度。结果LCBDE+LC组和ERCP/EST+LC组患者的基线特征相似。结石清除率相当(97.37% 对 95.18%,P = .306),LCBDE+LC 组略胜一筹。LCBDE+LC 组的住院时间明显更短(6.49 ± 1.18 天对 6.77 ± 1.11 天,P < .05)。LCBDE+LC 组的住院总费用也较低(5188.78 美元 ± 861.26 对 6498.76 美元 ± 1190.58,P < .01)。此外,LCBDE+LC 组的胰腺炎发病率较低(0.66% 对 6.02%,P < .01)。在腹腔感染、胆管炎、胆道出血或胆汁渗漏等其他短期并发症方面,两组之间没有明显差异。术后随访显示,LCBDE+LC 组患者的满意度和接受度更高(SSQ-8,85.84 ± 4.31 分对 81.20 ± 4.54 分,P < .01)。结论:我们的研究结果表明,LCBDE+LC 是治疗胆石症合并胆总管结石的一种安全有效的方法。然而,进一步的前瞻性临床试验对于证实这些结果并确认其更广泛的适用性至关重要。
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引用次数: 0
Evaluation of Surgical Results and Effectiveness of Laparoscopic Transabdominal Preperitoneal and Laparoscopic Totally Extraperitoneal Approaches in Bilateral Inguinal Hernia Repair: A Randomized Analysis. 双侧腹股沟疝修补术中腹腔镜经腹膜前入路和腹腔镜完全腹膜外入路的手术效果和有效性评估:随机分析。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-11-08 DOI: 10.1089/lap.2024.0360
Zafer Şenol

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.

背景:腹腔镜手术被推荐为双侧腹股沟疝修补术的标准方法。文献中很少有比较腹腔镜经腹膜前(TAPP)和腹腔镜全腹膜外(TEP)方法用于双侧腹股沟疝修补术的研究。本研究旨在比较腹腔镜 TAPP 和腹腔镜 TEP 方法用于双侧腹股沟疝修补术的手术效果和有效性。方法:研究共纳入了100例2016年1月至2023年3月期间应用腹腔镜TAPP和腹腔镜TEP方法进行双侧腹股沟疝手术的患者。患者被随机平均分为两组。从复发率、切口肿胀、阴囊水肿和肿胀、缝线开裂以及恢复工作的平均时间等方面对术后随访结果进行统计分析。结果采用腹腔镜 TAPP 方法手术的双侧腹股沟疝患者与采用腹腔镜 TEP 方法手术的双侧腹股沟疝患者相比,术后复发率明显降低(2% 对 16%),切口部位肿胀明显减轻(4% 对 24%),恢复工作的平均时间明显缩短(3.6 ± 2.3 对 6.3 ± 5.8)(P < .05)。阴囊水肿和肿胀以及缝线开裂的结果在两种方法之间没有显著差异(P > .05)。结论:两种方法都广泛用于双侧腹股沟疝修补术。术后结果显示,腹腔镜TAPP方法术后复发率较低,切口部位肿胀较少,患者恢复工作的平均时间较短,似乎优于腹腔镜TEP方法。
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引用次数: 0
Is It Necessary to Endoscopically Evaluate the Anastomosis in Robotic or Laparoscopic Surgical Procedures for Colorectal Cancer? 在机器人或腹腔镜结直肠癌手术中是否有必要对吻合口进行内窥镜评估?
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-11-07 DOI: 10.1089/lap.2024.0347
Rıdvan Yavuz, Orhan Aras, Hüseyin Çiyiltepe, Onur Dinçer, Ömer Kürklü, Erhan Özyurt, Zinet Asuman Onuk, Tebessüm Çakır

Background: In the surgical treatment of colorectal cancers, disease-free survival and life expectancy are inversely proportional to the increase in complications. We evaluated the superiority of colonoscopy and air and water tests in detecting anastomotic leaks in sigmoid and rectosigmoid junction colon cancers. Methods: Data of patients who underwent robotic/laparoscopic surgical procedures for sigmoid and rectosigmoid junctional colon cancers at a single center between January 2018 and February 24 were retrospectively evaluated. The anastomoses were evaluated by intraoperative colonoscopy (IOC) and intraoperative air leak test (IALT), and two groups were formed. Intraoperative leaks, intraoperative repair techniques, and postoperative anastomotic leaks were evaluated. Results: In our study, there were 125 patients in the IOC group and 148 patients in the IALT group, totaling 273 patients. Leakage was detected in 7 patients (4.7%) in the IALT group and 14 patients (11.2%) in the IOC group (P = .06). In the IALT group, 5 of 7 patients were repaired primary, and the anastomosis was reconstructed in 2 patients. In the IOC group, 10 of 14 patients were repaired primary, 2 patients underwent reanastomosis, and 2 patients needed colostomy. Of these 15 patients with postoperative leakage, 4 had intraoperative leakage (2 patients in the IALT group and 2 patients in the IOC group), and all of them underwent primary repair. Conclusion: In the anastomotic evaluation of sigmoid colon and rectosigmoid junction tumors, we found that IOC detected more leaks than IALT, but in these leaks, reanastomosis and/or diversion ostomy was superior to primary repair.

背景:在结直肠癌的手术治疗中,无病生存率和预期寿命与并发症的增加成反比。我们评估了结肠镜检查和气水试验在检测乙状结肠和直肠乙状结肠交界处结肠癌吻合口漏方面的优越性。方法对2018年1月至2月24日期间在一个中心接受机器人/腹腔镜手术治疗乙状结肠和直肠乙状结肠交界处结肠癌的患者数据进行回顾性评估。通过术中结肠镜检查(IOC)和术中漏气检测(IALT)对吻合口进行评估,并分为两组。对术中渗漏、术中修复技术和术后吻合口渗漏进行了评估。结果在我们的研究中,IOC 组有 125 名患者,IALT 组有 148 名患者,共计 273 名患者。IALT 组有 7 名患者(4.7%)发现吻合口漏,IOC 组有 14 名患者(11.2%)发现吻合口漏(P = 0.06)。在 IALT 组中,7 名患者中有 5 名进行了初次修复,2 名患者的吻合口进行了重建。在 IOC 组中,14 位患者中有 10 位进行了初次修复,2 位患者进行了再吻合,2 位患者需要进行结肠造口术。在这 15 名术后出现渗漏的患者中,有 4 人在术中出现渗漏(IALT 组 2 人,IOC 组 2 人),他们都进行了初次修复。结论在乙状结肠和直肠乙状结肠交界处肿瘤的吻合评估中,我们发现 IOC 比 IALT 发现了更多的渗漏,但在这些渗漏中,重新吻合和/或转流造口术优于初次修复术。
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引用次数: 0
Non-Cardiac Perioperative Mortality Factors at a Single Urban Veterans Affairs Medical Center. 一个城市退伍军人事务医疗中心的非心脏病围手术期死亡率因素。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-08-09 DOI: 10.1089/lap.2024.0213
J Alex Randall, Samuel O Dennis, Fred Brody

Background: The Veterans affairs (VA) surgical quality improvement program was established to evaluate the quality of VA surgical care to over nine million United States Veterans. Patient demographics vary by region, with urban areas correlating with higher mortality rates. This study attempts to determine the factors associated with 30-day mortality at a single VA medical center in an urban setting. Methods: Patients included in the study were at least 18 years of age and underwent a surgical procedure between January 2013 and June 2023. Baseline demographics included preoperative comorbidities, American Society of Anesthesiology (ASA) class, and preoperative lab values. Clinical outcomes included postoperative mortality within 30 days of the procedure. Chi-square, t-test, ANOVA, and multivariate logistic regressions were used to determine relationships, using P < .05 to determine significance. Results: A total of 11,547 patients with complete data were included, of which 92 patients (0.8%) died within 30 days of surgery. A higher preoperative hematocrit was protective against 30-day mortality. A perioperative transfusion, bleeding disorder, chronic obstructive pulmonary disease (COPD), history of a myocardial infarction, higher ASA class, and an emergency procedure all increased the likelihood of perioperative mortality. Conclusions: Veterans who seek surgical care at Veterans Health Administration centers receive high quality care with a low mortality rate. Identifying risk factors for perioperative mortality provides the opportunity to stratify those veterans at highest risk.

背景:退伍军人事务局(VA)外科质量改进计划旨在评估退伍军人事务局为 900 多万美国退伍军人提供的外科护理质量。不同地区的患者人口结构各不相同,城市地区的死亡率较高。本研究试图确定城市地区退伍军人医疗中心 30 天死亡率的相关因素。方法:参与研究的患者至少年满 18 周岁,并在 2013 年 1 月至 2023 年 6 月期间接受了外科手术。基线人口统计学数据包括术前合并症、美国麻醉学会(ASA)等级和术前化验值。临床结果包括术后 30 天内的死亡率。采用卡方检验、t 检验、方差分析和多变量逻辑回归确定关系,以 P < .05 为显著性标准。结果:共纳入了 11,547 名数据完整的患者,其中 92 名患者(0.8%)在术后 30 天内死亡。术前血细胞比容越高,30 天内的死亡率越低。围手术期输血、出血性疾病、慢性阻塞性肺病 (COPD)、心肌梗死病史、较高的 ASA 等级以及急诊手术都会增加围手术期死亡的可能性。结论在退伍军人健康管理中心寻求手术治疗的退伍军人可获得低死亡率的高质量医疗服务。识别围手术期死亡率的风险因素为对风险最高的退伍军人进行分层提供了机会。
{"title":"Non-Cardiac Perioperative Mortality Factors at a Single Urban Veterans Affairs Medical Center.","authors":"J Alex Randall, Samuel O Dennis, Fred Brody","doi":"10.1089/lap.2024.0213","DOIUrl":"10.1089/lap.2024.0213","url":null,"abstract":"<p><p><b><i>Background:</i></b> The Veterans affairs (VA) surgical quality improvement program was established to evaluate the quality of VA surgical care to over nine million United States Veterans. Patient demographics vary by region, with urban areas correlating with higher mortality rates. This study attempts to determine the factors associated with 30-day mortality at a single VA medical center in an urban setting. <b><i>Methods:</i></b> Patients included in the study were at least 18 years of age and underwent a surgical procedure between January 2013 and June 2023. Baseline demographics included preoperative comorbidities, American Society of Anesthesiology (ASA) class, and preoperative lab values. Clinical outcomes included postoperative mortality within 30 days of the procedure. Chi-square, <i>t</i>-test, ANOVA, and multivariate logistic regressions were used to determine relationships, using <i>P</i> < .05 to determine significance. <b><i>Results:</i></b> A total of 11,547 patients with complete data were included, of which 92 patients (0.8%) died within 30 days of surgery. A higher preoperative hematocrit was protective against 30-day mortality. A perioperative transfusion, bleeding disorder, chronic obstructive pulmonary disease (COPD), history of a myocardial infarction, higher ASA class, and an emergency procedure all increased the likelihood of perioperative mortality. <b><i>Conclusions:</i></b> Veterans who seek surgical care at Veterans Health Administration centers receive high quality care with a low mortality rate. Identifying risk factors for perioperative mortality provides the opportunity to stratify those veterans at highest risk.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"980-984"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914465","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
Intraparenchymal Indocyanine Green Use Improves Nodal Yield During Minimally Invasive Tumor Nephrectomy in Children. 肾小球内吲哚菁绿可提高儿童微创肿瘤肾切除术的结节率
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-07-05 DOI: 10.1089/lap.2024.0114
Rebecca Roberts, Max Pachl

Introduction: Correctly identifying positive lymph nodes associated with pediatric renal tumors is key to guiding management. Recommended targets for lymph node sampling are commonly missed during tumor nephrectomy, particularly if minimally invasive surgery (MIS) is performed. Indocyanine green (ICG) is used for lymph node mapping in adult oncology with excellent efficacy and safety profile. Materials and Methods: A prospective study was undertaken at a single-quaternary-level pediatric surgery center. All patients undergoing MIS radical or partial nephrectomy for renal tumors 2016-2023 were included. Patients managed from 2020 onwards received intra-parenchymal ICG prior to lymph node sampling. Main Results: Twenty-five patients underwent MIS nephrectomy at mean age 2 years 10 months. Eighteen patients were pre-ICG and 7 received ICG. ICG administration successfully demonstrated fluorescent nodes in all patients. Median number of nodes sampled was three pre-ICG and seven with ICG (P = 0.009). Forty-six nodes were sampled across 7 ICG patients-33 fluorescent, 10 non-fluorescent, and 3 identified histologically. Three nodes overall contained active disease, two pre-ICG and one fluorescent node with ICG. Neither operative time (180 pre-ICG versus 161 minutes ICG, P = 0.7) nor length of stay (72 versus 84 hours, P = 0.3) were significantly affected by ICG administration. There were no adverse events associated with ICG use. Conclusions: ICG is safe and effective at identifying nodes in MIS resection of pediatric renal tumors with the potential to increase the number of nodes sampled. Further research is needed, specifically a randomized control trial with extended follow-up.

导言:正确识别与小儿肾脏肿瘤相关的阳性淋巴结是指导治疗的关键。在肿瘤肾切除术中,尤其是进行微创手术(MIS)时,通常会遗漏推荐的淋巴结取样目标。吲哚菁绿(ICG)在成人肿瘤学中用于淋巴结图谱绘制,具有良好的疗效和安全性。材料与方法:在一家四级儿科手术中心进行了一项前瞻性研究。纳入了2016-2023年所有接受MIS肾肿瘤根治术或肾部分切除术的患者。2020年起接受治疗的患者在淋巴结取样前接受肾实质内ICG。主要结果:25名患者接受了MIS肾切除术,平均年龄为2岁10个月。18名患者在ICG前接受了检查,7名患者接受了ICG检查。所有患者均成功显示出荧光结节。ICG前取样的结节中位数为3个,ICG后为7个(P = 0.009)。7 名使用 ICG 的患者共取样 46 个结节--33 个荧光结节、10 个非荧光结节和 3 个经组织学鉴定的结节。共有 3 个结节含有活动性疾病,其中 2 个为 ICG 前结节,1 个为 ICG 荧光结节。使用 ICG 对手术时间(ICG 前 180 分钟对 ICG 后 161 分钟,P = 0.7)和住院时间(72 小时对 84 小时,P = 0.3)均无明显影响。使用 ICG 没有导致不良反应。结论:ICG在小儿肾肿瘤MIS切除术中能安全有效地识别结节,并有可能增加取样结节的数量。还需要进一步的研究,特别是延长随访时间的随机对照试验。
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引用次数: 0
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Journal of Laparoendoscopic & Advanced Surgical Techniques
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