Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Background: Appropriate surgical techniques for controlling bleeding and preserving residual liver function are key to the success of laparoscopic liver resection. This study aims to evaluate the application effect of intraoperative ultrasound in the Pringle maneuver of laparoscopic liver resection. Materials and Methods: Between January 2022 and June 2023, 100 patients underwent laparoscopic liver resection and were randomly allocated to receive application of intraoperative ultrasound for Pringle maneuver (intraoperative ultrasound group, n = 50) or conventional Pringle maneuver (conventional group, n = 50). Intraoperative blood loss, blood transfusion, operation time, hepatic portal block time, complications (bile leakage, hemorrhage, ascites, and posthepatectomy liver failure), and hospital stay were compared between groups, along with the alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TB) levels at postoperative days 1, 3, and 7. Results: The operation time, postoperative ALT, AST, and TB levels on postoperative days 1, 3, and 7, complications (bile leakage, hemorrhage, ascites, and posthepatectomy liver failures), and hospital stay were comparable between groups. Compared with the conventional group, the intraoperative ultrasound group had significantly less intraoperative blood loss (P = .015), lower blood transfusion rate (P = .035), and less hepatic portal block time (P = .012). Conclusions: Applying intraoperative ultrasound in laparoscopic liver resection for hepatic pedicle occlusion is a safe, simple, and effective method.

Background: Cholelithiasis and inguinal hernias are common surgical conditions that often coexist. Laparoscopic techniques are increasingly used for both cholecystectomy and inguinal hernia repair. This study aimed to systematically review the available evidence on the safety and efficacy of simultaneous laparoscopic cholecystectomy (LC) and laparoscopic inguinal hernia repair (LIHR). Methods: A systematic search of the PubMed/MEDLINE and Google Scholar databases was performed for articles published until March 2024 using specific keywords. Studies meeting predetermined inclusion and exclusion criteria were analyzed. Results: Ten studies comprising 199 patients were included in the review. The mean operative time for combined LC and LIHR ranged from 55 to 157 minutes, with an average hospital stay between 1 and 4 days. The overall complication rate was 22%, with seroma/hematoma formation (6.5%) being most common. There were no reported mortalities or cases of mesh infection. Discussion: This review suggested that simultaneous LC and LIHR is a safe and effective option for patients with both conditions. The combined procedure offers potential benefits such as reduced hospital stay, faster recovery, and cost savings. Although the optimal sequence of surgical procedures for LIHR and LC remains debatable, the risk of mesh infection appears to be minimal.

Background: Laparoscopic procedure for rectal prolapse has extend throughout the world as a minimally invasive treatment. Various techniques have been reported regarding the use of mesh, fixation, and rectal mobilization. However, a standard technique has not been established yet. Method: The original procedure of laparoscopic ventral mesh rectopexy was modified as described below. The posterior rectal cavity was dissected in proximity to the levator ani, and the lateral ligament was partially divided. After mobilization of the rectum, trimmed polypropylene mesh was placed on the ventral side of the upper rectum and fixed. The mesh was fixed in a semi-spiral shape along the long axis of the intestinal tract. Results: Fifteen patients underwent this procedure. The length of rectal prolapse were 5 (4-30) cm. The grade of rectal prolapse according to the Oxford Grading System was V in all patients. The median operative time and blood loss were 176 (range: 100-252) minutes and 0 (0-43) mL, respectively. No postoperative complications were observed in any of the patients. One patient experienced recurrence (6.7%). The remaining 14 patients did not experience recurrence during the follow-up period, which had a median of 54.5 months (range: 6-119 months). Conclusion: This modified laparoscopic semi-spiral mesh rectopexy may be considered for the surgical treatment of rectal prolapse.

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

Background: Laparoscopic cholecystectomy is one of the most common surgical procedures. Several techniques of ligating the cystic duct have been compared in randomized trials, but data on comparative effectiveness are missing. Our aim was to systematically review the literature and, if appropriate, synthesize the available evidence. Methods: A systematic search of PubMed, Scopus, Ovid, and Cochrane Library was conducted to identify randomized studies comparing different ligation techniques of the cystic duct in laparoscopic cholecystectomy. Network meta-analysis synthesized evidence from all available techniques. Techniques compared were metal (MC), absorbable (AC), or polymer clips (PC), suture ligation (SL), and ultrasonic shears (US). Results: Twenty-three randomized studies with 2851 patients were included in our study. A well-connected network was formed for bile leak and a star-shaped network for operative time, with MC as the common comparator. No difference was found when SL, AC, US, or PC were compared for bile leak. Operative time was statistically significantly reduced when US were compared to MC (mean difference [MD] = -14.32 [-19.37, -9.28]), SL MD = -20.16 (-10.84, -29.47), and AC MD = -18.32 (-1.25, -35.39). The remaining techniques had similar operative times. PC had the highest probability of being the best technique P = 41.8, and SL had the highest probability P = 46.1 of being the second best for bile leak. US had a 98.1% chance of being the best technique for operative time. Conclusions: Given that all techniques demonstrate similar efficacy, the decision should be based on cost, familiarity with the technique, and environmental factors.

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

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

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

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