Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Introduction: The rising prevalence of obesity in the United States is paralleled by an increase in type II diabetes (T2D) and metabolic-associated steatotic liver disease. While lifestyle changes often do not afford sustainable weight loss, bariatric surgery, particularly sleeve gastrectomy (SG), offers a durable solution. This study investigates long-term outcomes in Veterans who underwent SG with concurrent liver biopsy. Methods: All patients undergoing SG with a liver biopsy from January 2018 to March 2021 were included. Baseline demographics and comorbidities included age, gender, race, preoperative BMI, hemoglobin A1c (HgbA1c), T2D, hypertension (HTN), gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), and presence of steatosis and fibrosis. Patients were followed postoperatively at 1, 3, and 5 years. Patient demographics and comorbidities were stratified by liver scores and compared pre- and postoperatively. A paired t-test compared variables. Multivariate linear regression assessed associations between liver pathology and BMI. Multivariate logistic regression analyzed associations between comorbidities and liver pathology. A P < .05 was significant. Results: A total of 95 patients underwent a laparoscopic SG with a liver biopsy. There was a level of steatosis (81%) or fibrosis (76.8%) in the majority of biopsies. For the entire cohort, there was a significant BMI reduction from baseline (40.6 ± 3.0 kg/m²) at 1, 3, and 5 years (33.9 ± 4.2, 35.0 ± 4.6, 34.7 ± 4.9 kg/m²; P < .001). At 5 years, % total weight loss (TWL) for no, low, and high liver scores was 18.3 ± 7.5, 13.5 ± 1.6, and 13.7 ± 2.5(P = .82). At 5 years postoperatively, there were significant reductions in mean HgbA1c level (6.2 versus 5.7, P < .001), T2D (47.4% versus 36.8%, P < .001), HTN (56.8% versus 39.0%, P < .001), GERD (49.5% versus 31.6%, P < .001), and OSA (66.3% versus 42.1%, P < .001). There was no significant difference in any postoperative comorbidity, BMI, or %TWL based on pathological liver scores (P > .05). Conclusion: This study underscores the long-term efficacy of SG in a predominantly African American Veteran cohort, irrespective of liver pathology. These results advocate for bariatric surgery to treat obese patients with liver disease, and even those with advanced hepatic conditions can achieve substantial health benefits.

Background: The aim of this study is to compare the postoperative outcomes of laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique with the defect closure technique using sutures and intraperitoneal mesh (IPOM plus), evaluating recurrence and bulging rates at least one year postoperatively. The secondary objective is to compare postoperative complications: seroma and pain at 30 days, 6 months, and 1 year post-surgery. Methods: Patients with midline primary ventral and incisional hernias between 4 and 10 cm were included. A CT scan was performed on all patients to assess the correct spatial values preoperatively and at 1 month, 6 months, and 12 months postoperatively. Pain was evaluated using the visual analog scale. Results: A total of 50 patients underwent LIRA, and 48 patients underwent IPOM plus between January 2022 and May 2023. The mean defect area in the LIRA group was larger than in the IPOM plus group (63.5 ± 37.5 cm² versus 55.2 ± 33.9 cm²). In the LIRA group, 2/48 instances of bulging (4.4%) occurred, whereas in the IPOM plus group, there were 6/50 instances of bulging (21.3%) and 2/50 recurrences (6.4%). One month post-surgery, a clinical seroma was observed in 8/48 patients (16%) and 9/50 patients (18.7%) in the LIRA and IPOM plus groups, respectively, with complete resolution at 6 months. Postoperative pain was found to be lower in the LIRA group. Conclusions: In this study, the LIRA technique demonstrated lower rates of bulging, recurrence, and postoperative pain compared with IPOM plus at 1 year of follow-up. Further multicentric prospective studies with a larger patient sample and longer follow-up are necessary to draw definitive conclusions.

Introduction: Inguinoscrotal hernia (ISH) hernias pose higher risk of complications. Traditionally, complete dissection of the hernia sac has been considered the standard approach but, more recently, primary abandonment of the sac (PAS) has emerged as simpler alternative and potentially reduced complications. Seromas are common postoperatively, but their association with sac abandonment remains debatable. Objective: To evaluate the long-term impact of PAS in minimally invasive ISH repairs. Methods: A total of 29 patients, in a prospective observational study, who underwent minimally invasive IHS repair with PAS technique were included. ISH was defined as hernia sac longer than 7 cm from the deep inguinal annulus. Primary outcome was seroma incidence and its impact in at least 1 year follow-up. Results: Seroma was observed in 62.1% of patients at 7 days, decreasing to 31.0% at 30 days, 10.3% at 90 days, 6.9% at 6 months, and 3.4% at 12 months. No drainage procedure was required. One patient developed ischemic orchitis, and no postoperative hematoma or recurrence was observed. Patients with longer hernia sacs had a significantly higher risk of seroma, particularly those with sacs over 10 cm. L3 hernia classification was also associated with increased seroma rates compared with L2. No other patient-related or surgical factors were linked to seroma risk. Conclusions: Since seroma is usually an acute postoperative complication, 1 year of follow-up may be considered adequate for this outcome. Despite a higher early seroma rate, most resolved spontaneously within 3 months, and none required intervention. PAS does not increase long-term seroma risk and may represent a simple and promising alternative for ISH repair.

Introduction: A JJ stent placed before retrograde intrarenal surgery (RIRS) may passively dilate the ureter and facilitate ureteral access sheath (UAS) implantation. No studies have examined the significance of preoperative JJ stent diameter, even though numerous studies have shown that UAS insertion is simpler in patients with them. Our study examines the relationship between preoperative ureteral stent caliber and UAS placement and RIRS results. Materials and Methods: A total of 655 patients with known preoperative double-J stent size before RIRS were analyzed. The patients were categorized into two groups based on their preoperative stent diameter (Group 1: 4.8 Fr and Group 2: 6 Fr). Demographic and clinical data of the patients, stone characteristics, surgical data, perioperative and postoperative complications, duration of hospitalization, and stone-free rates (SFRs) were analyzed for comparison. Results: The groups contained 323 and 332 patients. The demographic data of the two groups were similar. There was no statistically significant difference between SFR, UAS insertion rate, hospitalization time, and complications. The success rate of placing a UAS with a higher caliber was statistically significantly higher in those with a 6 Fr JJ stent than in those with a 4.8 Fr stent (P = .001). The operation time was also shorter in the group with a thicker stent (P = .003). Conclusions: Our data suggest that while the preoperative JJ stent diameter does not significantly affect overall UAS insertion success, complication rates, or postoperative stone-free status, using a 6 Fr stent facilitates the placement of larger UAS calibers and may decrease operation time. Consequently, although both stent diameters are efficacious, selecting a 6 Fr stent may provide procedural benefits without jeopardizing safety or results.

Background: Laparoscopic adjustable gastric banding (LAGB) was once a widely adopted bariatric procedure due to its reversibility and minimally invasive nature. However, concerns about long-term complications, particularly intragastric migration and slippage, have led to a decline in its use. Methods: We conducted a retrospective review of 411 patients who underwent LAGB between 2002 and 2010 at a tertiary care center. Data on demographics, complication rates, time to onset, and management strategies were analyzed. Follow-up data were available for 178 patients over a 15-year period. Results: Band migration was diagnosed in 33 patients (18.5%), with a median detection time of 74 months post-implantation. Most cases (54.5%) were diagnosed between 6 and 10 years postoperatively. Common clinical presentations included weight regain (45.4%) and port-site infection with fever (33.3%), while 21.2% were asymptomatic. Surgical removal was performed in all migration cases, with a laparoscopic approach successfully used in 84.8%. Conversion to open surgery was necessary in 2 patients, and primary laparotomy was used in 3 early cases. Band slippage occurred in 10.7% of patients, with 63.2% requiring surgical intervention. Postoperative complications were minimal and managed conservatively. Conclusions: Our findings confirm that LAGB is associated with a significant long-term risk of complications, particularly band migration, which may occur more than a decade postoperatively. Long-term follow-up is essential, and routine upper GI imaging should be considered in all patients with LAGB, especially in those presenting with port-site infections. These results highlight the importance of individualized management and long-term vigilance in patients undergoing LAGB.

Background: This study aimed to identify the biomarkers that was associated with the postoperative incisional pain in patients with acute cholecystitis undergoing laparoscopic cholecystectomy surgery (ACC-LC). Methods: Sixty ACC-LC patients were enrolled and divided into mild pain (MP) and moderate-to-severe pain (MSP) groups based on their visual analog scale (VAS) scores 24 hours postoperatively. RNA sequencing was used to screen the potential pain associated markers, and ELISA were used to analyze the expression of one identified marker, CXCR5 in peripheral blood mononuclear cells (PBMCs). Single nucleotide polymorphism genotyping for CXCR5 rs3922 was performed, and its correlation with pain levels, inflammatory markers, and perioperative clinical features were assessed. Results: CXCR5 expression was significantly upregulated in the MSP group compared to the MP group. Higher CXCR5 levels correlated with increased VAS scores and were predictive of pain severity. The CXCR5 rs3922 G allele was associated with elevated CXCR5-associated pain levels, together with the increased Interleukin-6 (IL-6) levels, and decreased Transforming Growth Factor-beta (tgf-β) levels. Patients carrying the GG genotype also exhibited higher Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels, indicating greater liver damage, and experienced a longer time to anal exhaust and more postoperative complications. Conclusion: CXCR5 expression and the rs3922 polymorphism were associated with incisional pain and inflammatory damage in ACC-LC patients. These findings suggest that CXCR5 may serve as a biomarker for pain prediction and personalized pain management strategies.

Purpose: This study aimed to identify predictive clinical factors and computed tomography (CT) findings for difficult laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC). Methods: We retrospectively reviewed 549 patients with AC who underwent LC following preoperative CT scans from January 2011 to August 2020. Difficult LC was defined as requiring conversion to laparotomy or subtotal cholecystectomy, blood loss >500 mL, operative time significantly exceeding average, or bile duct injury. Clinical characteristics and specific CT findings were analyzed using univariate and multivariate logistic regression. Results: Twenty-seven patients (4.9%) experienced difficult LC. Multivariate analysis identified body mass index (BMI) >30 kg/m² (odds ratio [OR] = 4.70, 95% confidence interval [CI]: 1.86-11.92; P = .004) and C-reactive protein (CRP) ≥60 mg/L (OR = 3.12, 95% CI: 1.31-7.44; P = .01) as independent predictors. Radiological findings from CT, such as peri-gallbladder fluid and fat stranding, demonstrated no significance statistically. Conclusions: High BMI and elevated CRP levels were significant independent predictors for difficult LC in patients with AC. Preoperative CT findings alone did not predict surgical difficulty, suggesting clinical factors should remain the primary consideration in preoperative assessment.

Aim: This study aims to evaluate the descending and ascending approaches in laparoscopic adrenalectomy, focusing on their impact on surgical outcomes. Methods: This retrospective study included patients who underwent transperitoneal laparoscopic adrenalectomy for indications other than pheochromocytoma between 2018 and 2025. Patients were divided into two groups: those who underwent the descending approach (Group D) and those who underwent the ascending approach (Group A). Preoperative, intraoperative, and postoperative data were collected, including age, the American Society of Anesthesiology scores, tumor characteristics, operative time, blood loss, blood pressure variations, and hospital stay duration. Statistical analyses were performed using SPSS 25.0, with P < .05 considered statistically significant. Results: A total of 63 patients were analyzed (Group D: 30, Group A: 33). The mean operative time was significantly shorter in Group D (92 versus 110 minutes, P = .027). Blood loss was lower in Group D (80 versus 120 mL, P = .022), with a smaller hemoglobin decrease (1.2 versus 1.8 g/dL, P = .025). There was no significant difference in intraoperative blood pressure fluctuations, hospital stay, or major complications. Conclusions: The descending approach may offer advantages in reducing operative time and blood loss in laparoscopic adrenalectomy. However, both techniques remain viable options with comparable complication rates. Further studies are needed to confirm these findings in larger cohorts.

Introduction: Minimally invasive lens cleaning remains a persistent problem. Several internal and external cleaning devices are available, but most products are expensive, interrupt operative flow, require additional materials, or lack universal clinical efficacy. This study evaluates a novel minimally invasive lens cleaner. Methods: Patients undergoing a laparoscopic procedure from April to July 2025 were included. The number of times the laparoscope was removed for cleaning during the operation was measured. The duration of cleaning time was measured also. The cleaning time included removal, cleaning, reinsertion, and resumption of the operation. A control group utilized the Clearify^© while an experimental group utilized the novel device. The mean number of lens cleaning episodes and duration of lens cleaning were compared using a t test between the two groups with a P < .05 as significant. Results: Twenty control and 20 experimental cases were compared, including foregut, biliary, and bariatric procedures. The mean number of cleaning episodes/case for the control group during biliary, bariatric, and foregut procedures was 5.3 ± 1.5, 11.4 ± 6.2, and 11.8 ± 2.7, respectively. The mean number of cleaning episodes/case for the experimental group during bariatric and foregut procedures was .5  ±  0.9 and .3  ± 0 .5, respectively. The mean number of wipes in the foregut and bariatric group was significantly lower for the experimental group (P < .05). The lens cleaner was applicable for 5 mm and 10 mm angled laparoscopes. Longer operations in the control group required more cleaning episodes. However, operative time did not impact the number of cleaning episodes in the experimental group. The mean total time per case in the control group was significantly longer versus the experimental group (P < .05). Conclusion: The novel lens cleaner was clinically efficacious and significantly decreased the number of cleaning episodes. The product provided a clear view of the operative field while enhancing procedural efficiency by decreasing the number of times operative flow was disrupted.