Showing papers in "Surgical Laparoscopy Endoscopy & Percutaneous Techniques in 2022"
TL;DR: In this paper , the authors investigated the efficacy and safety of eTEP and IPOM approach in ventral and incisional hernia repair, and compared the two techniques in five trials containing 433 patients.
Abstract: Open sublay technique and laparoscopic intraperitoneal onlay mesh (IPOM) technique are the most common used procedures in ventral and incisional hernia repair, however, each technique has its own disadvantages. The enhanced view total extraperitoneal technique (eTEP) aims to put the mesh in the retromuscular space by minimal invasive technique. This study is to investigate the efficacy and safety of eTEP and IPOM approach in ventral and incisional hernia repair.The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through May 1, 2021, using the keywords "enhanced view extraperitoneal," "extended view totally extraperitoneal," "eTEP," "TEP," "laparoscopic retromuscular," "ventral hernia," "incisional hernia," "laparoscopic intraperitoneal onlay mesh," "IPOM." All relevant articles and reference lists in these original studies were also obtained from the above databases.Five trials containing 433 patients were included in the present study. Compared with the IPOM technique, the eTEP ventral/incisional hernia repair was associated a longer operative time [mean difference=44.79; 95% confidence interval (CI): 26.57, 63; P=0.00001], less acute pain on postoperative day 1 (standardized mean difference=-3.90; 95% CI: -4.42, -3.38; P<0.00001), and day 7 (standardized mean difference=-3.72; 95% CI: -6.09, 1.35; P=0.002), and the eTEP group had a shorter hospital stay compared with the IPOM group (mean difference=-0.56; 95% CI: -0.74, -0.39; P=0.00001). There was no significant difference concerning the incidence of seroma, hematoma, intraoperative complication, and postoperative ileus between eTEP and IPOM groups.The eTEP technique in ventral and incisional hernia repair shows significantly lower acute postoperative pain and shorter hospital study but a longer operative time. In addition, there is no significant difference in terms of intraoperative or postoperative complications. Further randomized controlled studies with long-term follow-up are needed to evaluate the eTEP technique.
8 citations
TL;DR: The eTEP technique in ventral and incisional hernia repair shows significantly lower acute postoperative pain and shorter hospital study but a longer operative time, and there is no significant difference in terms of intraoperative or postoperative complications.
Abstract: Background: Open sublay technique and laparoscopic intraperitoneal onlay mesh (IPOM) technique are the most common used procedures in ventral and incisional hernia repair, however, each technique has its own disadvantages. The enhanced view total extraperitoneal technique (eTEP) aims to put the mesh in the retromuscular space by minimal invasive technique. This study is to investigate the efficacy and safety of eTEP and IPOM approach in ventral and incisional hernia repair. Methods: The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through May 1, 2021, using the keywords “enhanced view extraperitoneal,” “extended view totally extraperitoneal,” “eTEP,” “TEP,” “laparoscopic retromuscular,” “ventral hernia,” “incisional hernia,” “laparoscopic intraperitoneal onlay mesh,” “IPOM.” All relevant articles and reference lists in these original studies were also obtained from the above databases. Results: Five trials containing 433 patients were included in the present study. Compared with the IPOM technique, the eTEP ventral/incisional hernia repair was associated a longer operative time [mean difference=44.79; 95% confidence interval (CI): 26.57, 63; P=0.00001], less acute pain on postoperative day 1 (standardized mean difference=−3.90; 95% CI: −4.42, −3.38; P<0.00001), and day 7 (standardized mean difference=−3.72; 95% CI: −6.09, 1.35; P=0.002), and the eTEP group had a shorter hospital stay compared with the IPOM group (mean difference=−0.56; 95% CI: −0.74, −0.39; P=0.00001). There was no significant difference concerning the incidence of seroma, hematoma, intraoperative complication, and postoperative ileus between eTEP and IPOM groups. Conclusions: The eTEP technique in ventral and incisional hernia repair shows significantly lower acute postoperative pain and shorter hospital study but a longer operative time. In addition, there is no significant difference in terms of intraoperative or postoperative complications. Further randomized controlled studies with long-term follow-up are needed to evaluate the eTEP technique.
7 citations
TL;DR: Indocyanine green (ICG) fluorescence imaging is an easy and reproducible method to detect hepatic lesions, both primary and metastatic, and is effective in real-time assessment of surgical margins by evaluating the integrity of the fluorescent rim around the CRLM.
Abstract: Indocyanine green (ICG) fluorescence imaging is an easy and reproducible method to detect hepatic lesions, both primary and metastatic. This review reports the potential benefits of this technique as a tactile mimicking visual tool and a navigator guide in minimally invasive liver resection of colorectal liver metastases (CRLM). PubMed and MEDLINE databases were searched for studies reporting the use of intravenous injection of ICG before minimally invasive surgery for CLRM. The search was performed for publications reported from the first study in 2014 to April 2021. The final review included 13 articles: 6 prospective cohort studies, 1 retrospective cohort study, 3 case series, 1 case report, 1 case-matched study, and 1 clinical trial registry. The administered dose ranged between 0.3 and 0.5 mg/kg, while timing ranged between 1 and 14 days before surgery. CRLM detection rate ranged between 30.3% and 100% with preoperative imaging (abdominal computed tomography/magnetic resonance imaging), between 93.3 and 100% with laparoscopic ultrasound, between 57.6% and 100% with ICG fluorescence, and was 100% with combined modalities (ICG and laparoscopic ultrasound) with weighted averages of 77.42%, 95.97%, 79.03%, and 100%, respectively. ICG fusion imaging also allowed to detect occult small-sized lesions, not diagnosed preoperatively. In addition, ICG is effective in real-time assessment of surgical margins by evaluating the integrity of the fluorescent rim around the CRLM.
5 citations
TL;DR: In this article , the authors compared the performance of EUS-guided drainage in critically ill PFC cases with infected walled-off necrosis (WON) and/or organ failure (OF) using biflanged metal stents (BFMS) or double-pigtail plastic stents(DPPS).
Abstract: Endoscopic ultrasound (EUS)-guided drainage is the preferred treatment of pancreatic fluid collections (PFC). However, the choice of the stent for EUS-guided drainage in critically ill PFC cases with infected walled-off necrosis (WON) and/or organ failure (OF) remains unknown.Between January 2018 and December 2019, consecutive patients with symptomatic PFC subjected to EUS-guided drainage using biflanged metal stents (BFMS) or double-pigtail plastic stents (DPPS) were compared for technical success, clinical success, duration of the procedure, need for intensive care unit stay, duration of intensive care unit stay, ventilator need, resolution of OF, the duration for resolution of OF, complications, need for salvage percutaneous drainage or surgery and mortality. A subgroup of patients having infected WON with/without OF were analyzed separately.Among 120 patients (84.6% males) with PFC (108 WON, 22 pseudocyst) who underwent EUS-guided drainage, there was no difference in outcome parameters in BFMS and DPPS groups. Among patients with WON, clinical success was significantly higher (96.2% vs. 81.8%, P=0.04), with significantly shorter hospital stay (6 vs. 10 d) and procedure duration (17.18±4.6 vs. 43.6±9.7 min, P<0.0001) in the BFMS group. Among patients with infected WON with/without OF, the clinical success was significantly higher (100% vs. 73.9%, P=0.02), and the duration of the procedure was significantly lower (16.28±4.4 vs. 44.39±10.7, P<0.0001) in BFMS compared with DPPS group.EUS-guided drainage of WON using BFMS scores over DPPS. In patients having infected WON with/without OF, BFMS may be preferred over DPPS.
4 citations
TL;DR: SADI-S has shown to be a possible alternative treatment option to BPD-DS in managing patients with obesity and further randomized controlled studies with more extended follow-up periods are necessary to ascertain the safety and efficacy of the treatment.
Abstract: Background: Biliopancreatic diversion with duodenal switch (BPD-DS) is an effective yet technically challenging bariatric surgery with many complications. Alternatively, single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) was recently introduced as a simplified bariatric procedure. This meta-analysis aimed to assess the safety and efficacy of SADI-S compared with BPD-DS in the management of patients with obesity. Methods: Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to May 2022 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis system. The review was registered prospectively with PROSPERO (CRD42022333521). Results: From 123 studies screened, 6 studies met the eligibility criteria, with a total of 1847 patients with obesity undergoing either SADI-S (n=818) or BPD-DS (n=1029). Preoperative body mass index was similar between the 2 groups, and the BPD-DS group had a greater % excess body mass index loss (EBMIL) (MD=−10.16%, 95% confidence interval: −11.80, −8.51, I2=0%) at 2 years compared with the SADI-S group. There was no difference observed in preoperative comorbidities and remission, including diabetes, hypertension, and dyslipidemia between SADI-S and BPD-DS cohorts. Compared with BPD-DS, SADI-S had shorter hospital stays (MD=−1.36 d, 95% CI: −2.39, −0.33, I2=86%), and fewer long-term (>30 d) complications (OR=0.56, 95% CI: 0.42, 0.74, I2=20%). Conversely, among nutritional deficiency outcomes, the SADI-S group had few patients with abnormal vitamin D (OR=0.51, 95% CI: 0.36, 0.72, I2=0%) values than the BPD-DS group. Conclusions: SADI-S has shown to be a possible alternative treatment option to BPD-DS in managing patients with obesity. Despite the promising results, further randomized controlled studies with more extended follow-up periods are necessary to ascertain the safety and efficacy of the treatment.
4 citations
TL;DR: LRYGB is associated with a higher proportion of surgical and endoscopic interventions at 5 years compared with LVSG, and more high-quality, long-term studies are required to further elucidate both surgical and nutritional long- term outcomes post these procedures.
Abstract: Background: There is a paucity of data that compares the relative complication profiles of laparoscopic vertical sleeve gastrectomy (LVSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) at 5 years. Objectives: The aim was to compare late complications of LVSG and LRYGB. Methods: We updated our previous systematic review and meta-analysis of randomized controlled trials of primary LVSG and LRYGB procedures in adults, to review late (5 years) complication outcomes (PROSPERO 112054). Electronic databases were searched from January 2015 to July 2021 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was utilized to estimate weighted mean differences where meta-analysis was possible. Bias and certainty of evidence was assessed using the Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluations. Results: Four randomized controlled trials met the inclusion criteria (n=531; LVSG=272, LRYGB=259). No late treatment-related mortality was reported with either procedure. A significant reduction in surgical reoperations (odds ratio: 0.47, 95% confidence interval: 0.27-0.82, P=0.01) and endoscopic interventions (odds ratio: 0.29, 95% confidence interval: 0.12-0.71, P=0.02) were reported at 5 years post-LVSG relative to LRYGB. Reoperations were more frequently performed for reflux management in LVSG and for internal hernia repairs in LRYGB. Complications requiring medical management were common following both procedures. Limitations included few eligible studies for inclusion, and varying definitions of medically managed complications. Conclusions: LRYGB is associated with a higher proportion of surgical and endoscopic interventions at 5 years compared with LVSG. More high-quality, long-term studies are required to further elucidate both surgical and nutritional long-term outcomes post these procedures.
4 citations
TL;DR: In this paper , the safety and efficacy of single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) was compared with BPD-DS in the management of patients with obesity.
Abstract: Biliopancreatic diversion with duodenal switch (BPD-DS) is an effective yet technically challenging bariatric surgery with many complications. Alternatively, single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) was recently introduced as a simplified bariatric procedure. This meta-analysis aimed to assess the safety and efficacy of SADI-S compared with BPD-DS in the management of patients with obesity.Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to May 2022 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis system. The review was registered prospectively with PROSPERO (CRD42022333521).From 123 studies screened, 6 studies met the eligibility criteria, with a total of 1847 patients with obesity undergoing either SADI-S (n=818) or BPD-DS (n=1029). Preoperative body mass index was similar between the 2 groups, and the BPD-DS group had a greater % excess body mass index loss (EBMIL) (MD=-10.16%, 95% confidence interval: -11.80, -8.51, I 2 =0%) at 2 years compared with the SADI-S group. There was no difference observed in preoperative comorbidities and remission, including diabetes, hypertension, and dyslipidemia between SADI-S and BPD-DS cohorts. Compared with BPD-DS, SADI-S had shorter hospital stays (MD=-1.36 d, 95% CI: -2.39, -0.33, I 2 =86%), and fewer long-term (>30 d) complications (OR=0.56, 95% CI: 0.42, 0.74, I 2 =20%). Conversely, among nutritional deficiency outcomes, the SADI-S group had few patients with abnormal vitamin D (OR=0.51, 95% CI: 0.36, 0.72, I 2 =0%) values than the BPD-DS group.SADI-S has shown to be a possible alternative treatment option to BPD-DS in managing patients with obesity. Despite the promising results, further randomized controlled studies with more extended follow-up periods are necessary to ascertain the safety and efficacy of the treatment.
4 citations
TL;DR: In this paper , the Hartung-Knapp-Sidik-Jonkman random effects model was used to estimate weighted mean differences where meta-analysis was possible and bias and certainty of evidence was assessed using the Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluations.
Abstract: There is a paucity of data that compares the relative complication profiles of laparoscopic vertical sleeve gastrectomy (LVSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) at 5 years.The aim was to compare late complications of LVSG and LRYGB.We updated our previous systematic review and meta-analysis of randomized controlled trials of primary LVSG and LRYGB procedures in adults, to review late (5 years) complication outcomes (PROSPERO 112054). Electronic databases were searched from January 2015 to July 2021 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was utilized to estimate weighted mean differences where meta-analysis was possible. Bias and certainty of evidence was assessed using the Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluations.Four randomized controlled trials met the inclusion criteria (n=531; LVSG=272, LRYGB=259). No late treatment-related mortality was reported with either procedure. A significant reduction in surgical reoperations (odds ratio: 0.47, 95% confidence interval: 0.27-0.82, P =0.01) and endoscopic interventions (odds ratio: 0.29, 95% confidence interval: 0.12-0.71, P =0.02) were reported at 5 years post-LVSG relative to LRYGB. Reoperations were more frequently performed for reflux management in LVSG and for internal hernia repairs in LRYGB. Complications requiring medical management were common following both procedures. Limitations included few eligible studies for inclusion, and varying definitions of medically managed complications.LRYGB is associated with a higher proportion of surgical and endoscopic interventions at 5 years compared with LVSG. More high-quality, long-term studies are required to further elucidate both surgical and nutritional long-term outcomes post these procedures.
3 citations
TL;DR: The Critical View of Safety (CVS) aims at preventing bile duct injuries (BDI) in laparoscopic cholecystectomy (LCC) as mentioned in this paper .
Abstract: Background: The Critical View of Safety (CVS) aims at preventing bile duct injuries (BDIs) in laparoscopic cholecystectomy (LCC). This study investigated CVS utilization among surgeons. Methods: Photos from LCCs were scored for satisfactory CVS. Rates of satisfactory CVS, BDIs, and postoperative complications among residents and consultants were compared. A lecture on CVS was given halfway through the study. Results: The study comprised 1532 patients. Residents had higher rates of satisfactory CVS in elective LCCs compared with consultants (34.9% vs. 23.0%, P<0.001), but not in emergency LCCs (18.4% vs. 15.0%, P=0.252). No significant differences in BDIs or postoperative complications emerged between residents and consultants. After the lecture, elective LCCs were photographed more frequently (80.3% vs. 74.0%, P=0.032), but rates of satisfactory CVS, BDIs, and postoperative complications remained unchanged. Conclusions: Utilization of CVS can be affected by a single lecture but affecting rates of satisfactory CVS may require stronger interventions.
3 citations
TL;DR: In this paper , the suitability of Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, American Society of Anesthesiologist (ASA) grade, and Tokyo Guidelines 2018 (TG18) grade was investigated.
Abstract: Intervention options in acute cholecystitis (AC) include drainage (percutaneous/endoscopic) or surgery. Several scoring systems have been used to risk stratify acute surgical patients, but few have been validated. This study investigated the suitability of Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, American Society of Anesthesiologist (ASA) grade, and Tokyo Guidelines 2018 (TG18) grade as predictors of outcome and assess laparoscopic cholecystectomy versus percutaneous cholecystostomy (PC) as treatment options in patients with AC.Retrospective data was collected from patients that underwent acute inpatient cholecystectomy (index admission), urgent interval cholecystectomy (2 to 4 wk) and PC between 2016 and 2018. Data included baseline demographics, co-morbidities, ASA grade, APACHE-II score, TG18 grade, morbidity, and mortality. A P-value of <0.05 was statistically significant. Area under the receiver operating characteristic curve was calculated to compare accuracy of APACHE-II, ASA and TG18 in predicting morbidity.A total of 344 consecutive patients (266 cholecystectomies and 84 PC) were included in the study. Significant difference in co-morbidities [median Charlson Co-Morbidity Index (CCI) 1 surgery and 4 cholecystostomy (PC) (P<0.05)], median APACHE-II score (3 surgery and 9 PC), median TG18 grade (1 surgery and 2 PC) and mortality rate [0% surgery and 7% cholecystostomy (PC)]. TG18 grade alone predicted postoperative/postprocedure morbidity (receiver operating characteristic; AUC=0.884; 95% confidence interval: 0.845-0.923; odds ratio: 4.38, 96% confidence interval, P<0.05).Utilization of the TG18 grade have shown to be more accurate in risk stratifying and predicting outcomes in patients with AC and therefore may appropriately guide biliary intervention.PC can be utilized in a select group of septic and co-morbid patients (myocardial infarction <6 weeks, chest infection and acute cerebrovascular accident) unable to withstand surgical intervention or in those with complex biliary disease (Mirizzi Syndrome). In a proportion, PC drains sepsis to improve critical state of the patient enough to consider an interval cholecystectomy with satisfactory outcomes.
2 citations
TL;DR: In this paper , the authors assessed the educational value of YouTube's top 20 most viewed major laparoscopic liver resection (LLR) videos, based on adherence to key steps in LLR and compliance to the modified LAP-VEGaS.
Abstract: Surgical videos uploaded on social media platforms like YouTube augment the learning experience of advanced procedures like major laparoscopic liver resection (LLR). However, because of the heterogeneous quality, the educational value of such videos is unproven. This study assesses the educational value of YouTube's top 20 most viewed major LLR videos.The search terms "laparoscopic hemihepatectomy," "laparoscopic right hepatectomy," and "laparoscopic left hepatectomy" were searched on YouTube on October 7, 2020. Exclusion criteria were minor hepatectomy, open hepatectomy, live donor right and left hepatectomy, robotic hepatectomy videos, and nonstandard laparoscopic technique. Videos were graded based on adherence to key steps in LLR and compliance to the modified LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS); 29 of the original 37 consensus statements were used in our study.The videos have a median of 7647 views (range: 2675 to 67,449), a median of 34 likes (range: 3 to 67), and a median of 1 dislike (range: 0 to 22). The median duration of major LLR videos was 11.0 minutes (range: 6.38 to 223 min). Majority of the videos had duration of <30 minutes (n=18/20, 90%). There were 14 videos (70%) demonstrating all defined surgical steps. The liver mobilization was shown in 17 videos (75%). Vascular inflow control of hepatic artery and portal vein and vascular outflow control were demonstrated in 18 videos (90%). Parenchymal transection and hemostasis were shown in all videos. The median LAP-VEGaS score across all 20 videos is 6 (range: 1 to 11) out of 29, translating to a median score of 20.6% (range: 3.4% to 37.9%). Thirteen out of 29 of the LAP-VEGaS criteria graded (44.8%) were not met by any of the 20 videos.The top 20 most viewed surgical videos on laparoscopic right and left hepatectomy may not be the ideal material for the educational value of surgical trainees. The LAP-VEGaS guidelines are too exhaustive for relevance to social media platforms as an educational tool.
TL;DR: In this paper , a systematic search of PubMed, Embase, and the Cochrane Library databases was carried out using the terms "laparoscopic," "circular," "linear," "anastomosis," "gastric bypass" in accordance to PRISMA guidelines.
Abstract: To compare the rate of complications of linear versus circular gastrojejunal anastomosis of laparoscopic Roux-en-Y gastric bypass.A systematic search of PubMed, Embase, and the Cochrane Library databases was carried out using the terms "laparoscopic," "circular," "linear," "anastomosis," "gastric bypass" in accordance to PRISMA guidelines. Only original articles in English language comparing linear versus circular anastomosis were included. No temporal interval was set. Outcome measures were wound infection, bleeding, marginal ulcer, leak, and stricture. Pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated. Heterogeneity was assessed using the I2 statistic. Funnel plots were used to detect publication bias.Twenty-two articles (7 prospective and 15 retrospective) out of 184 retrieved papers were included in this study. The pooled analysis showed a reduced odd of wound infection and bleeding after linear anastomosis. Likelihood of marginal ulcer, leak, and stricture was similar after the 2 techniques. Wound infection was reported in 15 studies (OR, 0.17; 95% CI, 0.06-0.45; P=0.0003; I2=91), bleeding in 9 (OR, 0.45; 95% CI, 0.34-0.59; P=0.00001; I2=6) marginal ulcer in 11 (OR, 0.61; 95% CI, 0.26-1.41; P=0.25; I2=65), leaks in 15 (OR, 0.61; 95% CI, 0.21-1.67; P=0.34; I2=83) and stricture in 18 (OR, 0.48; 95% CI, 0.23-1.00; P=0.05; I2=68).Laparoscopic RYGB can be safely performed both with circular and linear staplers. Rates of wound infection and bleeding were significantly lower after linear gastrojejunal anastomosis.
TL;DR: In this article , the effect of the sleeve gastrectomy with transit bipartition (SG-TB) on serum total testosterone and metabolic variable changes in men with obesity and type 2 diabetes was investigated.
Abstract: Metabolic/bariatric surgery has been shown to increase testosterone in males with obesity. This study investigated the effect of the novel metabolic/bariatric surgery procedure, sleeve gastrectomy with transit bipartition (SG-TB), on serum total testosterone and metabolic variable changes in men with obesity and type 2 diabetes.In a prospective single-center cohort study, laboratory samples were analyzed preoperatively and at 6 months following SG-TB in patients with a body mass index (BMI) ≥30 kg/m2. Changes in metabolic parameters and testosterone were evaluated.Between July 2018 and March 2019, 166 patients with a mean baseline BMI of 34.9±3.8 kg/m2 (mean age 51.5±9.3 y), glycosylated hemoglobin 9.5±1.3%, and testosterone 3.1±1.3 underwent SG-TB. At 6-month follow-up, mean excess BMI loss was 70.2±24.3%; glycosylated hemoglobin, 6.6±1.1% (P<0.001); and testosterone, 4.5±1.5 (P<0.001).In the early term following SG-TB, more than any other factor assessed, BMI loss was found to be a significant driver of improvement in testosterone levels. Regardless of preoperative obesity classification, patients with initially low testosterone attained significantly increased testosterone levels at 6-month follow-up.
TL;DR: In this article , the albumin-bilirubin (ALBI) grade has been proposed to evaluate liver function and predict prognosis in patients with hepatocellular carcinoma (HCC).
Abstract: The albumin-bilirubin (ALBI) grade has been proposed to evaluate liver function and predict prognosis in patients with hepatocellular carcinoma (HCC). Data are scarce in terms of the clinical application of ALBI score in patients with HCC undergoing radiofrequency ablation (RFA). The current study sought to assess the prognostic efficacy of ALBI grade in early-stage HCC after RFA.We retrospectively reviewed 344 treatment-naive patients, whereby the overall survival (OS), recurrence-free survival (RFS), local tumor progression, and intrahepatic distant recurrence were assessed using Kaplan-Meier analysis. Predictors determining OS and RFS after RFA were analyzed using Cox proportional hazards analysis.During a median follow-up time of 48.0 months (range: 2 to 158 mo), 48 patients had died because of tumor progression or liver failure. Patients with ALBI grade 2 had poorer OS (P=0.033) and RFS (P=0.002), and higher intrahepatic distant recurrence rate (P<0.001) than those with ALBI grade 1. Local tumor progression rates were comparable between the 2 groups (P=0.801). Multivariate analyses showed that ABLI grade 2 was the only independent risk factor for poor OS (hazard ratio=1.850, 95% confidence interval: 1.041-3.286, P=0.036) and poor RFS (hazard ratio=1.467, 95% confidence interval: 1.094-1.968, P=0.011) after RFA. For Child-Pugh grade A group, patients divided by ALBI grade 1 versus grade 2 showed significant differences in both OS and RFS (P=0.039 and 0.002).The ALBI grade can be used to discriminate long-term prognosis in patients with HCC following RFA and to further stratify prognosis in those with Child-Pugh grade A.
TL;DR: LA is being well adopted in the veterans affairs system with an 8-fold increase over 20 years, with lower morbidity and mortality compared with the open approach for benign adrenal pathologies, and patients with the laparoscopic approach were functionally independent, shorter OT, less intraoperative blood transfusion, shorter LOS, and lower mortality and morbidity.
Abstract: Background: Since the introduction of laparoscopic adrenalectomy (LA) in 1992, it has become the standard of care for most adrenal benign pathologies. This study compares the outcomes and trends of open (OA) versus LA in veterans for benign pathologies. Methods: Veterans Affairs Surgical Quality Improvement Program was queried for adrenalectomies performed for benign pathologies during the period 2000-2019. Data collection included demographics, comorbidities, operative details, and postoperative outcomes. Results: A total of 1683 patients were included (91.4% males, mean age 59.6, mean body mass index 31.2, and 87.2% with American Society of Anesthesiologists class≥III). Overall, the mean operative time (OT) was 3.2 hours, the majority performed by general surgeons (71.4%), and the mean length of stay (LOS) was 4.1 days. There were 12 (0.7%) 30-day mortalities, and 162 patients (8.8%) developed ≥1 complication. LA was performed in 70.9% (1306), with the conversion rate of 0.85% (10). When compared with OA, patients with the laparoscopic approach were functionally independent, shorter OT, less intraoperative blood transfusion, shorter LOS, and lower mortality and morbidity. Dependent functional status, congestive heart failure, American Society of Anesthesiologists class ≥III, and smoking were independent predictors of mortality, whereas intraoperative transfusions, chronic obstructive pulmonary disease, and dependent functional status were predictors of morbidity. Trend analysis showed an 8-fold increase in the use of LA. However, trend analysis for morbidity and mortality rates showed no significant change for both approaches. Conclusion: LA is being well adopted in the veterans affairs system with an 8-fold increase over 20 years, with lower morbidity and mortality compared with the open approach for benign adrenal pathologies.
TL;DR: BC-EIS could achieve a higher variceal eradication rate and milder intraoperative bleeding signs in large EVs, and 11.5-minutes appeared to be the optimal compression time in bc-E IS.
Abstract: Background: The management of large esophageal varices (EVs) remains challenging because of the difficulty of endoscopic variceal ligation and fatal post-endoscopic variceal ligation bleeding ulcers. The current study evaluated the efficacy and safety of balloon-compression endoscopic injection sclerotherapy (bc-EIS) in the treatment of large EVs. Materials and Methods: This retrospective study included 105 patients with cirrhosis exhibiting large EVs (64 in the bc-EIS group and 41 in the EIS group). Primary outcomes included the initial rate of variceal eradication and intraoperative bleeding signs. Secondary outcomes included incidences of rebleeding, mortality, complications, and optimal time of balloon-compression (bc). Results: The initial rate of variceal eradication in the bc-EIS group was significantly higher than that in the EIS group (46.9 vs. 24.4%; P=0.021). The incidence of intraoperative bleeding, which was represented as oozing and spurting, in the bc-EIS group was markedly lower than that in the EIS group (43.8 vs. 61.0% and 9.4 vs. 39.0%, respectively; P=0.043). Patients in the bc-EIS group showed a significantly lower incidence of rebleeding (0.0 vs. 17.1%; P=0.001). However, no significant difference in mortality rate was observed between different groups. Chest pain or discomfort tended to be more common in the EIS group than in the bc-EIS group (58.5 vs. 17.2%; P=0.001). The cut-off value of 11.5-minutes appeared to have a maximum combined sensitivity and specificity of 80.0% and 58.8%, respectively. The area under the curve was 0.708 (95% confidence interval =0.576-0.839; P=0.004). Conclusion: bc-EIS could achieve a higher variceal eradication rate and milder intraoperative bleeding signs in large EVs. Furthermore, 11.5-minutes appeared to be the optimal compression time in bc-EIS.
TL;DR: In this article , the authors tested a novel bowel preparation method before colonoscopy using insoluble dietary fiber and probiotics (PB), and the mean required volume of MoviPrep was significantly lower in the WBF with PB group than in the control group (582.5 vs. 1305 mL, P<0.0001).
Abstract: Background: In screening colonoscopy, patients usually have to ingest large amounts of bowel-cleansing agents, including polyethylene glycol (PEG). This is difficult and has various side effects; thus, patients avoid undergoing a colonoscopy. We tested a novel bowel preparation method before colonoscopy using insoluble dietary fiber and probiotics (PB). Methods: This was a prospective clinical study conducted between October 2018 and March 2019 at a general hospital. Forty participants were randomly assigned to low-volume PEG solution diet (MoviPrep), wheat bran fiber (WBF) and probiotic Bifidobacterium animalis subsp. lactis GCL2505 (PB GCL2505), or standard-volume regimen (1.0 to 1.5 L of MoviPrep) (control group). The patient compliance and the quality of bowel preparation were evaluated. Results: Forty individuals aged 38 to 83 years were randomly assigned to the WBF with PB (n=20) and control (n=20) groups. All participants underwent bowel preparation before colonoscopy according to each protocol. The mean required volume of MoviPrep was significantly lower in the WBF with PB group than in the control group (582.5 vs. 1305 mL, P<0.0001). Successful bowel-cleansing rates were not significantly different between the 2 groups; however, the ratio of the Harefield Cleansing Scale grades C and D was significantly lower in the WBF with PB group than in the control group (P=0.0471). Conclusions: The intake of WBF and GCL2505 before colonoscopy reduces the required PEG quantities while maintaining bowel-cleansing quality. This novel, minimally invasive pretreatment method makes colonoscopy more accessible contributing to the prevention and early treatment of colorectal cancer.
TL;DR: In this paper, the authors evaluated the impact of a defunctioning stoma on AL and its consequences after left colectomy in high-risk patients, and found that defunctional stoma does not appear to reduce the rate of AL in high risk patients, but its impact on the management of AL remains unclear.
Abstract: Introduction: Left colectomy is associated with a 7% risk of anastomotic leak. In 2011, a prediction score for AL [the colon leakage score (CLS)] was developed. The aim was to evaluate the impact of a defunctioning stoma on AL and its consequences after left colectomy in high-risk patients. Patients: From January 2012 to June 2019, high-risk patients who underwent a left colectomy with anastomosis were included in this retrospective, single-center study. Two groups of patients were defined: patients undergoing a left colectomy with an anastomosis without a defunctioning stoma (no-stoma group) and those with a defunctioning stoma (stoma group). The primary endpoint was the rate of anastomotic leakage. Results: Ninety-two patients were included in this study. The anastomotic leakage rate was 16.4% in the no-stoma group and 21.6% in the stoma group (P=0.5). A conservative approach was applied to 11.2% in the no-stoma group and 50% in the stoma group (P=0.1). The severe morbidity rate was 14.5% in the no-stoma group and 21.6% in the stoma group (P=0.4). The rate of unplanned admissions was 7% in the no-stoma group and 27% in the stoma group (P=0.01). Conclusion: A defunctioning stoma does not appear to reduce the rate of AL in high-risk patients, but its impact on the management of AL remains unclear.
TL;DR: In this paper , the outcomes and trends of open (OA) versus laparoscopic adrenalectomy (LA) in veterans for benign pathologies were compared and the trend analysis for morbidity and mortality rates showed no significant change for both approaches.
Abstract: Background: Since the introduction of laparoscopic adrenalectomy (LA) in 1992, it has become the standard of care for most adrenal benign pathologies. This study compares the outcomes and trends of open (OA) versus LA in veterans for benign pathologies. Methods: Veterans Affairs Surgical Quality Improvement Program was queried for adrenalectomies performed for benign pathologies during the period 2000-2019. Data collection included demographics, comorbidities, operative details, and postoperative outcomes. Results: A total of 1683 patients were included (91.4% males, mean age 59.6, mean body mass index 31.2, and 87.2% with American Society of Anesthesiologists class≥III). Overall, the mean operative time (OT) was 3.2 hours, the majority performed by general surgeons (71.4%), and the mean length of stay (LOS) was 4.1 days. There were 12 (0.7%) 30-day mortalities, and 162 patients (8.8%) developed ≥1 complication. LA was performed in 70.9% (1306), with the conversion rate of 0.85% (10). When compared with OA, patients with the laparoscopic approach were functionally independent, shorter OT, less intraoperative blood transfusion, shorter LOS, and lower mortality and morbidity. Dependent functional status, congestive heart failure, American Society of Anesthesiologists class ≥III, and smoking were independent predictors of mortality, whereas intraoperative transfusions, chronic obstructive pulmonary disease, and dependent functional status were predictors of morbidity. Trend analysis showed an 8-fold increase in the use of LA. However, trend analysis for morbidity and mortality rates showed no significant change for both approaches. Conclusion: LA is being well adopted in the veterans affairs system with an 8-fold increase over 20 years, with lower morbidity and mortality compared with the open approach for benign adrenal pathologies.
TL;DR: In this paper , an improved collateral ventilation method was proposed to identify the inflation-deflation line without waiting and without any auxiliary materials needed during robotic-assisted anatomic segmentectomy.
Abstract: Identifying intersegmental planes is considered the key step during segmentectomy. Several techniques, including modified inflation-deflation techniques, target-segment jet ventilation, and infrared-fluorescence-enhanced methods, have been reported for the identification of intersegmental planes. However, limitations of these methods have also been reported. Here, we described an improved collateral ventilation method to identify the inflation-deflation line without waiting and without any auxiliary materials needed during robotic-assisted anatomic segmentectomy. We present this handy technique of identifying the intersegmental planes and comment on its advantages, including decreased operative time and improved clarity of the inflation-deflation line.
TL;DR: In the early term following SG-TB, BMI loss was found to be a significant driver of improvement in testosterone levels, and regardless of preoperative obesity classification, patients with initially low testosterone attained significantly increased testosterone levels at 6-month follow-up.
Abstract: Background: Metabolic/bariatric surgery has been shown to increase testosterone in males with obesity. This study investigated the effect of the novel metabolic/bariatric surgery procedure, sleeve gastrectomy with transit bipartition (SG-TB), on serum total testosterone and metabolic variable changes in men with obesity and type 2 diabetes. Methods: In a prospective single-center cohort study, laboratory samples were analyzed preoperatively and at 6 months following SG-TB in patients with a body mass index (BMI) ≥30 kg/m2. Changes in metabolic parameters and testosterone were evaluated. Results: Between July 2018 and March 2019, 166 patients with a mean baseline BMI of 34.9±3.8 kg/m2 (mean age 51.5±9.3 y), glycosylated hemoglobin 9.5±1.3%, and testosterone 3.1±1.3 underwent SG-TB. At 6-month follow-up, mean excess BMI loss was 70.2±24.3%; glycosylated hemoglobin, 6.6±1.1% (P<0.001); and testosterone, 4.5±1.5 (P<0.001). Conclusion: In the early term following SG-TB, more than any other factor assessed, BMI loss was found to be a significant driver of improvement in testosterone levels. Regardless of preoperative obesity classification, patients with initially low testosterone attained significantly increased testosterone levels at 6-month follow-up.
TL;DR: Efficacy and complication rates of bariatric surgeries are similar in patients with BMI 50 to 60 kg/m2 and >60kg/ m2, providing evidence supporting similar management of patients despite specific subgroups.
Abstract: Introduction: Patients undergoing bariatric surgery with body mass index (BMI) >50 kg/m2 are at a higher risk of surgical morbidity when compared with less obese patients, however, there is limited data correlating surgical risk and efficacy with increasing BMI in patients with severe obesity. We hypothesize that regardless of the degree above 50 kg/m2 their BMI, patients with severe obesity respond similarly to bariatric surgery. Materials and Methods: We performed a retrospective analysis of patients with BMI >50 kg/m2 who underwent biliopancreatic diversion with duodenal switch, Roux-en-Y gastric bypass, or sleeve gastrectomy at a single institution. Outcomes were compared in patients with a BMI between 50 and 60 kg/m2 to patients with a BMI >60 kg/m2 and included percent total weight loss as well as early and late complications. Statistical analyses were performed using logistic regression, univariate, and multivariate models. Results: There were 571 patients with BMI >50 kg/m2 who underwent bariatric surgery at our center, 170 (29.8%) had a BMI >60 kg/m2. Percent total weight loss was statistically significant between the BMI 50 and 60 kg/m2 and BMI >60 kg/m2 groups at 24 months (P=0.047) but not at 60 months (P=0.54). No significant difference was found in the incidence of early complications in a univariate (P=0.46) or a multivariate (P=0.06) analysis. The BMI >60 subgroup was associated with a higher rate of late complications in univariate analysis (heart rate=2.37; 1.03-5.47, P=0.04), but not in multivariate analysis (P=0.78). Conclusions: Efficacy and complication rates of bariatric surgeries are similar in patients with BMI 50 to 60 kg/m2 and >60 kg/m2, providing evidence supporting similar management of patients despite specific subgroups.
TL;DR: Bupivacaine spraying reduces postoperative abdominal pain, while drain placement minimizes shoulder pain by reducing CO2 remaining under the diaphragm.
Abstract: Background: Although many studies have investigated control of postoperative pain, inadequacy of treatment still remains. In this study, we aimed to identify a method with the capacity to minimize abdominal and right shoulder pain after laparoscopic cholecystectomy. Materials and Methods: A total of 684 subjects, 77% (n=527) female and 23% (n=157) male, were included in this study. A T-drain was prescribed for patients requiring bile duct exploration and patients with acute cholecystitis were excluded from the study. Subjects were classified into groups as follows: Group 1: control group without drain and intraperitoneal analgesics; Group 2: a drain was placed but no intraperitoneal analgesic was applied; Group 3: no drain was placed and intraperitoneal subhepatic bupivacaine was applied; and Group 4: drain was placed and intraperitoneal subhepatic bupivacaine was applied. Parietal pain and visceral pain were evaluated with visual analog scale (VAS). Results: A drain was present in 51.9% (n=355) of the cases. A statistically significant difference was found between the preoperative pulse rate measurements of the cases according to the groups (P=0.009; <0.01). Subhepatic bupivacaine was administered in 50.1% (n=355) of the cases. A statistically significant difference was found between the second, fourth, sixth, 12th, and 24th hour VAS scores of the cases according to the groups [2 h VAS scores (mean±SD): Group 1: 3.58±1.07, Group 2: 3.86±1.12, Group 3: 1.20±0.67, and Group 4: 1.50±1.21 (P<0.001)]; [4 h VAS scores (mean±SD): Group 1: 2.55±1.26, Group 2: 2.87±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 (P<0.001)]; [6 h VAS scores (mean±SD): Group 1: 2.50±0.91, Group 2: 2.53±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 (P<0.001)]; [12 h VAS scores (mean±SD): Group 1: 3.24±1.2, Group 2: 3.49±1.14, Group 3: 2.83±0.98, and Group 4 : 2.99±1.36 (P<0.001)]; and [24 h VAS scores (mean±SD): Group 1: 3.75±0.99, Group 2: 4.01±0.91, Group 3: 3.61±1.34, and Group 4: 4.01±1.08 (P<0.001)]. Conclusion: Bupivacaine spraying reduces postoperative abdominal pain, while drain placement minimizes shoulder pain by reducing CO2 remaining under the diaphragm.
TL;DR: In this article , the authors evaluated the feasibility of using a standardized intraoperative neuromonitoring method for TOETVA in consecutive patients who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA).
Abstract: Intraoperative neuromonitoring in thyroid surgeries has become popular, but the standardized manner of intraoperative neuromonitoring during transoral endoscopic thyroidectomy vestibular approach (TOETVA) is not well established. This study evaluated the feasibility of using a standardized intraoperative neuromonitoring method for TOETVA.Medical records of consecutive patients who underwent TOETVA with intraoperative neuromonitoring were retrospectively reviewed. Patients were positioned before intubation to prevent tube migration, then intubated using video laryngoscopy. The electromyography amplitudes of the vagal nerves and the recurrent laryngeal nerves were checked before (V1, R1) and after (V2, R2) thyroid resection. V1 and V2 signals were evaluated using a long ball tip stimulator with a stimulus current of 3 mA. R1 and R2 signals were obtained using the stimulus current of 1 to 3 mA.Forty-two patients (3 males and 39 females) were included. Lobectomy was performed in 40 patients (95.2%) and total thyroidectomy in 2 (4.8%). Pathologic diagnoses were 30 papillary thyroid carcinomas, 2 follicular thyroid carcinomas, and 9 benign diseases. Conversion to open surgery occurred in 1 patient due to bleeding. Thus, 43 nerves at risk in 41 patients were analyzed. V1 and R1 signals were detected from all nerves. The mean V1 and R1 amplitudes were 738.7±391.4 μV and 804.4±347.5 μV, respectively, and 38 (88.3%) and 39 (90.7%) nerves had R1 and V1 amplitudes of more than 500 μV. There were 2 cases (4.6%) of transient recurrent laryngeal nerve injury. R2 and V2 signals were detected in the 41 remaining nerves. The mean R2 and V2 amplitudes were 917.2±505.2 μV and 715.7±356.2 μV, respectively, and 36 (87.8%) and 32 (78.0%) nerves had respective R2 and V2 amplitudes of more than 500 μV.Intraoperative neuromonitoring could be performed in a standardized manner in TOETVA, and the quality of intraoperative neuromonitoring was excellent. Further studies are needed to verify the feasibility of the current approach.
TL;DR: The ALBI grade can be used to discriminate long-term prognosis in patients with HCC following RFA and to further stratify prognosisIn those with Child-Pugh grade A.
Abstract: Background: The albumin-bilirubin (ALBI) grade has been proposed to evaluate liver function and predict prognosis in patients with hepatocellular carcinoma (HCC). Data are scarce in terms of the clinical application of ALBI score in patients with HCC undergoing radiofrequency ablation (RFA). The current study sought to assess the prognostic efficacy of ALBI grade in early-stage HCC after RFA. Methods: We retrospectively reviewed 344 treatment-naive patients, whereby the overall survival (OS), recurrence-free survival (RFS), local tumor progression, and intrahepatic distant recurrence were assessed using Kaplan-Meier analysis. Predictors determining OS and RFS after RFA were analyzed using Cox proportional hazards analysis. Results: During a median follow-up time of 48.0 months (range: 2 to 158 mo), 48 patients had died because of tumor progression or liver failure. Patients with ALBI grade 2 had poorer OS (P=0.033) and RFS (P=0.002), and higher intrahepatic distant recurrence rate (P<0.001) than those with ALBI grade 1. Local tumor progression rates were comparable between the 2 groups (P=0.801). Multivariate analyses showed that ABLI grade 2 was the only independent risk factor for poor OS (hazard ratio=1.850, 95% confidence interval: 1.041-3.286, P=0.036) and poor RFS (hazard ratio=1.467, 95% confidence interval: 1.094-1.968, P=0.011) after RFA. For Child-Pugh grade A group, patients divided by ALBI grade 1 versus grade 2 showed significant differences in both OS and RFS (P=0.039 and 0.002). Conclusion: The ALBI grade can be used to discriminate long-term prognosis in patients with HCC following RFA and to further stratify prognosis in those with Child-Pugh grade A.
TL;DR: Evaluating the different "timing" ("early" vs. "delayed" cholecystectomy) through the application of network meta-analyses found the most adequate interval associated with the best outcomes.
Abstract: Background: Acute cholecystitis (AC) is largely diffused among population worldwide. Laparoscopic cholecystectomy is the treatment of choice. Current evidence suggests a clinical benefit of early cholecystectomy. The aim of the present study was to evaluate the different “timing” (“early” vs. “delayed” cholecystectomy), through the application of network meta-analyses, to define the most adequate interval associated with the best outcomes. Materials and methods: A network meta-analysis of randomized controlled trials was conducted. Results: Early cholecystectomy ≤72 hours from symptoms reduced conversion rate in comparison to: cholecystectomy ≤7 days from symptoms (P=0.044), delayed cholecystectomy within 1 to 5 weeks from first admission (P=0.010) and 6 to 12 weeks from symptoms resolutions (P=0.009). Delaying cholecystectomy to 6 to 12 weeks reduces operating time in respect to early cholecystectomy ≤72 hours from symptoms (P=0.001), within 24 hours from admission (P=0.001), ≤72 hours from admission (P=0.001) and ≤7 days from symptoms (P=0.001). Cholecystectomy ≤24 hours from admission was the best strategy to reduce total in-hospital stay, whereas delaying cholecystectomy to 6 to 12 weeks was the worst strategy. The same applied when cholecystectomy was performed ≤72 hours from symptoms in respect to both delayed strategies (P=0.001 for both comparisons) or when it was performed ≤72 hours from admission (P=0.001 for both comparisons). Cholecystectomy ≤72 hours from symptoms onset was the best strategy to reduce postoperative complications, the worst was represented by delayed cholecystectomy at 1 to 5 weeks from first admission. Conclusion: AC should be operated as soon as possible. AC surgical management should be considered in a dynamic time conception to optimize clinical, organizational, and economical outcomes.
TL;DR: Endoscopic operation for small gastrointestinal stromal tumors contributes to shortened lengths of surgery and hospital stay and reduces intraoperative blood loss and promotes gastroenteric functional recovery without increasing the risk of complications or tumor recurrence.
Abstract: This study aims to systematically evaluate the efficacy of endoscopic resection (ER), laparoscopic resection (LR), laparoscopic endoscopic cooperative surgery (LECS), and open surgery (OpS) for gastrointestinal stromal tumors with small diameters (≤5 cm). Relevant studies were collected through Pubmed, Cochrane Library, and Embase databases. Operative time, hospital stays, time to liquid diet, intraoperative bleeding, and complications were used as outcome indicators for meta-analysis. Twenty-four retrospective cohort studies with 2406 participants were analyzed. LR and OpS groups had longer operating time than the ER group. ER, LECS, and LR groups had decreased lengths of hospital stay than the OpS group. Moreover, patients in LR and LECS groups had fewer complications than those in the OpS group. Endoscopic operation for small gastrointestinal stromal tumors contributes to shortened lengths of surgery and hospital stay. This reduces intraoperative blood loss and promotes gastroenteric functional recovery without increasing the risk of complications or tumor recurrence.
TL;DR: In this study, single-dermatome laparoscopic appendectomy (SDLA) caused less pain in AA cases during postoperative period than SLA, and the SDLA method achieved higher patient satisfaction during the postoperatively period than the SLA method.
Abstract: Background: Laparoscopic appendectomy (LA), used since 1980, is a common surgical technique for acute appendicitis (AA) treatment. Laparoscopic surgical techniques can achieve higher patient satisfaction than conventional open surgery techniques. However, many patients complain of severe pain after laparoscopic abdominal surgeries. In this study, we compared single-dermatome laparoscopic appendectomy (SDLA), wherein all trocars were placed at the same dermatome field, with standard laparoscopic appendectomy (SLA), wherein trocars were placed at multiple dermatome sites, in terms of postoperative pain and patient satisfaction. Materials and Methods: The study was designed as a double-blind randomized controlled trial. Patients who underwent LA for AA between May 2019 and December 2019 were included in the study and randomized into 2 groups, wherein patients were included sequentially. The first group was operated with SLA surgery, whereas the second group was operated with SDLA surgery. All patients were assessed in terms of visual analog scale (VAS) scores, hemodynamic parameters, and patient satisfaction at postoperative 1, 2, 4, 6, 12, and 24 hours. Results: In the SLA technique, VAS values at postoperative 1, 2, and 4 hours were significantly higher than in the SDLA (P=0.009; P<0.05). No significant difference was observed between the surgical techniques in terms of VAS levels at postoperative 6, 12, and 24 hours (P>0.05). In the SDLA group, patient satisfaction was significantly higher than in the SLA group (P=0.024; P<0.05). Conclusions: In our study, SDLA caused less pain in AA cases during postoperative period than SLA. Further, the SDLA method achieved higher patient satisfaction during the postoperative period than the SLA method.
TL;DR: Underutilized laparoscopic common bile duct exploration (LCBDE) can provide many benefits to patients including avoidance of additional procedures, shorter length of stay, higher success rates, and less costs.
Abstract: Background: Biliary disease is common occurrence and can make up a large portion of the practice of a general surgeon. Choledocholithasis is a common entity amongst those with biliary disease. Although modern trends favor endoscopic retrograde cholangiopancreatography (ERCP) and other imaging modalities for the diagnosis and management of choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is likely underutilized. Methods: A literature summary utilizing a PUBMED search was performed to provide an up-to-date account regarding the latest data on LCBDE. A video identifying and explaining the critical components of a LBCDE procedure is provided. Results: LCBDE is an underutilized procedure which offers equivalent clinical outcomes compared with ERCP along with a shorter length of stay and reduced costs. LCBDE is also noted to be an effective option for common bile duct stones in the setting of altered anatomy, such as a Roux-en-Y gastric bypass. Conclusion: Although modern trends favor ERCP and other imaging modalities for the diagnosis and management of choledocholithiasis, LCBDE is likely underutilized by surgeons. LCBDE can provide many benefits to patients including avoidance of additional procedures, shorter length of stay, higher success rates, and less costs. Out video should act is a guide for those surgeons interested in implementation LCBDE in their practice.
TL;DR: HS and SSLS intrathoracic esophagogastric anastomoses are associated with significantly higher rates of an anastsomotic leak than CS anASTomosis.
Abstract: Background: Three anastomotic techniques are mostly used to create an esophagogastric anastomosis in a transthoracic esophagectomy: hand-sewn (HS), side-to-side linear-stapled (SSLS), and circular-stapled (CS). The aim of this study was to compare surgical outcomes after HS, SSLS, and CS intrathoracic esophagogastric anastomosis. Materials and Methods: A systematic review using the MEDLINE database was performed to identify original articles analyzing outcomes after HS, SSLS, and CS esophagogastric anastomosis. The main outcome was an anastomotic leakage rate. Secondary outcomes included overall morbidity, major morbidity, and mortality. A meta-analysis of proportions and linear regression models were used to assess the effect of each anastomotic technique on the different outcomes. Results: A total of 101 studies comprising 12,595 patients were included; 8835 (70.1%) with CS, 2532 (20.1%) with HS, and 1228 (9.8%) with SSLS anastomosis. Anastomotic leak occurred in 10% [95% confidence interval (CI), 6%-15%], 9% (95% CI, 6%-13%), and 6% (95% CI, 5%-7%) of patients after HS, SSLS, and CS anastomosis, respectively. Risk of anastomotic leakage was significantly higher with HS anastomosis (odds ratio=1.73, 95% CI: 1.47-2.03, P<0.0001) and SSLS (odds ratio=1.68, 95% CI: 1.36-2.08, P<0.0001), as compared with CS. Overall morbidity (HS: 52% vs. SLSS: 39% vs. CS: 35%) and major morbidity (HS: 33% vs. CS: 19%) rates were significantly lower with CS anastomosis. Mortality rate was 4% (95% CI, 3%-6%), 2% (95% CI, 2%-3%), and 3% (95% CI, 3%-4%) after HS, SSLS, and CS anastomosis, respectively. Conclusion: HS and SSLS intrathoracic esophagogastric anastomoses are associated with significantly higher rates of an anastomotic leak than CS anastomosis.