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Wu XW, Yang DQ, Wang MW, Jiao Y. Occurrence and prevention of incisional hernia following laparoscopic colorectal surgery. World J Gastrointest Surg 2024; 16:1973-1980. [PMID: 39087097 PMCID: PMC11287670 DOI: 10.4240/wjgs.v16.i7.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 07/22/2024] Open
Abstract
Among minimally invasive surgical procedures, colorectal surgery is associated with a notably higher incidence of incisional hernia (IH), ranging from 1.7% to 24.3%. This complication poses a significant burden on the healthcare system annually, necessitating urgent attention from surgeons. In a study published in the World Journal of Gastrointestinal Surgery, Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence. This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery, emphasizing the impact of obesity, surgical site infection, and the choice of incision location on its development. Furthermore, we summarize the currently available preventive measures for IH. Given the low surgical repair rate and high recurrence rate associated with IH, prevention deserves greater research and attention compared to treatment.
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Affiliation(s)
- Xi-Wen Wu
- The First Operating Room, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ding-Quan Yang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ming-Wei Wang
- Ministry of Health Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun 130000, Jilin Province, China
| | - Yan Jiao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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2
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Whalen A, Holla S, Renshaw S, Olson M, Sreevalsan K, Poulose BK, Collins CE. Outcomes and quality of life of frail patients following elective ventral hernia repair: Retrospective review of a national hernia collaborative. Am J Surg 2024; 233:65-71. [PMID: 38383165 DOI: 10.1016/j.amjsurg.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Ventral hernia repair (VHR) is one of the most common general surgery procedures among older adults but is often deferred due to a higher risk of complications. This study compares postoperative quality of life (QOL) and complications between frail and non-frail patients undergoing elective VHR. We hypothesized that frail patients would have higher complication rates and smaller gains in quality of life compared to non-frail patients. STUDY DESIGN Patients 65 years of age and older, undergoing elective VHR between 2018 and 2022 were selected from the ACHQC (Abdominal Core Health Quality Collaborative) and grouped based on frailty scores obtained using the Modified Frailty Index (mFI-5). Logistic regression adjusting for hernia characteristics (size, recurrent, parastomal, incisional) were performed for 30-day outcomes including surgical site infections (SSI), surgical site occurrences (SSO), surgical site infections/occurrences requiring procedural intervention (SSOPI), and readmission. Multivariable analyses controlling for patient and procedure characteristics were performed comparing QOL scores (HerQLes scale, 0-100) at baseline, 30 days, 6 months and 1 year postoperatively. RESULTS A total of 4888 patients were included, 29.17% non-frail, 47.87% frail, and 22.95% severely frail. On adjusted analysis, severely frail patients had higher odds of SSO (most commonly seroma formation) but no evidence of a difference in SSI, SSOPI, readmission or mortality. Severely frail patients had lower median QOL scores at baseline (48.3/100, IQR 26.1-71.7, p = 0.001) but reported higher QOL scores at both 30-days (68.3/100, IQR 41.7-88.3, p = 0.01) and 6-months (86.7/100, IQR 65.0-93.3, p = 0.005). CONCLUSION Severely frail patients reported similar increases in QOL and similar complications to their not frail counterparts. Our results demonstrate that appropriately selected older patients, even those who are severely frail, may benefit from elective VHR in the appropriate clinical circumstance.
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Affiliation(s)
- Alison Whalen
- The Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Sahana Holla
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Savannah Renshaw
- The Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Molly Olson
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Kavya Sreevalsan
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Benjamin K Poulose
- The Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Courtney E Collins
- The Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Huang X, Shao X, Cheng T, Li J. Laparoscopic intraperitoneal onlay mesh (IPOM) with fascial repair (IPOM-plus) for ventral and incisional hernia: a systematic review and meta-analysis. Hernia 2024; 28:385-400. [PMID: 38319440 DOI: 10.1007/s10029-024-02983-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/28/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE Despite advancements in laparoscopic ventral hernia repair (LVHR) using the intraperitoneal onlay mesh technique (sIPOM), recurrence remains a common postoperative complication. The objective of this systematic review and meta-analysis is to compare the efficacy of defect closure (IPOM-plus) versus non-closure in ventral and incisional hernia repair. The aim is to determine which technique yields better outcomes in terms of reducing recurrence and complication rates. METHODS A comprehensive literature review was conducted in the PubMed, Web of Science, Cochrane Library, Embase, and ClinicalTrials.gov databases from their inception until October 1, 2022, to identify all online English publications that compared the outcomes of laparoscopic ventral hernia repair with and without fascia closure. RESULTS Three randomized controlled trials (RCTs) and eleven cohort studies involving 1585 patients met the inclusion criteria. The IPOM-plus technique was found to reduce the recurrence of hernias (OR = 0.51, 95% CI [0.35, 0.76], p < 0.01), seroma (OR = 0.48, 95% CI [0.32, 0.71], p < 0.01), and mesh bulging (OR = 0.08, 95% CI [0.01, 0.42], p < 0.01). Subgroup analysis revealed that body mass index (BMI) (OR = 0.43, 95% CI [0.29, 0.65], p < 0.0001), type of article (OR = 0.51, 95% CI [0.35, 0.76], p = 0.0008 < 0.01), geographical location (OR = 0.54, 95% CI [0.36, 0.82], p = 0.004 < 0.01), follow-up time (OR = 0.50, 95% CI [0.34, 0.73], p = 0.0004 < 0.01) had a significant influence on the postoperative recurrence of the IPOM-plus technique. CONCLUSION The IPOM-plus technique has been shown to greatly reduce the occurrence of recurrence, seroma, and mesh bulging. Overall, the IPOM-plus technique is considered a safe and effective procedure. However, additional randomized controlled studies with extended follow-up periods are necessary to further evaluate the IPOM-plus technique.
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Affiliation(s)
- X Huang
- School of Medicine, Southeast University, Nanjing, 210009, China
| | - X Shao
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - T Cheng
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - J Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China.
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Andersson J, Angenete E, Gellerstedt M, Haglind E. Developing a multivariable prediction model of global health-related quality of life in patients treated for rectal cancer: a prospective study in five countries. Int J Colorectal Dis 2024; 39:35. [PMID: 38441657 PMCID: PMC10914847 DOI: 10.1007/s00384-024-04605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Rectal cancer and its treatment have a negative impact on health-related quality of life (HRQoL). If risk factors for sustained low HRQoL could be identified early, ideally before the start of treatment, individualised interventions could be identified and implemented to maintain or improve HRQoL. The study aimed to develop a multivariable prediction model for global HRQoL 12 months after rectal cancer treatment. METHODS Within COLOR II, a randomised, multicentre, international trial of laparoscopic and open surgery for rectal cancer, a sub-study on HRQoL included 385 patients in 12 hospitals and five countries. The HRQoL study was optional for hospitals in the COLOR II trial. EORTC QLQ-C30 and EORTC QLQ-CR38 were analysed preoperatively and at 1 and 12 months postoperatively. In exploratory analyses, correlations between age, sex, fatigue, pain, ASA classification, complications, and symptoms after surgery to HRQoL were studied. Bivariate initial analyses were followed by multivariate regression models. RESULTS Patient characteristics and clinical factors explained 4-10% of the variation in global HRQoL. The patient-reported outcomes from EORTC QLQ-C30 explained 55-65% of the variation in global HRQoL. The predominant predictors were fatigue and pain, which significantly impacted global HRQoL at all time points measured. CONCLUSION We found that fatigue and pain were two significant factors associated with posttreatment global HRQoL in patients treated for rectal cancer T1-T3 Nx. Interventions to reduce fatigue and pain could enhance global HRQoL after rectal cancer treatment. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov No. NCT00297791.
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Affiliation(s)
- John Andersson
- Department of General and Orthopaedic Surgery, Alingsås Hospital, Alingsås, Sweden
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Angenete
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | | | - Eva Haglind
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
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Liang JT, Liao YT, Chen TC, Huang J, Hung JS. Changing patterns and surgical outcomes of small bowel obstruction in the era of minimally invasive surgery for colorectal cancer. Int J Surg 2024; 110:1577-1585. [PMID: 38051917 PMCID: PMC10942203 DOI: 10.1097/js9.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION This study aimed to investigate whether the incidence, patterns, and surgical outcomes of small bowel obstruction (SBO) have changed in the era of minimally invasive surgery (MIS) for primary colorectal cancer (CRC). METHODS Consecutive patients who underwent laparotomy for SBO were divided into MIS and traditional open surgery (TOS) groups based on the previous colorectal cancer operation technique used. The MIS group was selected from 1544 consecutive patients who underwent MIS as a treatment for primary CRCs between 2014 and 2022, while the TOS group was selected from 1604 consecutive patients who underwent TOS as a treatment for primary CRCs between 2004 and 2013. The demographics, clinicopathological features, and surgical outcomes were compared between the two groups. RESULTS The SBO incidence in patients who underwent MIS for primary CRC was significantly lower than that in patients who underwent TOS (4.4%, n =68/1544 vs. 9.7%, n =156/1604, P <0.0001). Compared with the TOS group, the MIS group had significantly different ( P <0.0001) SBO patterns: adhesion (48.5 vs. 91.7%), internal herniation (23.5 vs. 2.6%), external herniation (11.8 vs. 1.9%), twisted bowel limbs (4.4 vs. 0.6%), ileal volvulus with pelvic floor adhesion (5.9 vs. 1.9%), and nonspecific external compression (5.9 vs. 1.3%). A subset analysis of patients with adhesive SBO (ASBO) showed that the MIS group tended to ( P <0.0001) have bands or simple adhesions (75.8%), whereas the TOS group predominantly had matted-type adhesions (59.4%). Furthermore, SBO in the MIS group had an acute (<3 months) or early (3-12 months) onset (64.7%), while that in the TOS group ( P <0.0001) had an intermediate or a late onset. When the surgical outcomes of SBO were evaluated, the TOS group had significantly more ( P <0.0001) blood loss and longer operation time; however, no significant difference was observed in the surgical morbidity/mortality (Clavien-Dindo classification ≧3, 11.8 vs. 14.1%, P =0.6367), hospitalization, and readmission rates between the two groups. Postoperative follow-up showed that the estimated 3-year (11.37 vs. 18.8%) and 6-year (25.54 vs. 67.4%) recurrence rates of SBO were significantly lower ( P =0.016) in the MIS group than in the TOS group. CONCLUSIONS The wide adoption of MIS to treat primary CRC has led to a lower incidence, altered patterns, and reduced recurrence rates of SBO. Awareness of this new trend will help develop surgical techniques to prevent incomplete restoration of anatomical defects and bowel malalignments specifically associated with MIS for CRC, as well as facilitate timely and appropriate management of SBO complications whenever they occur.
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Affiliation(s)
- Jin-Tung Liang
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
| | - Yu-Tso Liao
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
| | - Tzu-Chun Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, Republic of China
| | - John Huang
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
| | - Ji-Shiang Hung
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
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Mota BBL, Macedo TJB, Parra RS, Rocha JJRDA, Feres O, Feitosa MR. Retrospective analysis of surgical and oncological results of laparoscopic surgeries performed by residents of coloproctology. Rev Col Bras Cir 2023; 50:e20233404. [PMID: 37222382 PMCID: PMC10508675 DOI: 10.1590/0100-6991e-20233404-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/29/2022] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION with the improvement and wide acceptance of laparoscopy in colorectal operations, there was a need for specific training of surgeons in training. There are few studies evaluating the postoperative results of laparoscopic colectomies performed by resident physicians and their impact on patient safety. PURPOSE to analyze the surgical and oncological results of laparoscopic colectomies performed by coloproctology residents and compare them with data in the literature. METHODS this is a retrospective analysis of patients undergoing laparoscopic colorectal surgery performed by resident physicians at the Hospital das Clínicas de Ribeirão Preto, between 2014 and 2018. The clinical characteristics of the patients were studied, as well as the main surgical and oncological aspects in a period of one year. RESULTS we analyzed 191 operations, whose main surgical indication was adenocarcinoma, most of them stage III. The mean duration of surgeries was 210±58 minutes. There was a need for a stoma in 21.5% of the patients, mainly loop colostomy. The conversion rate was 23%, with 79.5% due to technical difficulties, and the main predictors of conversion were obesity and intraoperative accidents. The median length of stay was 6 days. Preoperative anemia was associated with a higher rate of complications (11.5%) and reoperations (12%). Surgical resection margins were compromised in 8.6% of cases. The one-year recurrence rate was 3.2% and the mortality rate was 6.3%. CONCLUSIONS videolaparoscopic colorectal surgery performed by residents showed efficacy and safety similar to data found in the literature.
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Affiliation(s)
- Bárbara Bianca Linhares Mota
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Tarcísio Junior Bittencourt Macedo
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Rogério Serafim Parra
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - José Joaquim Ribeiro DA Rocha
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Omar Feres
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Marley Ribeiro Feitosa
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
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Rios-Diaz AJ, Morris MP, Christopher AN, Patel V, Broach RB, Heniford BT, Hsu JY, Fischer JP. National epidemiologic trends (2008-2018) in the United States for the incidence and expenditures associated with incisional hernia in relation to abdominal surgery. Hernia 2022; 26:1355-1368. [PMID: 36006563 DOI: 10.1007/s10029-022-02644-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE It is unknown whether the trend of rising incisional hernia (IH) repair (IHR) incidence and costs until 2011 currently persists. We aimed to evaluate how the IHR procedure incidence, cost and patient risk-profile have changed over the last decade relative to all abdominal surgeries (AS). METHODS Repeated cross-sectional analysis of 38,512,737 patients undergoing inpatient 4AS including IHR within the 2008-2018 National Inpatient Sample. Yearly incidence (procedures/1,000,000 people [PMP]), hospital costs, surgical and patient characteristics were compared between IHR and AS using generalized linear and multinomial regression. RESULTS Between 2008-2018, 3.1% of AS were IHR (1,200,568/38,512,737). There was a steeper decrease in the incidence of AS (356.5 PMP/year) compared to IHR procedures (12.0 PMP/year) which resulted in the IHR burden relative to AS (2008-2018: 12,576.3 to 9,113.4 PMP; trend difference P < 0.01). National costs averaged $47.9 and 1.7 billion/year for AS and IHR, respectively. From 2008-2018, procedure costs increased significantly for AS (68.2%) and IHR (74.6%; trends P < 0.01). Open IHR downtrended (42.2%), whereas laparoscopic (511.1%) and robotic (19,301%) uptrended significantly (trends P < 0.01). For both AS and IHR, the proportion of older (65-85y), Black and Hispanic, publicly-insured, and low-income patients, with higher comorbidity burden, undergoing elective procedures at small- and medium-sized hospitals uptrended significantly (all P < 0.01). CONCLUSION IH persists as a healthcare burden as demonstrated by the increased proportion of IHR relative to all AS, disproportionate presence of high-risk patients that undergo these procedures, and increased costs. Targeted efforts for IH prevention have the potential of decreasing $17 M/year in costs for every 1% reduction.
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Affiliation(s)
- A J Rios-Diaz
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - M P Morris
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - A N Christopher
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - V Patel
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - R B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - B T Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - J Y Hsu
- Center for Clinical Epidemiology and Biostatistics (CCEB), University of Pennsylvania, Philadelphia, PA, USA
| | - J P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA.
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Greemland I, Raveh G, Gavrielli S, Sadot E, Kashtan H, Wasserberg N. High Rates of Incisional Hernia After Laparoscopic Right Colectomy With Midline Extraction Site. Surg Laparosc Endosc Percutan Tech 2021; 31:722-728. [PMID: 34320593 DOI: 10.1097/sle.0000000000000977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic surgery aims at reducing wound complications and improving cosmetics, among other advantages. High rates of postoperative ventral hernia (POVH) are observed after laparoscopic-assisted colectomies. MATERIALS AND METHODS In a 2011 to 2016 retrospective study of all patients at Rabin Medical Center, we examined POVH prevalence after right hemicolectomy for neoplasia and correlation to specimen extraction site. We also compared laparoscopic-assisted colectomy to hand-assisted laparoscopic colectomy. Included were patients who had postoperative abdominal computed tomography or magnetic resonance imaging scan as part of their routine oncological follow-up to 6 months postsurgery. Patients were excluded for conversion to laparotomy, and prior abdominal surgeries after right colectomy and before follow-up computed tomography/magnetic resonance imaging scan. Demographic and surgical data were collected from patient electronic records, and scans reviewed for POVH by a designated radiologist. RESULTS Of 370 patients, 138 (mean age 70.09 y, 58 males) were included: 54 (39.1%) were diagnosed with POVH, 42/72 (58.3%) at midline extraction site, and 12/66 (18.8%) at off-midline extraction sites (P<0.0001). Surgical site infections and patients positive for tumor metastasis were associated with higher POVH rates. Most (74%) POVHs were identified within 18 months postsurgery (P<0.0001). Body mass index, age, sex, diabetes mellitus, smoking, tumor size, lymph nodes positive for metastasis, and hand-assisted laparoscopic colectomy were not associated with POVH prevalence. CONCLUSION High rates of radiologically diagnosed POVH were found after laparoscopic-assisted colectomy, with association to midline extraction site, surgical site infections, and positive tumor distant metastasis.
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Affiliation(s)
- Itzhak Greemland
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Raveh
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Gavrielli
- Department of Imaging, Rabin Medical Center, Beilinson Hospital, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Sadot
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Wasserberg
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Guilbaud T, Feretti C, Holowko W, Garbarino GM, Marchese U, Sarran A, Beaussier M, Gayet B, Fuks D. Laparoscopic Major Hepatectomy: Do Not Underestimate the Impact of Specimen Extraction Site. World J Surg 2020; 44:1223-1230. [PMID: 31748884 DOI: 10.1007/s00268-019-05285-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In laparoscopic major hepatectomy, analysis of outcomes according to specimen extraction site remains poorly described. The aim was to compare postoperative outcomes according to specimen extraction site. METHODS From 2000 to 2017, all laparoscopic major hepatectomies were reviewed and postoperative outcomes were analyzed according to specimen extraction site: subcostal (Group 1), midline (Group 2), or suprapubic (Group 3) incision. RESULTS Among 163 patients, 15 (9.2%) belonged to Group 1, 49 (30.1%) in Group 2, and 99 (60.7%) in Group 3. The proportion of right-sided, left-sided, or central hepatectomies, mortality, and overall and severe complications were comparable between groups. Group 1 had larger tumors (61 vs. 38 vs. 47 mm; P = 0.014), higher operative time (338 vs. 282 vs. 260 min; P < 0.008), higher adjacent organ resection rate (46.6 vs. 16.3 vs. 7.1%; P < 0.001), and tended to increase pulmonary complications (40.0 vs. 12.2 vs. 18.2%; P = 0.064). In Group 2, a previous midline incision scar was more frequently used for specimen extraction site (65.3 vs. 26.6 and 30.3%, Group 1 and 3; P < 0.001). Postoperative incisional hernia was observed in 16.4% (n = 23) and was more frequent in Group 2 (26.6 vs. 6.6% and 10.1%, Group 1 and Group 3; P = 0.030). Finally, Group 2 (HR 2.63, 95% CI 1.41-3.53; P = 0.032) was the only independent predictive factor of postoperative incisional hernia. CONCLUSIONS While using a previous incision makes sense, the increased risk of postoperative incisional hernia after midline incision promotes the suprapubic incision.
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Affiliation(s)
- Théophile Guilbaud
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France. .,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France. .,Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
| | - Carlotta Feretti
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
| | - Waclaw Holowko
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
| | - Giovanni Maria Garbarino
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
| | - Ugo Marchese
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
| | - Anthony Sarran
- Department of Radiology and Medical Imaging, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Marc Beaussier
- Department of Anesthesiology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Brice Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
| | - David Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
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10
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Prevalence of internal hernia following laparoscopic colorectal surgery: single-center report on 1300 patients. Surg Endosc 2020; 35:4315-4320. [PMID: 32875409 DOI: 10.1007/s00464-020-07921-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/17/2020] [Indexed: 01/05/2023]
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11
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Abstract
Short bowel syndrome (SBS) is a potential postoperative complication after intra-abdominal procedures. Whether the laparoscopic approach is as likely to result in SBS or the causative mechanisms are similar to open procedures is unknown. Our aim was to evaluate potential mechanisms of SBS after laparoscopic procedures. The records of 175 adult patients developing SBS as a postoperative complication were reviewed. One hundred forty-seven patients had open procedures and 28 laparoscopic. Colectomy (39%), hysterectomy (11%), and appendectomy (11%) were the most common open procedures. SBS followed laparoscopic gastric bypass (46%) and cholecystectomy (32%) most frequently. The mechanisms of SBS were different: adhesive obstruction (57 vs 22%, P < 0.05) was more common in the open group, whereas volvulus (18 vs 46%, P < 0.05) was more common after laparoscopy. Overall, ischemia (25 vs 32%) was similar but significantly more laparoscopic patients had postoperative hypoperfusion (32 vs 67%, P < 0.05). Eleven of the 13 laparoscopic bariatric procedures had internal hernias and volvulus. Of the nine patients undergoing cholecystectomy, four developed ischemia early postoperatively presumably secondary to pneumoperitoneum. SBS is an increasingly recognized complication of laparoscopic procedures. The mechanisms of intestinal injury differ from open procedures with a higher incidence of volvulus and more frequent ischemia from hypoperfusion.
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Affiliation(s)
- Corrigan L. McBride
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska; and
| | - Dmitry Oleynikov
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska; and
| | - Debra Sudan
- the Department of Surgery, Duke University, Durham, North Carolina
| | - Jon S. Thompson
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska; and
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12
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Peng F, Liu Y. Gastrointestinal Stromal Tumors of the Small Intestine: Progress in Diagnosis and Treatment Research. Cancer Manag Res 2020; 12:3877-3889. [PMID: 32547224 PMCID: PMC7261658 DOI: 10.2147/cmar.s238227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/17/2020] [Indexed: 12/12/2022] Open
Abstract
In recent years, the diagnosis and treatment of gastrointestinal stromal tumors (GISTs) of the small intestine have been a hot topic due to their rarity and non-specific clinical manifestations. With the development of gene and imaging technology, surgery, and molecular targeted drugs, the diagnosis and treatment of GISTs have achieved great success. For a long time, radical resection was prioritized to treat GISTs of the small intestine. At present, preoperative tumor staging is a novel treatment for unresectable malignant tumors. In addition, karyokinesis exponent is the sole independent predictor of progression-free survival of GISTs. The DNA, miRNA, and protein of exosomes have also been found to be biomarkers with prognostic implications. The research on the treatment of GISTs has become a focus in the era of precision medicine, ushering in the use of standardized, normalized, and individualized treatment.
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Affiliation(s)
- Fangxing Peng
- Gastrointestinal Surgery, No. 2 Affiliated Hospital of North Sichuan Medical College, Mianyang, Sichuan Province 621000, People's Republic of China.,Gastrointestinal Surgery, Sichuan Mianyang 404 Hospital, Mianyang, Sichuan Province 621000, People's Republic of China
| | - Yao Liu
- Gastrointestinal Surgery, No. 2 Affiliated Hospital of North Sichuan Medical College, Mianyang, Sichuan Province 621000, People's Republic of China.,Gastrointestinal Surgery, Sichuan Mianyang 404 Hospital, Mianyang, Sichuan Province 621000, People's Republic of China
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13
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Punjani R, Arora E, Mankeshwar R, Gala J. An early experience with transversus abdominis release for complex ventral hernias: a retrospective review of 100 cases. Hernia 2020; 25:353-364. [PMID: 32377962 DOI: 10.1007/s10029-020-02202-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Transversus abdominis release (TAR) is a relatively recent surgical technique for ventral hernia repair which allows placement of a large prosthesis in the retro-muscular plane with considerable myofascial medialization. A retrospective review of 100 cases who underwent TAR for complex ventral hernias was performed to evaluate the safety and efficacy of TAR in a series of large ventral hernias. METHODS Between March 2016 and May 2019, 100 consecutive patients who underwent open TAR were identified from our prospectively maintained database. A retrospective review was performed to analyze patient demographics, peri-operative events, adverse outcomes and recurrence. RESULTS 12 primary and 88 incisional hernia cases underwent TAR with prosthetic mesh repair during the study period. Mean age was 52.5 years, mean BMI was 30.87 kgs/m2, mean ASA class 1.95. In our series, 41% were diabetic, 11% had COPD. All patients underwent preoperative CT scans. The mean defect was 140.18 cm2. Average mesh area was 1344 cm2. Average blood loss was 245 mL. Defects were bridged in 19% cases despite bilateral component separation. Readmission rate at 1 month was 3%, for wound complications. We recorded 9 surgical site infections, 17 surgical site occurrences, 10 of which needed procedural interventions. We recorded no recurrences at a mean follow-up duration of 20.2 months. CONCLUSIONS Our early results with TAR are encouraging. We have demonstrated that the repair allows anatomical reconstruction with a large sublay mesh while inflicting minimal morbidity. TAR can be a valuable tool in complex ventral hernia repair.
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Affiliation(s)
| | - E Arora
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, 6th Floor, Main Hospital Building, Sir JJ Hospital Campus, Byculla, Mumbai, 400008, India.
| | - R Mankeshwar
- Department of Preventive and Social Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - J Gala
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, 6th Floor, Main Hospital Building, Sir JJ Hospital Campus, Byculla, Mumbai, 400008, India
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14
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Abdominal Wall Reconstruction (AWR): Initial Experience from an Indian Centre. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02123-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Wells LE, Smith B, Honaker MD. Rate of conversion to an open procedure is reduced in patients undergoing robotic colorectal surgery: A single-institution experience. J Minim Access Surg 2020; 16:229-234. [PMID: 31339114 PMCID: PMC7440010 DOI: 10.4103/jmas.jmas_318_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Robotic-assisted surgery is becoming increasingly used in colorectal operations. It has many advantages over laparoscopic surgery including three-dimensional viewing, motion scaling, improved dexterity and ergonomics as well as increased precision. However, there are also disadvantages to robotic surgery such as lack of tactile feedback, cost as well as limitations on multi-quadrant surgeries. The purpose of this study was to compare the rate of conversion to an open surgery in patients undergoing robotic-assisted colorectal surgery and traditional laparoscopic surgery. Methods Patients undergoing minimally invasive colorectal surgery for neoplastic and dysplastic disease from 2009 to 2016 were identified and examined retrospectively. The statistical software SAS, manufactured by SAS Institute, Cary, North Carolina. Continuous variables were analysed using analysis of variance test. Chi-square test was used to analyse categorical variables. P <0.05 was considered statistically significant. Results Two hundred and thirty-five patients were identified that underwent minimally invasive colorectal surgery. One hundred and sixty-four underwent laparoscopic resection and 71 underwent robotic-assisted resection. There was no statistical difference in gender or race between the two groups (both P > 0.05). Patients that underwent robotic-assisted resection were slightly younger than patients that underwent laparoscopic resection (61.6 years vs. 65.6 years; P= 0.02). When examining conversion to an open procedure, patients that underwent robotic-assisted resection had a significantly lower chance of conversion than did the patients undergoing a laparoscopic approach (11.27% vs. 29.78%; P= 0.0018). Conclusion Conversion rates from a minimally invasive procedure to an open procedure appear to be lower with robotic-assisted surgery compared to laparoscopic surgery.
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Affiliation(s)
- Leah Ellis Wells
- Department of Internal Medicine, Mercer University School of Medicine, Navicent Health, Macon, Georgia
| | - Betsy Smith
- Department of Internal Medicine, Mercer University School of Medicine, Navicent Health, Macon, Georgia
| | - Michael Drew Honaker
- Surgical Oncology and Colorectal Surgery, Mercer University School of Medicine, Navicent Health, Macon, Georgia
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16
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Sebastian-Valverde E, Poves I, Membrilla-Fernández E, Pons-Fragero MJ, Grande L. The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction. BMC Surg 2019; 19:40. [PMID: 31014318 PMCID: PMC6480811 DOI: 10.1186/s12893-019-0504-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/09/2019] [Indexed: 12/18/2022] Open
Abstract
Background Postoperative adhesions represent 75% of all acute small bowel obstructions. Although open surgery is considered the standard approach for adhesiolysis, laparoscopic approach is gaining popularity. Methods A retrospective study with data from a prospectively maintained data base of all patients undergoing surgical treatment for adhesive small bowel obstruction (ASBO) from January 2007 to May 2016 was conducted. Postoperative outcomes comparing open vs laparoscopic approaches were analysed. An intention to treat analysis was performed. The aim of the study was to evaluate the potential benefits of the laparoscopic approach in the treatment of ASBO. Results 262 patients undergoing surgery for ASBO were included. 184 (70%) and 78 (30%) patients were operated by open and laparoscopic approach respectively. The conversion rate was 38.5%. Patients in the laparoscopic group were younger (p < 0.001), had fewer previous abdominal operations (p = 0.001), lower ASA grade (p < 0.001), and less complex adhesions were found (p = 0.001). Operative time was longer in the open group (p = 0.004). Laparoscopic adhesiolysis was associated with a lower overall complication rate (43% vs 67.9%, p < 0.001), lower mortality (p = 0.026), earlier oral intake (p < 0.001) and shorter hospital stay (p < 0.001). Specific analysis of patients with single band and/or internal hernia who did not need bowel resection, also demonstrated fewer complications, earlier oral intake and shorter length of stay. In the multivariate analysis, the open approach was an independent risk factor for overall complications compared to the laparoscopic approach (Odds Ratio = 2.89; 95% CI 1.1–7.6; p = 0.033). Conclusions Laparoscopic management of ASBO is feasible, effective and safe. The laparoscopic approach improves postoperative outcomes and functional recovery, and should be considered in patients in whom simple band adhesions are suspected. Patient selection is the strongest key factor for having success.
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Affiliation(s)
- Enric Sebastian-Valverde
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Ignasi Poves
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Estela Membrilla-Fernández
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - María José Pons-Fragero
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Luís Grande
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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17
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Tang L, Zhao P, Kong D. The risk factors for benign small bowel obstruction following curative resection in patients with rectal cancer. World J Surg Oncol 2018; 16:212. [PMID: 30348158 PMCID: PMC6198517 DOI: 10.1186/s12957-018-1510-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/09/2018] [Indexed: 11/13/2022] Open
Abstract
Background So far there have been limited studies about the risk factors for benign small bowel obstruction (SBO) after colorectal cancer surgery. This study aimed to determine the factors affecting the development of benign SBO following curative resection in patients with rectal cancer. Methods Patients (3472) receiving curative resection of rectal cancer at the Department of Colorectal Cancer, Tianjin Medical University Cancer Institute and Hospital, between January 2003 and December 2012 were retrospectively studied. The incidence of benign SBO and its risk factors were then determined. Results The incidence of benign SBO was 7.3% (253/3472) in follow-up studies with an average time of 68 months. Further, 27% (68/253) of the patients received operative treatment because of the signs of strangulation or the lack of clinical improvement with conservative management. Open surgery and radiotherapy were defined as the risk factors for benign SBO after curative resection in patients with rectal cancer (P < 0.001). Conclusion Open surgery plus radiotherapy led to an increased risk of benign SBO in rectal cancer patients receiving curative resection.
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Affiliation(s)
- Liang Tang
- Department of Colorectal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Huanhuxi Road, Hexi District, Tianjin, People's Republic of China
| | - Peng Zhao
- Department of Colorectal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Huanhuxi Road, Hexi District, Tianjin, People's Republic of China
| | - Dalu Kong
- Department of Colorectal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Huanhuxi Road, Hexi District, Tianjin, People's Republic of China.
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18
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Johnson KN, Linnaus M, Notrica DM. Conversion from laparoscopic to open appendectomy: decreased risk at dedicated children's hospitals. Pediatr Surg Int 2018; 34:873-877. [PMID: 29926162 DOI: 10.1007/s00383-018-4297-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE The advent of laparoscopy has revolutionized surgical practice within the last 30 years. Conversion to open surgery, however, remains necessary at times, even for the most experienced laparoscopic surgeon. METHODS The kids' inpatient database was analyzed for 2006, 2009, and 2012 for patients who underwent laparoscopic appendectomy and conversion to open (CPT 470.1 and V64.41, respectively). Variables included in multivariable analysis were determined based on those variables found to have significance on univariate analysis. RESULTS A total of 104,865 patients, ages 0-17 years, underwent laparoscopic appendectomy during the three study periods. Of these, 2370 (2.2%) laparoscopic surgeries were converted to open appendectomy. Multivariable logistic regression showed significantly higher rates of conversion amongst patients with peritonitis (OR 6.7, p < 0.001) or abscess (OR 14.3, p < 0.001), obesity (OR 2.02, p < 0.001), age > 13 years (OR 1.53 for ages 13-15, OR 1.77 for ages 16-17, p < 0.001 for both), or cared for at rural hospitals (OR 1.55, p = 0.002). Rates of conversion decreased over time for children at adult hospitals and at urban hospitals, regardless of teaching status (p < 0.001 for both). CONCLUSION Risk factors for conversion from laparoscopic to open appendectomy included abscess, peritonitis, increased age, obesity, male gender, socioeconomic status and treatment at a non-pediatric-specific hospital, and the overall rate is decreasing over time.
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Affiliation(s)
- Kevin N Johnson
- Department of Pediatric Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, 48109, USA.
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19
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The sticky business of adhesion prevention in minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2018; 29:266-275. [PMID: 28582326 DOI: 10.1097/gco.0000000000000372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The negative impact of postoperative adhesions has long been recognized, but available options for prevention remain limited. Minimally invasive surgery is associated with decreased adhesion formation due to meticulous dissection with gentile tissue handling, improved hemostasis, and limiting exposure to reactive foreign material; however, there is conflicting evidence on the clinical significance of adhesion-related disease when compared to open surgery. Laparoscopic surgery does not guarantee the prevention of adhesions because longer operative times and high insufflation pressure can promote adhesion formation. Adhesion barriers have been available since the 1980s, but uptake among surgeons remains low and there is no clear evidence that they reduce clinically significant outcomes such as chronic pain or infertility. In this article, we review the ongoing magnitude of adhesion-related complications in gynecologic surgery, currently available interventions and new research toward more effective adhesion prevention. RECENT FINDINGS Recent literature provides updated epidemiologic data and estimates of healthcare costs associated with adhesion-related complications. There have been important advances in our understanding of normal peritoneal healing and the pathophysiology of adhesions. Adhesion barriers continue to be tested for safety and effectiveness and new agents have shown promise in clinical studies. Finally, there are many experimental studies of new materials and pharmacologic and biologic prevention agents. SUMMARY There is great interest in new adhesion prevention technologies, but new agents are unlikely to be available for clinical use for many years. High-quality effectiveness and outcomes-related research is still needed.
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20
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Glenn IC, El-Shafy IA, Bruns NE, Muenks EP, Duran YK, Hill JA, Peter SDS, Prince JM, Lipskar AM, Ponsky TA. Simple diverticulectomy is adequate for management of bleeding Meckel diverticulum. Pediatr Surg Int 2018; 34:451-455. [PMID: 29460177 DOI: 10.1007/s00383-018-4239-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE It is unclear whether simple diverticulectomy, rather than segmental bowel resection (SBR), is adequate treatment for gastrointestinal bleeding (GIB) secondary to Meckel diverticulum (MD). There is concern that ulcers in the adjacent bowel may continue to bleed if only the diverticulum is removed. This study seeks to determine if diverticulectomy is satisfactory treatment for bleeding MD. METHODS A multi-institution, retrospective review was performed for patients with a diagnosis of MD and GIB who underwent simple diverticulectomy or small bowel resection. Exclusion criteria were comorbid surgical conditions and other causes of GIB. The primary outcome was post-operative bleeding during the initial hospitalization. Secondary outcomes were bleeding after discharge, transfusion or additional procedure requirement, re-admission, and overall complications. RESULTS There were 59 patients who met study criteria (42 diverticulectomy, 17 SBR). One patient in the SBR group had early post-operative bleeding (p = 0.288). There was one re-admission (p = 0.288) and three total complications in the SBR group (p = 0.021). There were no cases of bleeding or other complications in the diverticulectomy group. CONCLUSION This study suggests that simple diverticulectomy is adequate for treatment of GIB caused by MD. Furthermore, diverticulectomy appears to have a lower overall complication rate.
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Affiliation(s)
- Ian C Glenn
- Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Ibrahim Abd El-Shafy
- Cohen Children's Medical Center of New York, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Nicholas E Bruns
- Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - E Pete Muenks
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Yara K Duran
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Joshua A Hill
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Jose M Prince
- Cohen Children's Medical Center of New York, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Aaron M Lipskar
- Cohen Children's Medical Center of New York, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Todd A Ponsky
- Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA.
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21
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Shubinets V, Fox JP, Lanni MA, Tecce MG, Pauli EM, Hope WW, Kovach SJ, Fischer JP. Incisional Hernia in the United States: Trends in Hospital Encounters and Corresponding Healthcare Charges. Am Surg 2018. [DOI: 10.1177/000313481808400132] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Incisional hernia (IH) is a challenging, potentially morbid condition. This study evaluates recent trends in hospital encounters associated with IH care in the United States. Using Nationwide Inpatient Sample databases from 2007 to 2011, annual estimates of IH-related hospital discharges, charges, and serious adverse events were identified. Significance in observed trends was tested using regression modeling. From 2007 to 2011, there were 583,054 hospital discharges associated with a diagnosis of IH. 81.1 per cent had a concurrent procedure for IH repair. The average discharge included a female patient (63.2%), 59.8 years of age, with either Medicare (45.3%) or Private insurance (38.3%) as the anticipated primary payer. Comparing 2007 to 2011, significant increases in IH discharges (12%; 2007 = 109,702 vs 2011 = 123,034, P = 0.009) and IH repairs (10%; 2007 = 90,588 vs 2011 = 99,622, P < 0.001) were observed. This was accompanied by a 37 per cent increase in hospital charges (2007 = $44,587 vs 2011 = $60,968, P < 0.001), resulting in a total healthcare bill of $7.3 billion in 2011. Significant trends toward greater patient age (2007 = 59.7 years vs 2011 = 60.2 years, P < 0.001), higher comorbidity index (2007 = 3.0 vs 2011 = 3.5, P < 0.001), and increased frequency of serious adverse events (2007 = 13.5% vs 2011 = 17.7%, P < 0.001) were noted. Further work is needed to identify interventions to mitigate the risk of IH development.
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Affiliation(s)
- Valeriy Shubinets
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin P. Fox
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A. Lanni
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael G. Tecce
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric M. Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - William W. Hope
- Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, North Carolina
| | - Stephen J. Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P. Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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22
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Scaringi S, Giudici F, Zambonin D, Ficari F, Bechi P. Totally robotic intracorporeal side-to-side isoperistaltic strictureplasty for Crohn's disease. J Minim Access Surg 2018; 14:341-344. [PMID: 29319021 PMCID: PMC6130192 DOI: 10.4103/jmas.jmas_212_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The development of bowel-sparing techniques (strictureplasties) for extended stricturing Crohn's disease (CD) and the increased use of minimally invasive surgery (wound sparing) represent the two most important improvements in inflammatory bowel disease surgery from the origin. Nevertheless, the minimally invasive approach for extended stricturing forms is usually avoided primarily because of difficulties in performing complex intracorporeal sutures. We describe a totally intracorporeal robotic ileocecal resection with a yet described modified side-to-side isoperistaltic strictureplasty for an extended ileocecal CD. The strictureplasty was 6 cm long including the stricture in its middle part. Adopting this approach, the preserved small bowel was about 10 cm longer. Operative time was about 4 h, with a blood loss of about 50 ml. The patients' post-operative course was uneventful, enteral nutrition started at post-operative day 2 and gradual oral food intake from day 3. She was discharged on post-operative day 6. Histology confirmed a stricturing CD, and the patient is recurrence free at 34 months' follow-up. Our report suggests that robotic-assisted intracorporeal strictureplasty is feasible and that robotics could represent an interesting instrument for allowing the intersection between minimally invasive and bowel-sparing surgery for CD.
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Affiliation(s)
- Stefano Scaringi
- Department of Surgery and Translational Medicine, Surgical Unit, University of Florence, Florence, Italy
| | - Francesco Giudici
- Department of Surgery and Translational Medicine, Surgical Unit, University of Florence, Florence, Italy
| | - Daniela Zambonin
- Department of Surgery and Translational Medicine, Surgical Unit, University of Florence, Florence, Italy
| | - Ferdinando Ficari
- Department of Surgery and Translational Medicine, Surgical Unit, University of Florence, Florence, Italy
| | - Paolo Bechi
- Department of Surgery and Translational Medicine, Surgical Unit, University of Florence, Florence, Italy
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23
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Abstract
Laparoscopic colorectal surgery has now become widely adopted for the treatment of colorectal neoplasia, with steady increases in utilization over the past 15 years. Common minimally invasive techniques include multiport laparoscopy, single-incision laparoscopy, and hand-assisted laparoscopy, with the choice of technique depending on several patient and surgeon factors. Laparoscopic colorectal surgery involves a robust learning curve, and fellowship training often lays the foundation for a high-volume laparoscopic practice. This article provides a summary of the various techniques for laparoscopic colorectal surgery, including operative steps, the approach to difficult patients, and the learning curve for proficiency.
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Affiliation(s)
- James Michael Parker
- Department of Surgery, Middlesex Hospital Surgical Alliance, 520 Saybrook Road, Suite S-100, Middletown, CT 06457, USA
| | - Timothy F Feldmann
- Department of Surgery, Capital Medical Center, 3900 Capital Mall Drive Southwest, Olympia, WA 98502, USA
| | - Kyle G Cologne
- Division of Colorectal Surgery, University of Southern California Keck School of Medicine, 1441 Eastlake Avenue, Suite 7418, Los Angeles, CA 90033, USA.
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24
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Smolarek S, Shalaby M, Paolo Angelucci G, Missori G, Capuano I, Franceschilli L, Quaresima S, Di Lorenzo N, Sileri P. Small-Bowel Obstruction Secondary to Adhesions After Open or Laparoscopic Colorectal Surgery. JSLS 2017; 20:JSLS.2016.00073. [PMID: 28028380 PMCID: PMC5147680 DOI: 10.4293/jsls.2016.00073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: Small-bowel obstruction (SBO) is a common surgical emergency that occurs in 9% of patients after abdominal surgery. Up to 73% are caused by peritoneal adhesions. The primary purpose of this study was to compare the rate of SBOs between patients who underwent laparoscopic (LPS) and those who had open (OPS) colorectal surgery. The secondary reasons were to evaluate the rate of adhesive SBO in a cohort of patients who underwent a range of colorectal resections and to assess risk factors for the development of SBO. Method: This was a retrospective observational cohort study. Data were analyzed from a prospectively collected database and cross checked with operating theater records and hospital patient management systems. Results: During the study period, 707 patients underwent colorectal resection, 350 of whom (49.5%) were male. Median follow-up was 48.3 months. Of the patients included, 178 (25.2%) underwent LPS, whereas 529 (74.8%) had OPS. SBO occurred in 72 patients (10.2%): 20 (11.2%) in the LPS group and 52 (9.8%) in the OPS group [P = .16; hazards ratio (HR) 1.4 95% CI 0.82–2.48] within the study period. Conversion to an open procedure was associated with increased risk of SBO (P = .039; HR 2.82; 95% CI 0.78–8.51). Stoma formation was an independent risk factor for development of SBO (P = .049; HR, 0.63; 95% CI 0.39–1.03). The presence of an incisional hernia in the OPS group was associated with SBO (P = .0003; HR, 2.85; 95% CI 1.44–5.283). There was no difference in SBO between different types of procedures: right colon, left colon, and rectal surgery. Patients who developed early small-bowel obstruction (ESBO) were more often treated surgically compared to late SBO (P = .0001). Conclusion: The use of laparoscopy does not influence the rate of SBO, but conversion from laparoscopic to open surgery is associated with an increased risk of SBO. Stoma formation is associated with a 2-fold increase in SBO. Development of ESBO is highly associated with a need for further surgical intervention.
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Affiliation(s)
- Sebastian Smolarek
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mostafa Shalaby
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Giulia Missori
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Capuano
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Silvia Quaresima
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Di Lorenzo
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
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Otani K, Ishihara S, Nozawa H, Kawai K, Hata K, Kiyomatsu T, Tanaka T, Nishikawa T, Yasuda K, Sasaki K, Murono K, Watanabe T. A retrospective study of laparoscopic surgery for small bowel obstruction. Ann Med Surg (Lond) 2017; 16:34-39. [PMID: 28316782 PMCID: PMC5342981 DOI: 10.1016/j.amsu.2017.02.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/25/2017] [Accepted: 02/25/2017] [Indexed: 01/22/2023] Open
Abstract
Background Open laparotomy is widely accepted as the standard surgical treatment for small bowel obstruction (SBO). However, laparoscopic surgery has recently become a treatment option. There is no consensus on the appropriate settings for the laparoscopic treatment of SBO. The purpose of this study is to evaluate the outcomes of laparoscopic surgery for SBO. Patients and methods From January 2012 to May 2016, 48 consecutive patients underwent surgical treatment for SBO in our department. We retrospectively reviewed these cases and compared the features and the outcomes between laparoscopic and open surgery. Results Thirty-four and 14 patients underwent open surgery and laparoscopic surgery, respectively. Four of the laparoscopic cases (28.6%) were converted to open surgery. Laparoscopic surgery tended to be associated with a shorter operative time than open surgery (p = 0.066). The first postoperative oral intake was significantly earlier in patients who underwent laparoscopic surgery (p = 0.044). The duration of hospitalization after surgery and the rates of postoperative complications did not differ to a statistically significant extent. Laparoscopic treatment was accomplished in 7 out of 8 cases (87.5%) with SBO due to band occlusion. Conclusion Laparoscopic surgery for SBO is less invasive than open surgery and is equally feasible in selected patients. SBO due to band occlusion may be a preferable indication for laparoscopic surgery. In order to confirm the safety of laparoscopic treatment, and to clarify the appropriate settings for laparoscopic surgery for SBO, it will be necessary to perform further studies in a larger population and with a long follow-up period.
Surgical treatment for small bowel obstruction in 48 patients were retrospectively reviewed. Laparoscopic surgery was performed in 14 patients, and 4 cases were converted to open surgery. Laparoscopic surgery is less invasive than open surgery and is equally feasible in selected patients. Band occlusion may be a preferable indication to laparoscopic surgery.
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Affiliation(s)
- Kensuke Otani
- Corresponding author. Department of Surgical Oncology, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.Department of Surgical OncologyThe University of TokyoHongo7-3-1Bunkyo-kuTokyo113-8655Japan
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Abstract
Port site hernias are emerging as a problematic complication of laparoscopic surgery. The aim of this study was to elucidate the characteristics of port site hernias and determine the long-term outcomes based on the interval between primary surgery and hernia occurrence. Twenty-four patients were surgically treated for trocar site hernia between 1997 and 2013. The patients were grouped into early-onset group (EOG; less than one month) and late-onset group (LOG; more than one month) based on the interval between laparoscopic surgery and hernia onset. A retrospective analysis was performed. There were seven patients in the EOG and 17 patients in the LOG. The body mass index was significantly higher (P = 0.033) in the LOG. In the EOG, primary closure was performed, and there were no recurrences. In the LOG, mesh reinforcement was applied in 58.8 per cent of patients, and 29.4 per cent of patients had recurrences. This recurrence rate was higher than the recurrence rate after primary repair of incisional hernia after open laparotomy (P = 0.088). In conclusion, In the EOG, small bowel resection was more frequent, but once repaired, there were no recurrences. Although mesh reinforcement was applied in the LOG, the recurrence rate was not less than the EOG.
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Affiliation(s)
- Yoon-Hye Kwon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyung Choe
- Department of Surgery, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Ki Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Ashfaq A, Ahmadieh K, Shah AA, Garvey EM, Chapital AB, Johnson DJ, Harold KL. Incidence and outcomes of ventral hernia repair after robotic retropubic prostatectomy: A retrospective cohort of 570 consecutive cases. Int J Surg 2016; 38:74-77. [PMID: 28034772 DOI: 10.1016/j.ijsu.2016.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/12/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Robotic retropubic prostatectomy (RRP) has become one of the most commonly performed robotic procedures in the United States. Ventral hernia (VH) has been increasingly recognized as an important complication after laparoscopic procedures, in general. However, data related to VH after robotic procedures is relatively scarce, especially after RRP. With increasing popularity of RRP, the purpose of this study was to look at the incidence of VH and outcomes of ventral hernia repair (VHR) after RRP. METHODS All patients who underwent RRP at a single institution between January 2012 and June 2014 were studied retrospectively using electronic medical records. RESULTS A total of 570 patients underwent RRP, of which 33 (5.8%) developed VH during the study period. Fourteen (42%) patients were obese and five (15%) had diabetes. One patient (3%) had a surgical site infection after RRP and two (6%) patients were on immunomodulators/steroids. Median duration to develop VH after RRP was 12 (1-25) months. Out of the 33 patients with VH, ten (33%) underwent VHR; five laparoscopic and five open. Median size of hernia defect and mesh used was 25 (1-144) cm2 and 181 (15-285) cm2, respectively. Median length of hospital stay and follow up was 0 (0-4) days and 12 (1-14) months, respectively. One patient who had initial VHR done at an outside institution had a recurrence. Thirty-two (97%) patients were alive at their last follow up. One patient died secondary to progression of prostate cancer. There was no significant 30 day morbidity (surgical site infection, fascial dehiscence, pneumonia, acute kidney injury, myocardial infarction). Of patients who decided non-operative management of VH (n = 23, 67%), none developed a complication requiring emergent surgical intervention. CONCLUSION The incidence of VH after RRP is likely underreported in prior studies. Repair, either laparoscopic or open, is safe and effective in experienced hands. Patients who decide on watchful waiting can be followed with minimal risk of incarceration/strangulation. Further studies are needed to analyze the extraction techniques after RRP and correlate with incidence of VH.
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Affiliation(s)
- A Ashfaq
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - K Ahmadieh
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - A A Shah
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - E M Garvey
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - A B Chapital
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - D J Johnson
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - K L Harold
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA.
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Matsumoto S, Bito S, Fujii S, Inomata M, Saida Y, Murata K, Saito S. Prospective study of patient satisfaction and postoperative quality of life after laparoscopic colectomy in Japan. Asian J Endosc Surg 2016; 9:186-91. [PMID: 27113472 DOI: 10.1111/ases.12281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/21/2016] [Accepted: 01/31/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION This prospective cohort study was designed to compare the short-term and intermediate health-related quality of life of Japanese patients after laparoscopic colectomy (LC) or open colectomy (OC) for colonic cancer. METHODS Seventeen hospitals participated, and 240 colonic cancer patients with T3 or T4 invasion that were estimated as curatively resected were enrolled. Three patients were excluded as ineligible, one patient died suddenly before operation, and one patient was not registered based on the doctor's decision. Therefore, analysis was done on 235 patients who underwent either LC (n = 165) or OC (n = 70) in accordance with their stated preference. The major outcome scale end-point was health-related quality of life as assessed by the 36-item Short Form Health Survey (Japanese version 2.0). Accessory end-points were feeling of satisfaction 1 month after operation and recovery time needed to perform normal activities after operation. Observations were performed on enrollment, postoperative day 3, postoperative day 7, discharge day or postoperative month 1, and postoperative month 6. RESULTS Defecation condition, wound pain score, and abdominal pain score were better in the LC group than in the OC group on postoperative day 7 and in postoperative month 1. Recovery time to normal daily activity took 30 days in the LC group, whereas the OC group needed 44 days. CONCLUSION Patients' subjective responses indicated that LC was more beneficial than OC for patients with stage II or III colonic cancer. LC's superiority was seen particularly in the following indicators: (i) health-related quality of life during early postoperative days; (ii) recovery to normal daily activities; and (iii) defecation after surgery.
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Affiliation(s)
- Sumio Matsumoto
- Tokyo Medical Center National Hospital Organization, Tokyo, Japan
| | - Seiji Bito
- Tokyo Medical Center National Hospital Organization, General Internal Medicine, Tokyo Medical Center, Institute of Sensory Organ, Division of Health Care and Research Planning, Laboratory Clinical Epidemiology, Tokyo, Japan
| | - Shoichi Fujii
- Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Masashi Inomata
- Department of Surgery, Oita University School of Medicine, Yufu, Oita, Japan
| | - Yoshihisa Saida
- Third Department of Surgery, Toho University, Ohashi Hospital, Tokyo, Japan
| | - Kohei Murata
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
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Yao S, Tanaka E, Ikeda A, Murakami T, Okumoto T, Harada T. Outcomes of laparoscopic management of acute small bowel obstruction: a 7-year experience of 110 consecutive cases with various etiologies. Surg Today 2016; 47:432-439. [DOI: 10.1007/s00595-016-1389-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
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Ten-year outcomes following laparoscopic colorectal resection: results of a randomized controlled trial. Int J Colorectal Dis 2016; 31:1283-90. [PMID: 27090804 DOI: 10.1007/s00384-016-2587-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the impact of laparoscopy compared to open surgery on long-term outcomes in a large series of patients who participated in a randomized controlled trial comparing short-term results of laparoscopic (LPS) versus open colorectal resection. METHODS This is a retrospective review of a prospective database including 662 patients with colorectal disease (526, 79 % cancer patients) who were randomly assigned to LPS or open colorectal resection and followed every 6 months by office visits. The primary endpoint of the study was long-term morbidity. Secondary outcomes included 10-year overall, cancer-specific, and disease-free survivals. All patients were analyzed on an intention-to-treat basis. RESULTS Fifty-eight (8.8 %) patients were lost to follow-up. Median follow-up was 131 (IQR 78-153) months in the LPS group and 126 (IQR 52-152) months in the open group (p = 0.121). Overall, long-term morbidity rate was 11.8 % (36/309) in the LPS versus 12.6 % (37/295) in the open group (p = 0.770). Incisional hernia rate was 5.8 % (18/309) in the LPS group versus 8.1 % (24/295) in the open group (p = 0.264). Adhesion-related small-bowel obstruction occurred in five (1.6 %) patients in the LPS versus four (1.4 %) patients in the open group (p = 1.000). In 497 cancer patients, 10-year overall survival was 45.3 % in the LPS group and 40.9 % in the open group (p = 0.160). No difference was found in cancer-specific and disease-free survivals, also when patients were stratified according to cancer stage. CONCLUSION In this series, LPS colorectal resection was not associated with a lower long-term morbidity rate when compared to open surgery. Overall, cancer-specific and disease-free survivals were similar in cancer patients who were treated with LPS and open surgeries.
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Ferrarese A, Enrico S, Solej M, Surace A, Nardi MJ, Millo P, Allieta R, Feleppa C, D'Ambra L, Berti S, Gelarda E, Borghi F, Pozzo G, Marino B, Marchigiano E, Cumbo P, Bellomo MP, Filippa C, Depaolis P, Nano M, Martino V. Laparoscopic management of non-midline incisional hernia: A multicentric study. Int J Surg 2016; 33 Suppl 1:S108-13. [PMID: 27353846 DOI: 10.1016/j.ijsu.2016.06.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The laparoscopic repair of non-midline ventral hernia (LNM) has been debated. The aim of this study is to analyze our experience performing the laparoscopic approach to non-midline ventral hernias (NMVHs) in Northwest Italy for 6 years. METHODS A total of 78 patients who underwent LNM between March 2008 and March 2014 in the selected institutions were analyzed. We retrospectively analyzed the peri- and postoperative data and the recurrence rate of four subgroups of NMVHs: subcostal, suprapubic, lumbar, and epigastric. We also conducted a literature review. RESULTS No difference was found between the four subgroups in terms of demographic data, defect characteristics, admission data, and complications. Subcostal defects required a shorter operating time. Obesity was found to be a risk factor for recurrence. CONCLUSIONS In our experience, subcostal defects were easier to perform, with a lower recurrence rate, lesser chronic pain, and faster surgical performance. A more specific prospective randomized trial with a larger sample is awaited. Based on our experience, however, the laparoscopic approach is a safe treatment for NMVHs in specialized centers.
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Affiliation(s)
- Alessia Ferrarese
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | | | - Paolo Millo
- Hospital "Umberto Parini", Section of General Surgery, Aosta, Italy.
| | - Rosaldo Allieta
- Hospital "Umberto Parini", Section of General Surgery, Aosta, Italy.
| | - Cosimo Feleppa
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Luigi D'Ambra
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Stefano Berti
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Enrico Gelarda
- Hospital "Santa Croce e Carle", Section of General Surgery, Cuneo, Italy.
| | - Felice Borghi
- Hospital "Santa Croce e Carle", Section of General Surgery, Cuneo, Italy.
| | - Gabriele Pozzo
- Hospital "Civile", Section of General Surgery, Asti, Italy.
| | | | - Emma Marchigiano
- Hospital "Santa Croce", Section of General Surgery, Moncalieri, Italy.
| | - Pietro Cumbo
- Hospital "Santa Croce", Section of General Surgery, Moncalieri, Italy.
| | | | - Claudio Filippa
- Hospital "Gradenigo", Section of General Surgery, Torino, Italy.
| | - Paolo Depaolis
- Hospital "Gradenigo", Section of General Surgery, Torino, Italy.
| | - Mario Nano
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
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Pecorelli N, Greco M, Amodeo S, Braga M. Small bowel obstruction and incisional hernia after laparoscopic and open colorectal surgery: a meta-analysis of comparative trials. Surg Endosc 2016; 31:85-99. [PMID: 27287910 DOI: 10.1007/s00464-016-4995-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/18/2016] [Indexed: 01/13/2023]
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Ha GW, Lee MR, Kim JH. Adhesive small bowel obstruction after laparoscopic and open colorectal surgery: a systematic review and meta-analysis. Am J Surg 2016; 212:527-36. [PMID: 27427294 DOI: 10.1016/j.amjsurg.2016.02.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/13/2016] [Accepted: 02/28/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is considered that laparoscopic surgery is associated with a much lower rate of postoperative formation of adhesions than open surgery. This meta-analysis assessed the incidence of adhesion-related readmissions and surgery for adhesive small bowel obstruction (SBO) in patients who underwent laparoscopic or open colorectal surgery. METHODS Multiple comprehensive databases were searched systematically to identify relevant studies and meta-analysis was done. RESULTS Meta-analysis showed that laparoscopic surgery was associated with a lower rate of adhesive SBO, both for randomized clinical trials (relative risk [RR] .26, 95% confidence interval [CI] .10 to .67, I(2)=41%) and nonrandomized studies (RR .49, 95% CI .32 to .76, I(2)=91%). Laparoscopic surgery was also associated with a lower rate of subsequent surgery for adhesive SBO, both for randomized clinical trials (RR .25, 95% CI .06 to .96, I(2)=0%) and nonrandomized studies (RR .56, 95% CI .33 to .94, I(2)=77%). CONCLUSIONS Laparoscopic colorectal surgery significantly reduced the rates of adhesive SBO and subsequent surgery for adhesive SBO, compared with open surgery.
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Affiliation(s)
- Gi Won Ha
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk 561-180, South Korea
| | - Min Ro Lee
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk 561-180, South Korea.
| | - Jong Hun Kim
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk 561-180, South Korea
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Arumugam P, Balarajah V, Watt J, Abraham AT, Bhattacharya S, Kocher HM. Role of laparoscopy in hepatobiliary malignancies. Indian J Med Res 2016; 143:414-9. [PMID: 27377496 PMCID: PMC4928546 DOI: 10.4103/0971-5916.184300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Indexed: 01/02/2023] Open
Abstract
The many benefits of laparoscopy, including smaller incision, reduced length of hospital stay and more rapid return to normal function, have seen its popularity grow in recent years. With concurrent improvements in non-surgical cancer management the importance of accurate staging is becoming increasingly important. There are two main applications of laparoscopic surgery in managing hepato-pancreatico-biliary (HPB) malignancy: accurate staging of disease and resection. We aim to summarize the use of laparoscopy in these contexts. The role of staging laparoscopy has become routine in certain cancers, in particular T[2] staged, locally advanced gastric cancer, hilar cholangiocarcinoma and non-Hodgkin's lymphoma. For other cancers, in particular colorectal, laparoscopy has now become the gold standard management for resection such that there is no role for stand-alone staging laparoscopy. In HPB cancers, although staging laparoscopy may play a role, with ever improving radiology, its role remains controversial.
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Affiliation(s)
- Prabhu Arumugam
- Centre for Tumour Biology, Barts Cancer Institute – a CR-UK Centre of Excellence, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, UK
- Barts & the London HPB Centre, The Royal London Hospital, London, UK
| | - Vickna Balarajah
- Barts & the London HPB Centre, The Royal London Hospital, London, UK
| | - Jennifer Watt
- Centre for Tumour Biology, Barts Cancer Institute – a CR-UK Centre of Excellence, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, UK
- Barts & the London HPB Centre, The Royal London Hospital, London, UK
| | - Ajit T. Abraham
- Barts & the London HPB Centre, The Royal London Hospital, London, UK
| | | | - Hemant M. Kocher
- Centre for Tumour Biology, Barts Cancer Institute – a CR-UK Centre of Excellence, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, UK
- Barts & the London HPB Centre, The Royal London Hospital, London, UK
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Langbach O, Bukholm I, Benth JŠ, Røkke O. Long-term quality of life and functionality after ventral hernia mesh repair. Surg Endosc 2016; 30:5023-5033. [DOI: 10.1007/s00464-016-4850-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/29/2016] [Indexed: 12/12/2022]
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36
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Kössi J, Julkunen K, Setälä M, Luostarinen M. Adhesion-related readmissions after surgery for deep endometriosis with the use of icodextrin—long-term results. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s10397-015-0927-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zago M, Mariani D, Kurihara H, Baiocchi G, Vettoretto N, Bergamini C, Campanile FC, Agresta F. Laparoscopy in Small Bowel Obstruction. EMERGENCY LAPAROSCOPY 2016:117-135. [DOI: 10.1007/978-3-319-29620-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Shapiro R, Keler U, Segev L, Sarna S, Hatib K, Hazzan D. Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis. Surg Endosc 2015; 30:3823-9. [PMID: 26659237 DOI: 10.1007/s00464-015-4684-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/14/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic right colectomy with intracorporeal anastomosis is a procedure of increasing popularity. This study aims to compare short- and long-term outcomes of intracorporeal and extracorporeal anastomoses. METHODS This is a comparative study of two anastomosis techniques for laparoscopic right hemicolectomy. A total of 191 consecutive patients, operated for neoplasm of the right colon, were identified. The intracorporeal group included 91 patients and the extracorporeal group 100 patients. RESULTS Patient demographics and disease-related characteristics were similar. Mean operative time was longer in the intracorporeal group (155 vs. 142 min; P = 0.006). Intracorporeal anastomosis was associated with less overall postoperative complications (18.7 vs. 35 %, P = 0.011) and decreased rate of surgical site infections (4.4 vs. 14 %, P = 0.023). The need for postoperative intervention (Clavien-Dindo 3) was higher in the extracorporeal group (7 vs. 0 %; P = 0.015). There was no statistically significant difference in the incidence of postoperative leak, ileus and bleeding. Mean length of stay was significantly shorter in the intracorporeal group (5.9 ± 2.1 vs. 6.9 ± 3.0; P = 0.04). Moreover, more patients with intracorporeal anastomosis had a length of stay shorter than 4 days (28.6 vs. 14.1 %, P = 0.015). Extraction incision was periumbilical in 99 % of the patients in the extracorporeal group. In the intracorporeal group extraction, incision was transverse suprapubic (Pfannenstiel) in 85.7 %, transvaginal in 9.9 % and periumbilical in 3.3 % of the patients. The incidence rate of incisional hernia was lower in the intracorporeal group (2.2 vs. 17.0 %, P = 0.001). CONCLUSIONS Laparoscopic right hemicolectomy with intracorporeal anastomosis is associated with improved short- and long-term outcomes. The rates of postoperative complications requiring intervention and incisional hernias are decreased.
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Affiliation(s)
- Ron Shapiro
- Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel Aviv, Israel.
| | - Uri Keler
- Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel Aviv, Israel
| | - Lior Segev
- Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel Aviv, Israel
| | - Stav Sarna
- Department of Surgery B, Carmel Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Kamal Hatib
- Department of Surgery B, Carmel Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - David Hazzan
- Department of Surgery B, Carmel Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Hu J, Fan D, Lin X, Wu X, He X, He X, Wu X, Lan P. Safety and Efficacy of Sodium Hyaluronate Gel and Chitosan in Preventing Postoperative Peristomal Adhesions After Defunctioning Enterostomy: A Prospective Randomized Controlled Trials. Medicine (Baltimore) 2015; 94:e2354. [PMID: 26705233 PMCID: PMC4697999 DOI: 10.1097/md.0000000000002354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Peristomal adhesions complicate closure of defunctioning enterostomy. The efficacy and safety of sodium hyaluronate gel and chitosan in preventing postoperative adhesion have not been extensively studied. This study aims to evaluate the safety and efficacy of sodium hyaluronate gel and chitosan in the prevention of postoperative peristomal adhesions.This was a prospective randomized controlled study. One hundred and fourteen patients undergoing defunctioning enterostomy were enrolled. Patients were randomly assigned to receive sodium hyaluronate gel (SHG group) or chitosan (CH group) or no antiadhesion treatment (CON group) during defunctioning enterostomy. The safety outcomes included toxicities, stoma-related complications, and short-term and long-term postoperative complications. Eighty-seven (76.3%) of the 114 patients received closure of enterostomy, during which occurrence and severity of intra-abdominal adhesions were visually assessed by a blinded assessor.Incidence of adhesion appears to be lower in patients received sodium hyaluronate gel or chitosan but differences did not reach a significant level (SHG group vs CH group vs CON group: 62.1% vs 62.1% vs 82.8%, P = 0.15). Compared with the CON group, severity of postoperative adhesion was significantly decreased in the SHG and CH group (SHG group vs CH group vs CON group: 31.0% vs 27.6% vs 62.1%; P = 0.01). There was no significant difference in the occurrence of postoperative complications and other safety outcomes among the 3 groups.Sodium hyaluronate gel or chitosan smeared around the limbs of a defunctioning enterostomy was safe and effective in the prevention of postoperative peristomal adhesions.
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Affiliation(s)
- Jiancong Hu
- From the Department of Colorectal Surgery (JH, DF, XL, XW, XH, XH, XW, PL); the Department of Digestive Endoscopy (DF, XL); Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University (JH, DF, XL, XW, XH, XH, XW, PL); and Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, China (JH, DF, XL, XW, XH, XH, XW, PL)
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Incisional and port-site hernias following robotic colorectal surgery. Surg Endosc 2015; 30:3505-10. [PMID: 26541723 DOI: 10.1007/s00464-015-4639-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 10/19/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND The association between extraction site location, robotic trocar size, and the incidence of incisional hernias in robotic colorectal surgery remain unclear. Laparoscopic literature reports variable rates of incisional hernias versus open surgery, and variable rates of trocar site hernias. However, conclusions from these studies are confusing due to heterogeneity in closure techniques and may not be generalized to robotic cases. This study evaluates the effect of extraction site location on incisional hernia rates, as well as trocar hernia rates in robotic colorectal surgery. MATERIALS AND METHODS A retrospective review of multiport and single incision robotic colorectal surgeries from a single institution was performed. Patients underwent subtotal, segmental, or proctocolectomies, and were compared based on the extraction site through either a muscle-splitting (MS) or midline (ML) incision. Hernias were identified by imaging and/or physical exam. Demographics and risk factors for hernias were assessed. Groups were compared using a multivariate logistic regression analysis. RESULTS The study included 259 colorectal surgery patients comprising 146 with MS and 113 with ML extraction sites. Postoperative computed tomograms were performed on 155 patients (59.8 %) with a mean follow-up of 16.5 months. The overall incisional hernia rate was 5.8 %. A significantly higher hernia rate was found among the ML group compared to the MS group (12.4 vs. 0.68 %, p < 0.0001). Of the known risk factors assessed, only increased BMI was associated with incisional hernias (OR 1.18). No trocar site hernias were found. CONCLUSION Midline extraction sites are associated with a significantly increased rate of incisional hernias compared to muscle-splitting extraction sites. There is little evidence to recommend fascia closure of 8-mm trocar sites.
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Interest of Laparoscopy for "En Bloc" Resection of Primary Malignant Sacral Tumors by Combined Approach: Comparative Study With Open Median Laparotomy. Spine (Phila Pa 1976) 2015. [PMID: 26208224 DOI: 10.1097/brs.0000000000001069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE To compare laparoscopy with open median laparotomy for anterior approach in "en bloc" resection of primary malignant sacral tumors (PMST) in combined approach strategy. SUMMARY OF BACKGROUND DATA Wide margin surgical resection is the "gold standard" treatment of PMST. METHODS Two groups of patients suffering from PMST and operated for "en bloc" resection by combined approach (anterior and posterior) only differencing for the anterior approach were constituted: "laparoscopy" group (n = 11) and "laparotomy" group (n = 22). Intraoperative morbidity (blood loss, red blood cell transfusion (RBC transfusion), surgical procedure duration) and postoperative morbidity (surgical-site infection (SSI), perineal dysfunctions, local recurrence) were analyzed. Surgical margins were studied. Data of both groups were compared using nonparametric Mann-Whitney test for continuous data and Fisher test for categorical data. Overall survival (OS) and Disease-free survival (DFS) were analyzed by Kaplan-Meier method. RESULTS Blood loss during anterior approach was less important in "laparoscopy" group 71.9 mL (range 0-400 mL) as compared with 2140 mL (range 0-9000 mL) for "laparotomy" group (P = 0.019). Blood loss during posterior approach was not different between the 2 groups. Total blood loss including anterior and posterior approach was inferior in "laparoscopy" group 2208 mL (range 230-4800 mL) versus 5385.7 mL (range 1400-11500 mL) for "laparotomy" group (P = 0.026). We reported significant difference on blood transfusion (3.7 RBC transfusions (range 0-8) for "laparoscopy group" versus 10.1 RBC transfusions (range 0-35) for "laparotomy" group (P = 0.025)). Surgical duration, quality of surgical margins, perineal dysfunctions and SSI were equivalent for both groups. At a follow-up of 36.6 months for "laparoscopy" group and 115.3 months for "laparotomy" group, OS and DFS were equivalent. CONCLUSION Use of laparoscopy for anterior approach decreases intraoperative blood loss and intraoperative RBC transfusion without increasing surgical duration, without altering the quality of surgical margins and without impairing long-term outcomes. LEVEL OF EVIDENCE 4.
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Wang YW, Huang LY, Song CL, Zhuo CH, Shi DB, Cai GX, Xu Y, Cai SJ, Li XX. Laparoscopic vs open abdominoperineal resection in the multimodality management of low rectal cancers. World J Gastroenterol 2015; 21:10174-83. [PMID: 26401082 PMCID: PMC4572798 DOI: 10.3748/wjg.v21.i35.10174] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/12/2015] [Accepted: 07/15/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the safety and feasibility of laparoscopic abdominoperineal resection compared with the open procedure in multimodality management of rectal cancer. METHODS A total of 106 rectal cancer patients who underwent open abdominoperineal resection (OAPR) were matched with 106 patients who underwent laparoscopic abdominoperineal resection (LAPR) in a 1 to 1 fashion, between 2009 and 2013 at Fudan University Shanghai Cancer Center. Propensity score matching was carried out based on age, gender, pathological staging of the disease and administration of neoadjuvant chemoradiation. Data regarding preoperative staging, surgical technique, pathological results, postoperative recovery and complications were reviewed and compared between the LAPR and OAPR groups. Perineal closure around the stoma and pelvic floor reconstruction were performed only in OAPR, not in LAPR. Therefore, abdominoperineal resection procedure-specific surgical complications including parastomal hernia and perineal wound complications were compared between the open and laparoscopic procedure. Regular surveillance of the two cohorts was carried out to gather prognostic data. Disease-free survival was analyzed using Kaplan-Meier estimate and log-rank test. Subgroup analysis was performed in patients with locally advanced disease treated with preoperative chemoradiation followed by surgical resection. RESULTS No significant difference was found between the LAPR group and the OAPR group in terms of clinicopathological features. The operation time (180.8 ± 47.8 min vs 172.1 ± 49.2 min, P = 0.190), operative blood loss (93.9 ± 60.0 mL vs 88.4 ± 55.2 mL, P = 0.494), total number of retrieved lymph nodes (12.9 ± 6.9 vs 12.9 ± 5.4, P = 0.974), surgical complications (12.3% vs 15.1%, P = 0.549) and pathological characteristics were comparable between the LAPR and OAPR group, respectively. Compared with OAPR patients, LAPR patients showed significantly shorter postoperative analgesia (2.4 ± 0.7 d vs 2.7 ± 0.6 d, P < 0.001), earlier first flatus (57.3 ± 7.9 h vs 63.5 ± 9.2 h, P < 0.001), shorter urinary drainage time (6.5 ± 3.4 d vs 7.8 ± 1.3 d, P < 0.001), and shorter postoperative admission (11.2 ± 4.7 d vs 12.6 ± 4.0 d, P = 0.014). With regard to APR-specific complications (perineal wound complications and parastomal hernia), there were no significant differences between the two groups. Similar results were found in the 26 pairs of patients administered neoadjuvant chemoradiation in subgroup analysis. During the follow-up period, no port site recurrences were observed. CONCLUSION Laparoscopic abdominoperineal resection for multidisciplinary management of rectal cancer is safe, and is associated with earlier recovery and shorter admission time in combination with neoadjuvant chemoradiation.
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Taguchi Y, Komatsu S, Sakamoto E, Norimizu S, Shingu Y, Hasegawa H. Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial. Surg Endosc 2015; 30:1705-12. [PMID: 26275544 DOI: 10.1007/s00464-015-4453-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to assess whether laparoscopic appendectomy (LA) for complicated appendicitis (CA) effectively reduces the incidence of postoperative complications and improves various measurements of postoperative recovery in adults compared with open appendectomy (OA). METHODS This single-center, randomized controlled trial was performed in the Nagoya Daini Red Cross Hospital. Patients diagnosed as having CA with peritonitis or abscess formation were eligible to participate and were randomly assigned to an LA group or an OA group. The primary study outcome was development of infectious complications, especially surgical site infection (SSI), within 30 days of surgery. RESULTS Between October 2008 and August 2014, 81 patients were enrolled and randomly assigned with a 1:1 allocation ratio (42, LA; 39, OA). All were eligible for study of the primary endpoint. Groups were well balanced in terms of patient characteristics and preoperative levels of C-reactive protein. SSI occurred in 14 LA group patients (33.3 %) and in 10 OA group patients (25.6 %) (OR 1.450, 95 % CI 0.553-3.800; p = 0.476). Overall, the rate of postoperative complications, including incisional or organ/space SSI and stump leakage, did not differ significantly between groups. No significant differences between groups were found in hospital stay, duration of drainage, analgesic use, or parameters for postoperative recovery except days to walking. CONCLUSION These results suggested that LA for CA is safe and feasible, while the distinguishing benefit of LA was not validated in this clinical trial.
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Affiliation(s)
- Yoshiro Taguchi
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
| | - Shunichiro Komatsu
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.,Department of Gastroenterological Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Eiji Sakamoto
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Shinji Norimizu
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Yuji Shingu
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Hiroshi Hasegawa
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
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Liu YY, Diana M, Halvax P, Cho S, Légner A, Alzaga A, Swanström L, Dallemagne B, Marescaux J. Flexible endoscopic single-incision extraperitoneal implant and fixation of peritoneal dialysis catheter: proof of concept in the porcine model. Surg Endosc 2015; 29:2402-2406. [PMID: 25414067 DOI: 10.1007/s00464-014-3951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/11/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) catheters placed in the pelvic space without anchoring present a high rate of migration. We aimed to assess the feasibility of a single-incision approach, using a flexible endoscopic preperitoneal tunneling for catheter implantation and fixation. MATERIALS AND METHODS Eight pigs were involved in this experimental study. A 2/0 Vicryl loop was sutured at the tip of a PD catheter. In 4 pigs, a 1.5 cm incision was made on the left paramedian line and the parietal peritoneal layer was identified by splitting rectal muscles. A gastroscope was inserted in the incision and advanced in the extraperitoneal space. An exit hole was made in the peritoneum over the low pelvic cavity. A guidewire was left in the abdominal cavity, and the PD catheter was inserted over the guidewire. The endoscope was inserted in the tunnel again, and endoscopic clips were deployed over the Vicryl loop to fix the catheter. In 4 pigs, the PD catheter was inserted laparoscopically using a two-port approach. The catheter's tip was fixed with laparoscopic clips on the Vicryl loop. A strain test to assess the force required to detach clips was performed using a digital dynamometer. RESULTS Operative time for flexible endoscopic tunneling was longer when compared to the laparoscopic implant (29.5 ± 4.43 vs. 22.7 ± 2.51 min). Mean force to displace the catheter was similar after flexible endoscopic fixation when compared to laparoscopic clip fixation (5.57 N ± 2.76 vs. 4.15 N ± 1.76). CONCLUSIONS Flexible endoscopic extraperitoneal tunneling allows for minimally invasive single-incision PD catheter placement and fixation.
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Affiliation(s)
- Yu-Yin Liu
- IRCAD, Digestive and Endocrine Surgery, University of Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
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Sharma R, Reddy S, Thoman D, Grotts J, Ferrigno L. Laparoscopic Versus Open Bowel Resection in Emergency Small Bowel Obstruction: Analysis of the National Surgical Quality Improvement Program Database. J Laparoendosc Adv Surg Tech A 2015; 25:625-30. [DOI: 10.1089/lap.2014.0446] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rohit Sharma
- Santa Barbara Cottage Hospital, Santa Barbara, California
| | | | - David Thoman
- Santa Barbara Cottage Hospital, Santa Barbara, California
| | | | - Lisa Ferrigno
- Santa Barbara Cottage Hospital, Santa Barbara, California
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Koketsu S, Sameshima S, Okuyama T, Yamagata Y, Takeshita E, Tagaya N, Oya M. An effective new method for the placement of an anti-adhesion barrier film using an introducer in laparoscopic surgery. Tech Coloproctol 2015; 19:551-3. [PMID: 26165210 DOI: 10.1007/s10151-015-1340-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/23/2015] [Indexed: 12/31/2022]
Affiliation(s)
- S Koketsu
- Department of Surgery, Koshigaya Hospital, Dokkyo Medical University, 2-1-50, Minamikoshigaya, Koshigaya City, Saitama, 343-8555, Japan,
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Bolnick A, Bolnick J, Diamond MP. Postoperative Adhesions as a Consequence of Pelvic Surgery. J Minim Invasive Gynecol 2015; 22:549-63. [DOI: 10.1016/j.jmig.2014.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 01/12/2023]
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Klaristenfeld DD, McLemore EC, Li BH, Abbass MA, Abbas MA. Significant reduction in the incidence of small bowel obstruction and ventral hernia after laparoscopic compared to open segmental colorectal resection. Langenbecks Arch Surg 2015; 400:505-12. [PMID: 25876737 DOI: 10.1007/s00423-015-1301-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/30/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study is to assess the incidence of incisional ventral hernia and small bowel obstruction following laparoscopic and open colorectal resection. METHODS A retrospective review was performed of a large database comprising 13 hospitals, serving 3.6 million patients in Southern California. Patients 18 years and older undergoing elective colorectal resection over a 3-year period were included. The crude incidence rates were calculated, and relative risks of ventral hernia and small bowel obstruction were determined using multivariable proportional hazard modeling. RESULTS Four thousand six hundred and thirteen patients underwent 4765 colorectal resections between August 2008 and August 2011. Fifty-nine percent of the cases were performed laparoscopically; the median age was 63 years, and 49% were males. Colorectal carcinoma (45%) and diverticulitis (18%) were the most common indications for surgery. The median follow-up was 2.4 years. Kaplan-Meier estimates of ventral hernia at 1, 2, and 3 years among the open cohort were significantly higher at 10.1, 17.0, and 20.5%, compared to 5.7, 8.7, and 10.8% in the laparoscopic cohort (p < 0.001). Similarly, small bowel obstruction was higher in the open compared to the laparoscopic group (open 10.4, 15.0, and 18.3% vs. laparoscopic 2.7, 4.4, and 5.5%, p < 0.001). Patients undergoing laparoscopic colorectal resection were less likely to develop ventral hernia [adjusted hazard ratio (AHR) 0.64 (95% CI 0.52, 0.80); p < 0.0001] and small bowel obstruction [AHR 0.41 (95% CI 0.31, 0.54); p < 0.0001]. CONCLUSIONS The incidence of incisional ventral hernia and small bowel obstruction is significantly reduced in patients who undergo laparoscopic compared to open colorectal resection.
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Vergis AS, Steigerwald SN, Bhojani FD, Sullivan PA, Hardy KM. Laparoscopic right hemicolectomy with intracorporeal versus extracorporeal anastamosis: a comparison of short-term outcomes. Can J Surg 2015; 58:63-8. [PMID: 25621913 DOI: 10.1503/cjs.001914] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is wide variation among laparoscopic colon resection techniques, including the approach for mobilization and the extent of intracorporal vessel ligation, bowel division or anastamosis. We compared the short-term outcomes of laparoscopic right hemicolectomy (LRHC) with intracorporeal (IA) versus extracorporeal (EA) anastamosis. METHODS We retrospectively reviewed all elective laparoscopic right hemicolectomies performed at St. Joseph's Hospital between January 2008 and September 2009 and compared the demographic, pathologic, operative and outcome data. RESULTS Fifty LRHCs were completed during the study period: 21 IA and 29 EA. The groups were similar in age, sex, body mass index, American Society of Anesthesiologists score, previous laparotomy and preoperative invasive pathology. There was no difference between IA and EA in mean duration of surgery (170 v. 181 min, p = 0.78), estimated blood loss (14 v. 42 mL, p = 0.15), perioperative blood transfusions (5% v. 14%, p = 0.29), in-hospital morbidity (33% v. 41%, p = 0.56), out-of-hospital morbidity (19% v. 31% p = 0.34), emergency department visits (10% v. 17%, p = 0.16) or 30-day readmissions (5% v. 7%, p = 0.75). There was 1 anastamotic leak in each group and no perioperative deaths. Median length of stay was significantly shorter for IA (4 v. 5 d, p = 0.05). There were 6 extraction site hernias with EA and none with IA (p = 0.026). CONCLUSION Laparoscopic right hemicolectomy with IA has the advantage of a less hernia-prone Pfannenstiel extraction site, faster recovery and shorter stay in hospital EA.
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Affiliation(s)
- Ashley S Vergis
- The Division of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man
| | - Sarah N Steigerwald
- The Division of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man
| | | | - Paul A Sullivan
- The Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - Krista M Hardy
- The Division of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man
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Yamada T, Okabayashi K, Hasegawa H, Tsuruta M, Abe Y, Ishida T, Matsui S, Kitagawa Y. Age, Preoperative Subcutaneous Fat Area, and Open Laparotomy are Risk Factors for Incisional Hernia following Colorectal Cancer Surgery. Ann Surg Oncol 2015; 23 Suppl 2:S236-41. [PMID: 25743333 DOI: 10.1245/s10434-015-4462-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although incisional hernia (IH) is a common complication of abdominal surgery, the incidence rate and risk factors are not well known. The objectives of this study are to determine the incidence rate of IH following colorectal cancer surgery and to describe the associated risk factors. METHODS Between 2005 and 2010, patients who underwent surgery to treat colorectal cancer were examined. The diagnosis of IH was performed by CT scan, and the visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus were calculated using a 3D-image analysis system. Survival analysis was used to assess the incidence and risk factors of IH. RESULTS A total of 626 patients (326 open, 300 laparoscopic) were included in this study, with median follow-up of 54 (range 2-97) months. Forty patients were diagnosed with postoperative IH, and the cumulative, 5-year incidence of IH was 7.3 %. Univariate analysis revealed that age, body mass index, waist circumference, hip circumference, open laparotomy, wound infection, VFA, and SFA were significantly associated with incidence of IH. Multivariate analysis revealed that age [hazard ratio (HR) 1.043 (1.005-1.083), p = 0.027], open laparotomy [HR 4.410 (1.018-19.095), p = 0.047], and SFA [HR 1.013 (1.004-1.022), p = 0.005] were significant risk factors for developing IH. CONCLUSIONS Higher age and SFA, along with open surgery, are risk factors for developing IH.
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Affiliation(s)
- Toru Yamada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | | | - Masashi Tsuruta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Ishida
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shimpei Matsui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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