RESUMEN
OBJECTIVE: The aim of the study was to evaluate the occurrence of stress urinary incontinence after pelvic organ prolapse surgery using the laparoscopic sacrocolpopexy method. This is a retrospective multicenter study. METHODS: The study included 131 patients who underwent laparoscopic sacrocolpopexy and underwent at least a one-year follow-up in the form of a clinical examination. RESULTS: The group included patients with an average age of 63.4 years (38-80 years), BMI 26.6 kg/m2 (19.4-36 kg/m2), and parity 2 (0-4). Before surgery, 30 (22.9%) patients showed stress incontinence, and after surgery there were 50 (38.2%); the difference was statistically significant (P = 0.0007). Thirty (22.9%) patients underwent subsequent anti-incontinence surgery, while 10 (7.6%) patients experienced significant improvement of stress incontinence. CONCLUSION: Pelvic organ prolapse reconstruction surgery by laparoscopic sacrocolpopexy is associated with the risk of postoperative stress incontinence in 38.2%, of which de novo in 22.9% of cases.
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Laparoscopía , Prolapso de Órgano Pélvico , Incontinencia Urinaria de Esfuerzo , Humanos , Incontinencia Urinaria de Esfuerzo/cirugía , Incontinencia Urinaria de Esfuerzo/etiología , Femenino , Persona de Mediana Edad , Laparoscopía/efectos adversos , Prolapso de Órgano Pélvico/cirugía , Anciano , Estudios Retrospectivos , Anciano de 80 o más Años , Adulto , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Procedimientos Quirúrgicos Ginecológicos/métodos , IncidenciaRESUMEN
To investigate the safety of pancreatic body suspension (PBS) technique in laparoscopic splenectomy combined with pericardial devascularization for patients. A retrospective study inclusive of 16 patients who underwent laparoscopic splenectomy combined with pericardial devascularization from 2017 to 2022 was performed. A total of 5 patients underwent PBS technique and 11 underwent the traditional technique. There was no significant difference in age, sex, body mass index (BMI), preoperative serum white cell count (WBC), platelets (PLT), hemoglobin (HB), albumin (ALB), prothrombin time (PT), total bilirubin (TBIL), or spleen size between the 2 groups (Pâ >â .05). In the PBS group, the operation time was 280 minutes. The estimated intraoperative blood loss (EBL) was 250 mL. The mean postoperative hospitalization length was 11.2 days. There was no conversion to an open procedure or postoperative bleeding. In the traditional method group, the mean operation time was 240.91 minutes. The EBL was 290.91 mL. There were 2 cases of conversion to open, 3 cases of postoperative bleeding, and 1 reoperation. The incidence of postoperative short-term complications (postoperative bleeding, reoperation) was significantly higher in the traditional method group than in the PBS group (36.36% vs 0%, Pâ =â .034). PBS technique improved the safety of laparoscopic splenectomy combined with pericardial dissection and is worthy of clinical promotion.
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Laparoscopía , Tempo Operativo , Pericardio , Esplenectomía , Humanos , Esplenectomía/métodos , Esplenectomía/efectos adversos , Masculino , Femenino , Laparoscopía/métodos , Laparoscopía/efectos adversos , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Pericardio/trasplante , Pericardio/cirugía , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Páncreas/cirugía , Páncreas/irrigación sanguínea , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Tiempo de Internación/estadística & datos numéricosRESUMEN
OBJECTIVES: Donor hepatectomy is a major surgery with a relatively safeprofile anda reportedcomplication rate of ~20%. Most complications are non-life threatening and are resolved with conservative measures. However, rare complications may need invasive precautions, ranging from percutaneous interventions to surgeries. MATERIALS AND METHODS: We retrospectively analyzed all living donor hepatectomies at our center. Donors were divided into 2 groups: laparoscopic and open procedures. We collected preoperative, intraoperative and postoperative data of donors.Donor complications were recorded separately intraoperatively and postoperatively according to the Clavien-Dindo postoperative complication classification system. RESULTS: Between July 2018 and April 2023, 215 living donors had hepatectomies, including 48 laparoscopic and 167 open donor hepatectomies. Among donors, 91 were female donors (42.3%) and 124 were male donors (57.7%).The meanage of alldonorswas 33.5±8.1 years, and the mean body mass index (in kilogram divided by meters squared) was 24.6 ± 3.8. Among donors, 124 underwent right and 91 underwent left or left lateral hepatectomies. The mean operative time for all donors was 301 ± 83 minutes, the mean hospital stay was 5.8 ± 1.4 days, and the mean follow-up was 31.9 ± 15.8 months. Four patients (1.8%) had intraoperative complications, including 2 cases of bleeding, 1 diaphragm perforation, and 1 portal vein stenosis. Fourteen patients (7.4%) had major postoperative complications, with 5 patients requiring surgical intervention. CONCLUSIONS: Donor hepatectomy is a complicated surgery that requires extensive preoperative preparation and appropriate donor selection. Postoperative donor complications can be diagnosed early with close follow-up, and a multidisciplinary approach is essential for complication management.
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Hepatectomía , Laparoscopía , Trasplante de Hígado , Donadores Vivos , Complicaciones Posoperatorias , Humanos , Femenino , Trasplante de Hígado/efectos adversos , Masculino , Hepatectomía/efectos adversos , Estudios Retrospectivos , Adulto , Laparoscopía/efectos adversos , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Factores de Riesgo , Factores de Tiempo , Adulto Joven , Persona de Mediana EdadRESUMEN
INTRODUCTION: An endoscopic intragastric balloon (IGB) placement is one of the minimally invasive methods of obesity treatment. One of the rare serious complications is mechanical bowel obstruction requiring operative management. We report a case of a male patient with small bowel obstruction due to IGB migration and the literature review of complications during IGB treatment. Detailed Case Description: A patient with a BMI of 28 kg/m2 was admitted to the hospital with spontaneous deflation of an IGB. Due to the suspected location of IGB in the ileum laparoscopy was performed. The enterotomy was performed and the IGB removed. The procedure and the postoperative period were uneventful. DISCUSSION: Spontaneous IGB ruptures are reported in the literature with a frequency ranging from 0.6 to 23%. The majority of deflated devices are spontaneously excreted with the stool with no abdominal symptoms. Only 0.38% of IGBs cause mechanical bowel obstruction of requiring surgical management. Based on our own experience and literature review, we propose the diagnostic and therapeutic algorithm. CONCLUSION: Complications after IGB placement can range from mild to severe, that is why it is so important to make an early diagnosis based on the emerging symptoms and to implement prompt management to reduce or avoid serious complications. Any patient reporting disturbing symptoms occurring over a pro- longed period of time requires hospitalization and careful observation for the occurrence of gastrointestinal obstruction. The ideal option is hospitalization in the center which implemented the IGB and start with the algorithm we proposed.
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Migración de Cuerpo Extraño , Balón Gástrico , Obstrucción Intestinal , Humanos , Masculino , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Balón Gástrico/efectos adversos , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/etiología , Obesidad Mórbida/cirugía , Resultado del Tratamiento , Intestino Delgado , Adulto , Laparoscopía/efectos adversos , Persona de Mediana EdadRESUMEN
PURPOSE: Choosing the best stump closure method for laparoscopic appendectomy has been a debated issue, especially for patients with acute appendicitis. The lack of consensus in the literature and the diverse techniques available have prompted the need for a comprehensive evaluation to guide surgeons in selecting the most optimal appendiceal stump closure method. METHODS: A comprehensive search was conducted on multiple databases from inception until December 2023 to find relevant studies according to eligibility criteria. The primary outcome was the incidence of total complications. RESULTS: 25 studies with a total of 3308 patients were included in this study, overall complications did not reveal a significant advantage for any intervention (RR = 0.72, 95% CI: 0.53; 1.01), Superficial and deep infection risks were similar across all methods, Operative time was significantly longer with endoloop and Intracorporeal sutures (MD = 7.07, 95% CI: 3.28; 10.85) (MD = 26.1, 95% CI: 20.9; 31.29). CONCLUSIONS: There are no significant differences in overall complications among closure methods. However, Intracorporeal sutures and endoloop techniques were associated with extended operative durations.
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Apendicectomía , Apendicitis , Laparoscopía , Apendicectomía/métodos , Apendicectomía/efectos adversos , Humanos , Laparoscopía/métodos , Laparoscopía/efectos adversos , Apendicitis/cirugía , Técnicas de Sutura , Metaanálisis en Red , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Tempo Operativo , Resultado del TratamientoRESUMEN
BACKGROUND: In the last 3 decades, laparoscopic Heller myotomy (LHM) has represented the treatment of choice for esophageal achalasia, solving symptoms in most patients. Little is known about the fate of patients relapsing after LHM or their treatment. In this study, we aimed at evaluating the results of complementary pneumatic dilations (CPDs) after ineffective LHM. METHODS: We evaluated the patients who underwent LHM with Dor fundoplication (LHD) from 1992 to 2022 and were submitted to CPD for persistent or recurrent symptoms. The patients were followed clinically and with manometry, barium swallow, and endoscopy when necessary. An Eckardt score (ES) of > 3 was used as threshold for failure. RESULTS: Of 1420 patients undergoing LHD, 120 (8.4%) were considered failures and were offered CPD. Ten patients refused further treatment; in 5 CPD was not indicated for severe esophagitis; 1 patient had surgery for a misshaped fundoplication and 1 patient developed cancer 2 years after LHD; that leaves 103 patients who underwent a median 2 CPDs (IQR, 1-3), at a median of 15 (IQR, 8-36) months after surgery, with 3.0- to 4.0-cm Rigiflex dilator (Boston Scientific, Massachusetts, USA). No perforations were recorded. Only 6 patients were lost to follow-up. Thus, 97 were followed for a median of 37 months (IQR, 6-112) after the last CPD: 70 (72%) were asymptomatic, whereas 27 (28%) had significant persistent dysphagia (ES > 3). The only differences between the 2 groups were the ES after surgery (P < .01) and the number of required CPD. Overall, the combination of LHD + CPD provided a satisfactory outcome in 96.5% of the patients. CONCLUSION: CPDs represent an effective and safe option to treat patients after a failed LHD: when the postsurgery ES consistently remains high and the number of CPDs required to control symptoms exceeds 2, this may suggest the need for further invasive treatments.
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Dilatación , Acalasia del Esófago , Fundoplicación , Miotomía de Heller , Laparoscopía , Insuficiencia del Tratamiento , Humanos , Acalasia del Esófago/cirugía , Femenino , Masculino , Persona de Mediana Edad , Miotomía de Heller/métodos , Laparoscopía/métodos , Laparoscopía/efectos adversos , Fundoplicación/métodos , Adulto , Dilatación/métodos , Estudios Retrospectivos , Recurrencia , Anciano , Resultado del TratamientoRESUMEN
BACKGROUND: Postoperative wound recovery following laparotomy for port-site metastasis (PSM) resection is a concern. Reports indicate that wound healing disorders occur in patients with PSM. The challenges associated with PSM resection include the complete removal of the lesion, ensuring rapid wound healing, and maintaining the integrity of the abdominal wall. To date, there have been no reports on a minimally invasive approach for PSM resection following ovarian cancer through the inner side of the abdominal wall. CASE PRESENTATION: A 66-year-old G2P1 patient with a history of high-grade serous ovarian adenocarcinoma IIA presented with two abdominal wall masses, suspected to be PSM. She underwent laparoscopic resection of the lesions under general anesthesia. The excised masses measured approximately 10 cm and 5 cm, and margins were negative. The surgery lasted 1 hour and 33 minutes, with minimal intraoperative bleeding and no complications. The postoperative recovery was smooth. No recurrence was observed during the 12-month follow-up. CONCLUSIONS: In our view, laparoscopy may be used as a minimally invasive technique that allows for PSM in the abdominal wall.
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Laparoscopía , Neoplasias Ováricas , Humanos , Femenino , Laparoscopía/métodos , Laparoscopía/efectos adversos , Neoplasias Ováricas/cirugía , Neoplasias Ováricas/patología , Anciano , Pared Abdominal/cirugía , Pared Abdominal/patología , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
PURPOSE: Robotic-assisted rectal surgery (RARS) and Laparoscopic-assisted rectal surgery are the two techniques that are increasingly used for rectal cancer, and both have their advantages and disadvantages. This meta-analysis will analyze the outcomes of both techniques to determine their relative performance and suitability. METHODS: An extensive search was carried out on PubMed, Cochrane, Scopus, Embase, and Google Scholar, followed by a meta-analysis of all randomized controlled trials (RCTs) to assess both approaches for rectal cancer. RESULTS: This meta-analysis is comprised of fifteen RCTs. The conversion to open surgery (RR = 0.53, 95% CI: 0.38-0.74, P = 0.0002) was significantly lower in the RARS group. The outcomes like anastomotic leak, postoperative ileus, postoperative urinary retention (POUR), surgical site infection (SSI), and intra-abdominal abscess showed no significant difference between the two groups. The reoperation rate (RR = 0.56, 95% CI: 0.34-0.95, P = 0.03) was lower in the robotic group. High heterogeneity was obtained when pooling data on operative time, length of hospital stay, and blood loss. Oncological outcomes, including local recurrence, the number of harvested lymph nodes (LN) and distal resection margin showed no significant distinction among both groups, while the positive circumferential resection margin (CRM) (RR = 0.67, 95% CI: 0.49-0.91, P = 0.01) was lower in the RARS group. RARS demonstrated a significantly higher rate of total mesorectal excision (TME) (RR = 1.07, 95% CI: 1.01-1.14, P = 0.03). CONCLUSION: RARS is safe and feasible for rectal cancer patients and may be superior or equivalent to Laparoscopic-assisted rectal surgery, but high-standard, large-scale trials are required to determine the best approach.
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Laparoscopía , Neoplasias del Recto , Procedimientos Quirúrgicos Robotizados , Humanos , Neoplasias del Recto/cirugía , Neoplasias del Recto/patología , Laparoscopía/métodos , Laparoscopía/efectos adversos , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
PURPOSE: Parastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit. The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic Sugarbaker repair of PH following radical cystectomy and ileal conduit. METHODS: We retrospectively evaluated all patients who underwent laparoscopic treatment of PH following radical cystectomy and ileal conduit at Huashan Hospital, Fudan University from May 2013 to December 2022. RESULTS: Thirty-five patients were included in the study. Median follow up was 32months (IQR, 25-38 months). Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery. CONCLUSION: Surgical management of PH following radical cystectomy and ileal conduit is challenging. The laparoscopic Sugarbaker technique for repairing PH following radical cystectomy and ileal conduit has low complication and recurrence rate.
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Cistectomía , Herniorrafia , Laparoscopía , Derivación Urinaria , Humanos , Cistectomía/métodos , Cistectomía/efectos adversos , Masculino , Laparoscopía/métodos , Laparoscopía/efectos adversos , Estudios Retrospectivos , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Femenino , Anciano , Persona de Mediana Edad , Herniorrafia/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Hernia Incisional/etiología , Hernia Incisional/cirugía , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
OBJECTIVE: To analyze learning curves and appropriate experience on the features of mini-bypass surgery in 341 obese patients. MATERIAL AND METHODS: A total of 341 laparoscopic mini-gastric bypass surgeries performed by one surgeon were studied. The median age of patients was 40.5 [34; 48.3] years. There were 284 (83.2%) women and 57 (16.8%) men. The median BMI was 45 [40;52] kg/m2. RESULTS: The period of MGB development consisted of 138 interventions. Surgery time was 120 [100; 130] min and 90 [82.5; 100] mins after development of this technique (p=0.001). Complications occurred in 5 (1.5%) patients (1 patient with Clavien Dindo grade IIIA and 4 ones with grade IIIB). Of these, there were 3 patients with stapler suture defects. There were no complications only in the 4th quartile of surgeries. Surgical experience significantly affects postoperative outcomes. Surgery time was more influenced by surgical skill rather technique of anastomosis imposing. CONCLUSION: Polynomial regression objectively characterizes development of surgical skills lasting 138 interventions. MGB is safe for morbid obesity with a complication rate of 1.5% and no mortality.
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Derivación Gástrica , Laparoscopía , Curva de Aprendizaje , Obesidad Mórbida , Tempo Operativo , Complicaciones Posoperatorias , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Derivación Gástrica/métodos , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Laparoscopía/métodos , Laparoscopía/efectos adversos , Competencia Clínica , Índice de Masa Corporal , Federación de Rusia/epidemiología , Resultado del TratamientoRESUMEN
OBJECTIVE: To study the safety and efficacy of laparoscopic fundoplication and hiatal hernia repair for gastroesophageal reflux disease following hiatal hernia. MATERIAL AND METHODS: We retrospectively analyzed 56 patients with gastroesophageal reflux disease and hiatal hernia .They underwent laparoscopic fundoplication and hiatal hernia repair between January 2020 and January 2023. RESULTS: All surgeries were successful without conversion to open surgery. Surgery time was 56-180 min (mean 68.4±3.6), blood loss 30-200 ml (mean 40.3±5.6). No mortality and severe complications occurred. All patients were followed-up for 6-24 months. The GERD-Q and De Meester scores were significantly lower after 6 months compared to baseline values (p <0.05), and resting pressure was lower. Tone of lower esophageal sphincter was significantly higher compared to preoperative level (p <0.05). In 1-2 years after surgery, symptoms completely disappeared in 48 patients and significantly improved in 6 patients. Two patients had no improvement. Contrast-enhanced examination found no recurrent hiatal hernia and digestive tract obstruction. CONCLUSION. L: Aparoscopic fundoplication and hiatal hernia repair is safe and effective for gastroesophageal reflux disease with hiatal hernia.
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Fundoplicación , Reflujo Gastroesofágico , Hernia Hiatal , Laparoscopía , Humanos , Reflujo Gastroesofágico/cirugía , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/etiología , Hernia Hiatal/cirugía , Hernia Hiatal/diagnóstico , Hernia Hiatal/complicaciones , Fundoplicación/métodos , Femenino , Masculino , Persona de Mediana Edad , Laparoscopía/métodos , Laparoscopía/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto , Herniorrafia/métodos , Herniorrafia/efectos adversos , Complicaciones Posoperatorias/etiología , Tempo Operativo , AncianoRESUMEN
Postoperative hiatal hernia is a rare and specific complication after esophagectomy. This complication leads to emergency and affects mortality. Incidence of this complication has increased due to the great number of minimally invasive procedures over the past decades. In addition, chronic cough, preoperative hiatal hernia and transhiatal approach also increase the risk of recurrent hernias. Most post-esophagectomy hiatal hernias do not require emergency surgery. About 70% of patients have symptoms reducing the quality of life. About 25% of cases are asymptomatic and discovered incidentally during follow-up examinations. The role of surgery for asymptomatic post-esophagectomy hernias is a matter of debate because the risk of symptoms or complications is poorly predictable. Surgical treatment is the only radical method for symptomatic or complicated hernias. However, there is still no consensus regarding surgical approach and technique. Most surgeons prefer open surgery fearing severe adhesive process and other technical difficulties. Laparoscopic approach is widely accepted as the "gold standard" for primary hiatal hernia. However, minimally invasive access for post-esophagectomy hiatal hernias is not sufficiently studied and described in several case reports. Currently, it is very important to study the risk factors of hiatal hernias after esophagectomy. We present successful laparoscopic repair of hiatal hernia after hybrid McKeown esophagectomy.
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Neoplasias Esofágicas , Esofagectomía , Hernia Hiatal , Herniorrafia , Laparoscopía , Complicaciones Posoperatorias , Humanos , Hernia Hiatal/cirugía , Hernia Hiatal/etiología , Esofagectomía/efectos adversos , Esofagectomía/métodos , Laparoscopía/métodos , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/etiología , Herniorrafia/métodos , Herniorrafia/efectos adversos , Neoplasias Esofágicas/cirugía , Masculino , Resultado del Tratamiento , Persona de Mediana EdadRESUMEN
BACKGROUND: Benign uretero-ileal anastomotic stricture (UIAS) is a potentially serious complication that can arise after radical cystectomy (RC) and subsequent urinary diversion. To preserve residual renal function and improve prognosis, it is crucial to derive insights from experience and tailor individualized treatment strategies for different patients. PATIENTS AND METHODS: From October 2014 to June 2021, a total of 47 patients with benign UIAS underwent endoscopic management (n = 19) or reimplantation surgery (n = 28). The basic data, perioperative conditions, and postoperative outcomes of the two groups were compared and analyzed to evaluate efficacy. RESULTS: Comparing preoperative and postoperative clinical efficacy within the same group, the endoscopic group showed no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (p > 0.05). However, significant differences were observed in glomerular filtration rate (GFR) levels on the affected side before surgery and after extubation (p < 0.05). In contrast, the laparoscopic reimplantation group did not exhibit significant differences in creatinine, BUN, or GFR levels of affected side before surgery and after extubation (p > 0.05). Postoperative clinical efficacy showed no significant difference in creatinine and BUN levels between the two groups (p > 0.05). However, GFR values of affected side in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (p < 0.05). Additionally, the laparoscopic reimplantation group was able to remove the single-J tube earlier than the endoscopic treatment group (p < 0.05), had a lower recurrence rate of hydronephrosis after extubation (p < 0.05), and experienced a later onset of hydronephrosis compared to the endoscopic treatment group (p < 0.05). CONCLUSIONS: Based on our experience in treating UIAS following RC combined with urinary diversion, laparoscopic reimplantation effectively addresses the issue of UIAS, allowing for the removal of the ureteral stent relatively soon after surgery. This approach maintains long-term ureteral patency, preserves residual renal function, reduces the risk of ureteral restenosis and hydronephrosis, and has demonstrated superior therapeutic outcomes in this study.
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Anastomosis Quirúrgica , Cistectomía , Complicaciones Posoperatorias , Uréter , Derivación Urinaria , Humanos , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Cistectomía/efectos adversos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Constricción Patológica/etiología , Constricción Patológica/cirugía , Anastomosis Quirúrgica/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Uréter/cirugía , Tasa de Filtración Glomerular , Íleon/cirugía , Estudios Retrospectivos , Neoplasias de la Vejiga Urinaria/cirugía , Resultado del Tratamiento , Creatinina/sangre , Laparoscopía/efectos adversos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiologíaRESUMEN
BACKGROUND: Inadequate surgical interventions can lead to serious complications such as tubo-ovarian abscesses in the upper female genital system, often resulting from untreated pelvic inflammatory disease. Pelvic inflammatory disease, caused by infections like Chlamydia trachomatis and Neisseria gonorrhoeae, leads to scarring and adhesions in the reproductive organs, with common risk factors including intrauterine device use and multiple sexual partners. Pelvic inflammatory disease primarily affects sexually active young women and can manifest with varied symptoms, potentially leading to complications like ectopic pregnancy, infertility, and chronic pelvic pain if untreated. CASE PRESENTATION: This case report presents a unique scenario involving a 17-year-old sexually inactive female who experienced concurrent tubo-ovarian abscess, acute cystitis, and pancolitis following laparoscopic ovarian cystectomy. Pelvic inflammatory disease and its complications are well-documented, but the simultaneous occurrence of acute cystitis and pancolitis in this context is unprecedented in the medical literature. The patient's presentation, clinical course, and management are detailed, highlighting the importance of considering diverse and severe complications in individuals with a history of gynecological surgeries. CONCLUSIONS: Our case report highlights the need for healthcare professionals to remain vigilant for atypical presentations of gynecological complications and emphasizes the value of interdisciplinary collaboration for optimal patient care. We encourage further research and awareness to enhance understanding and recognition of complex clinical scenarios associated with gynecological procedures.
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Absceso , Cistitis , Laparoscopía , Humanos , Femenino , Adolescente , Laparoscopía/efectos adversos , Cistitis/etiología , Absceso/etiología , Enfermedades del Ovario/etiología , Enfermedades del Ovario/cirugía , Complicaciones Posoperatorias/etiología , Enfermedad Inflamatoria Pélvica/etiología , Enfermedad Aguda , Enfermedades de las Trompas Uterinas/etiología , Enfermedades de las Trompas Uterinas/cirugíaRESUMEN
A single-blind, randomized controlled trial comparing oxycodone and fentanyl for patient-controlled intravenous analgesia (PCIA) after laparoscopic hysteromyomectomy found comparable pain relief between the two groups. The study included 60 participants, with NRS scores for pain at rest and when moving showing no significant differences between oxycodone and fentanyl groups at various time points postoperatively. Self-rating depression scale scores were also similar between the groups at 48 h. However, patients' satisfaction with PCIA was higher in the oxycodone group, with 73.3% reporting being very satisfied compared to 36.7% in the fentanyl group. Additionally, the oxycodone group had fewer incidences of headaches within 48 h postoperatively compared to the fentanyl group. These findings suggest that oxycodone may offer comparable pain relief, higher patient satisfaction, and fewer headaches for patients undergoing laparoscopic hysteromyomectomy compared to fentanyl, making it a suitable option for postoperative pain management in this population.Clinical trial registration number The study was registered with CHICTR.org, ChiCTR2100051924.
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Analgesia Controlada por el Paciente , Analgésicos Opioides , Fentanilo , Laparoscopía , Oxicodona , Dolor Postoperatorio , Humanos , Fentanilo/administración & dosificación , Fentanilo/uso terapéutico , Oxicodona/administración & dosificación , Oxicodona/uso terapéutico , Femenino , Analgesia Controlada por el Paciente/métodos , Laparoscopía/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Método Simple Ciego , Persona de Mediana Edad , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Satisfacción del Paciente , Dimensión del Dolor , Miomectomía Uterina/efectos adversos , Miomectomía Uterina/métodosRESUMEN
OBJECTIVE: To evaluate the application of a rehabilitation management protocol for urinary incontinence after robot-assisted laparoscopic prostatectomy (RALP). METHODS: We conducted a retrospective cohort study of 114 patients who underwent RALP between August 2021 and November 2021 as the control group and a prospective analysis of 114 patients who underwent RALP between May 2022 and August 2022 as the experimental group. The rehabilitation management protocol focused on preoperative stage, postoperative care, day of catheter removal, 1 month postoperative, 3 months postoperative, 6 months postoperative, and 12 months or more postoperative. RESULTS: The 24-h pad test was significantly lower in the experimental group compared with the control group at 2 and 6 months after RALP (both P < 0.01). The scores of the international consultation on incontinence questionnaire-short form (ICIQ-SF) in the experimental group were significantly lower than those in the control group at 1 month after RALP (P < 0.01).The scores of quality of life in the experimental group were significantly higher than those of the control group at 1, 2, and 6 months after RALP (all P < 0.01).The scores of Broome Pelvic Muscle Self-efficacy Scale (BPMSES) were lower than those of the control group at 1, 2, 3, and 6 months after RALP (all P < 0.01). CONCLUSION: The application of the rehabilitation management protocol had significant beneficial effects on urinary functions and quality of life in patients with prostate cancer after RALP.
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Laparoscopía , Prostatectomía , Neoplasias de la Próstata , Calidad de Vida , Procedimientos Quirúrgicos Robotizados , Incontinencia Urinaria , Humanos , Masculino , Prostatectomía/efectos adversos , Prostatectomía/métodos , Prostatectomía/rehabilitación , Incontinencia Urinaria/etiología , Incontinencia Urinaria/rehabilitación , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Laparoscopía/métodos , Laparoscopía/efectos adversos , Anciano , Estudios Prospectivos , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/rehabilitación , Encuestas y Cuestionarios , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/rehabilitación , Resultado del TratamientoRESUMEN
BACKGROUND: A recent meta-analysis concluded that outpatient appendectomy appears feasible and safe, but there is a lack of high-quality evidence and a randomized trial is needed. The aim of this trial is to demonstrate that outpatient appendectomy is non-inferior to conventional inpatient appendectomy in terms of overall morbi-mortality on the 30th postoperative day (D30). METHODS: SAMBA is a prospective, randomized, controlled, multicenter non-inferiority trial. We will include 1400 patients admitted to 15 French hospitals between January 2023 and June 2025. Inclusion criteria are patients aged between 15 and 74 years presenting acute uncomplicated appendicitis suitable to be operated by laparoscopy. Patients will be randomized to receive outpatient care (day-surgery) or conventional inpatient care with overnight hospitalization in the surgery department. The primary outcome is postoperative morbi-mortality at D30. Secondary outcomes include time from diagnosis to appendectomy, length of total hospital stay, re-hospitalization, interventional radiology, re-interventions until D30, conversion from outpatient to inpatient, and quality of life and patient satisfaction using validated questionnaires. DISCUSSION: The SAMBA trial tests the hypothesis that outpatient surgery (i.e., without an overnight hospital stay) of uncomplicated acute appendicitis is a feasible and reliable procedure in establishments with a technical platform able to support this management strategy. TRIAL REGISTRATION: ClinicalTrials.gov NCT05691348. Registered on 20 January 2023.
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Procedimientos Quirúrgicos Ambulatorios , Apendicectomía , Apendicitis , Estudios Multicéntricos como Asunto , Humanos , Apendicectomía/efectos adversos , Apendicectomía/métodos , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/métodos , Estudios Prospectivos , Apendicitis/cirugía , Apendicitis/mortalidad , Persona de Mediana Edad , Adulto , Adolescente , Anciano , Adulto Joven , Francia , Resultado del Tratamiento , Femenino , Factores de Tiempo , Laparoscopía/efectos adversos , Laparoscopía/métodos , Tiempo de Internación , Masculino , Estudios de Equivalencia como Asunto , Calidad de Vida , Satisfacción del Paciente , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
To evaluate the efficacy and postoperative complications of endoscopic thoracoscopic and laparoscopic radical esophagectomy compared to open surgery in esophageal cancer treatment. This retrospective study included 103 esophageal cancer patients admitted from August 2018 to March 2022, divided into observation (endoscopic surgery) and control (open surgery) groups. We compared intraoperative parameters, postoperative outcomes, immune function, and one-year overall survival (OS). Intraoperative bleeding volume, the retention time of chest tube, postoperative fasting time, and hospital stay in the observation group were smaller than those in the control group (Pâ <â .05). The differences were not statistically significant (Pâ >â .05) when comparing operative time, the number of intraoperative blood transfusion cases, and the rate of operating room extubation in these 2 groups. The differences were not statistically significant when comparing the amount of resected lymph nodes and the positive rate of incisal edge in these 2 groups (Pâ >â .05). There was no statistically significant difference in the complication rates such as pneumonia, pleural effusion, pneumothorax, pulmonary embolism, anastomotic fistula, the leakage of thoracic duct, the injury of RLN and arrhythmia in these 2 groups (Pâ >â .05). At 7 days postoperatively, the CD4+ and CD4+/CD8+ in the observation group and the control group were smaller than the preoperative ones in their same groups, and they were larger in the observation group than those in the control group (Pâ <â .05); There was no statistically significant difference on the CD8+ in the observation group and the control group at 7 days postoperatively compared with the preoperative ones in their same groups (Pâ >â .05). The 1-year postoperative OS rate was 81.63% (40/49) in the observation group and 72.22% (39/54) in the control group, and the difference was not statistically significant when comparing the OS rates of these 2 groups (Pâ =â .238, HRâ =â 0.622, 95% CIâ =â 0.279-1.385). Endoscopic thoracoscopic and laparoscopic esophagectomy offers less invasive treatment with significant short-term benefits and better preservation of immune function in esophageal cancer patients, making it a safe and effective surgical option.
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Neoplasias Esofágicas , Esofagectomía , Laparoscopía , Complicaciones Posoperatorias , Toracoscopía , Humanos , Esofagectomía/métodos , Esofagectomía/efectos adversos , Neoplasias Esofágicas/cirugía , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Laparoscopía/métodos , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Toracoscopía/métodos , Toracoscopía/efectos adversos , Anciano , Tempo Operativo , Resultado del Tratamiento , Tiempo de Internación/estadística & datos numéricosRESUMEN
OBJECTIVE: Our objective was to propose a laparoscopic modified simple ureteroneocystostomy for repairing iatrogenic ureteral injuries. In laparoscopic modified simple ureteroneocystostomy, the highest point of the bladder was found by cystoscopy, then we implanted a "fish mouth" ureter end into the bladder, leaving at least 1 cm of ureter end in the bladder as an anti-reflux procedure. CASE REPORT: We retrospectively reviewed a case series of lower third iatrogenic ureter injury during gynecology surgery of 11 patients who received laparoscopic modified simple ureteroneocystostomy at Da Lin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, from January 2011 to December 2020. One patient needs percutaneous nephrotomy due to infection and had the ureteroneocystostomy two months later. No obstruction, ureter stenosis/stricture, bladder leakage or other renal complications were noted after repair. CONCLUSION: Laparoscopic modified simple ureteroneocystostomy is technically feasible for repairing lower third ureter injuries, with no major complications.
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Cistostomía , Enfermedad Iatrogénica , Laparoscopía , Uréter , Humanos , Femenino , Uréter/lesiones , Uréter/cirugía , Laparoscopía/métodos , Laparoscopía/efectos adversos , Estudios Retrospectivos , Adulto , Cistostomía/métodos , Cistostomía/efectos adversos , Persona de Mediana Edad , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Procedimientos Quirúrgicos Ginecológicos/métodos , Procedimientos Quirúrgicos Ginecológicos/efectos adversosRESUMEN
INTRODUCTION: The effective techniques of surgical intervention that ensure the desired level of weight reduction outcomes (decreased level of obesity) not always improve QOL outcomes, explained by a range of post-surgery complications. There are the specific complications, strongly impacting the QOL of the patients after bariatric surgery and increasing postoperative comorbidity. AIM: The aim of this retrospective case control study was to evaluate the relative safety of primary LSG performed with standard and modified LSG techniques according to the Clavien-Dindo complication grading system and the rate of long-term complications in patients with BMI>40. MATERIALS AND METHODS: A total of 497 cases of patients were divided into 2 groups in accordance with the type of LSG performed. The first group (n = 246) were the patients managed with the Standard protocol of LSG and the second group (n = 251) included the patients treated with the modified protocol of the LSG. The prevalence of specific post-bariatric complications and short-term (30-days) complications was calculated and compared in the groups. The long-term complications were assessed after 1-year Ö f post-operation period in both intervention groups. The relative risk ratio, p-value and CI95% were calculated for all complications. The short-term (30-days) complications assessment in both intervention groups was performed in accordance with Clavien-Dindo classification of surgical complications. RESULTS: The remarkable reduction of relative risks was registered for the minor and major complications rates. Similarly, the total rates for the minor and major complications demonstrated strong difference between group I and group II (p<0,05). Тhe intraoperative and early (first 72 hours) complications (acute bleeding, and leakage) rates in patients of group I were reliably lower compared to the patients of group II (p<0,05). The RR indicators were 0.123 and 0.121 respectively for acute bleeding and leakage. The indicator of acute obstruction was not essentially different while intergroup comparison was significantly divergent (p<.05). However, the RRR was calculated as 80%. The total rate of intraoperative and first 72 hours complications was 7.3% vs 1.2% in group II. The difference was reliable (p-value<.05) in Gall stone disease, GERD, thrombosis malnutrition and anemia. Comparison of the Renal lithiasis and depression didn't reveal any essential difference between clinical groups (p-value>.05). CONCLUSION: The results we received are direct confirmation of the comparatively higher effectiveness of the modified LSG evidenced by a significant reduction of the major and minor complications in patients with BMI>40.