Clinical Efficacy Of Laparoscopic Surgery Research Articles

Anti-infective therapy durations predict psychological stress and laparoscopic surgery quality in pelvic abscess patients

BACKGROUND The degree of psychological stress and the difficulty and efficacy of laparoscopic surgery differ in patients with pelvic abscesses after different durations of anti-infection treatment. AIM To compare and analyse the effects of different durations of anti-infective therapy on patients’ preoperative psychological stress level and the clinical efficacy of laparoscopic surgery in patients with pelvic abscesses to offer a reference for the selection of therapy plans. METHODS A total of 100 patients with pelvic abscesses who were admitted to the Department of Gynecology of Suzhou Ninth Hospital affiliated to Soochow University (Suzhou Ninth People's Hospital) from January 2018 to December 2022 were retrospectively enrolled. According to the different durations of anti-infective therapy, they were divided into Group S (50 patients, received anti-infective therapy for 24-48 h) and Group L (50 patients, received anti-infective therapy for 48-96 h). Baseline data, state-trait anxiety score at admission and before surgery, self-rating anxiety scale (SAS) + self-rating depression scale (SDS) score, surgery time, adhesion grading score, intraoperative blood loss, presence or absence of intraoperative intestinal injury, ureteral injury or bladder injury, postoperative body temperature, length of hospital stay, and presence or absence of recurrence within 3 mo after surgery, chronic pelvic pain, incision infection, dysmenorrhea, menstrual disorder or intestinal obstruction were compared between the S group and the L group. RESULTS There was no significant difference in the background data between the S group and the L group (P < 0.05). There was no significant difference in the state-trait anxiety score or SAS + SDS score between the S group and the L group on admission (P < 0.05). The state-trait anxiety score and SAS + SDS score of the S group were lower than those of Group L after receiving different durations of anti-infective therapy (P < 0.05). There was no significant difference in the incidence of intestinal, ureteral or bladder injury between the S group and the L group (P < 0.05). The surgery time of Group S was shorter than that of Group L, and the adhesion score and intraoperative blood loss volume were lower than those of Group L (P < 0.05). There was no significant difference in the incidence of incision infection, dysmenorrhea, menstrual disorder or intestinal obstruction between the S group and the L group (P < 0.05). The postoperative body temperature of Group S was lower than that of Group L (P < 0.05), and the hospital stay was shorter than that of Group L (P < 0.05). The incidences of recurrence and chronic pelvic pain within 3 mo after surgery were lower than that of Group L (P < 0.05). CONCLUSION Twenty-four to forty-eight hours of anti-infective therapy is better than 48-96 h of anti-infective therapy for patients with pelvic abscesses because the degree of psychological stress is lower, which is more conducive to achieving better outcomes after laparoscopic surgery.

Clinical efficacy of laparoscopic surgery combined with drug therapy for endometriosis: A meta-analysis.

To systematically investigate the clinical efficacy and prognosis of laparoscopic surgery combined with drug therapy for endometriosis. Clinical randomized controlled trials regarding laparoscopic surgery combined with drug therapy for endometriosis and published between 2010 and 2022 were retrieved from PubMed, Web of Science and Embase, China National Knowledge Infrastructure, and Wanfang databases. Meta-analysis and sensitivity tests were performed using the Stata16.0 software. A total of 1332 articles were retrieved. Of them, 11 studies were included for final analysis, comprising of 521 cases in the treatment group (laparoscopic surgery combined with drug therapy) and 530 cases in the control group (laparoscopic surgery alone). Meta-analysis results showed that compared with the control group, the combined treatment had higher treatment effective rate [OR=4.542, 95% CI (3.062, 6.736), P<0.001], pregnancy rate [OR=3.341, 95% CI (2.336, 4.780), P<0.001], and lower incidence of adverse reactions [OR=0.348, 95% CI (0.208, 0.583), P<0.001] and recurrence rate [OR=0.187, 95% CI (0.106, 0.328), P<0.001]. In addition, after treatment, estradiol [SMD=-3.417, 95% CI (-4.631, -2.203), P<0.001] and follicle-stimulating hormone [SMD=-1.976, 95% CI (-3.202, -0.751), P=0.002] in the treatment group were significantly lower than the control group. Compared with laparoscopic surgery alone, laparoscopic surgery combined with drug therapy demonstrated better clinical efficacy and improved postoperative infertility and recurrence rate for treating endometriosis.

Clinical efficacy of laparoscopic surgery used for the excision of villus tissue and the repair of uterine scar in patients with cesarean scar pregnancy-II.

The present study described the clinical presentation of patients with cesarean scar pregnancy type II (CSP)-II diagnosed by ultrasound or magnetic resonance imaging, who underwent laparoscopic surgery resection or hysteroscopic treatment. The aim of the present study was to evaluate the outcomes of different treatments for CSP. The patients with CSP-II were assigned to the laparoscopy and hysteroscopy groups according to the type of surgery performed. The general indicators and post-operative outcomes were compared between the two groups. Statistically significant differences (P<0.05) were noted in the treatment efficacy indices between the two groups. The laparoscopic group exhibited a lower value of β-human chorionic gonadotropin (β-HCG) following surgery (P=0.017), a shorter time required for β-HCG to return to normal levels (P=0.001), a reduced post-operative thickness of the uterine scar (P<0.001) and a reduced menstruation recovery time (P<0.001). However, no significant differences were noted in blood loss during operation (P>0.05). On the whole, the data indicated that the laparoscopic resection of the scar with gestational tissue and wound repair may be used to preserve the uterus and may thus be an effective method for CSP-II. The appropriate treatment needs to be selected according to the condition of each patient. Based on the latter and on the available technology, priority may perhaps be given to laparoscopic surgery.

Long-term results of laparoscopic surgery and open surgery for colorectal cancer in Huaihe River Basin of China

In this study, we aimed to compare clinical efficacy of laparoscopic surgery and open surgery for colorectal cancer in the Huaihe River Basin in China. A total of 92 patients with colorectal cancer were selected as subjects. Patients were divided into control group (open surgery, n = 27 cases) and test group (laparoscopic surgery, n = 28 cases). Our results showed that the duration of operation (122.54 ± 14.85) min and length of incision (4.51 ± 1.065) cm were shorter in the experimental group than those in the control group. The intraoperative blood loss of the experimental group was (161.12 ± 10.694) ml, which was less than that of the control group (218.53 ± 15.369) ml (P < 0.05). Patients in the experimental group have higher Five-year survival rate and lower incidence of postoperative complications than those in the control group (all P < 0.05). In conclusion, in the treatment of colorectal cancer, laparoscopic surgery has a better clinical effect than open surgery, which is worthy of clinical application.

Comparative study of laparoscopic versus open radical gastrectomy in advanced gastric neuroendocrine carcinoma: Analysis from a high-volume institution

Gastric neuroendocrine carcinomas (G-NECs) are rare. This study aimed to explore the feasibility and clinical efficacy of laparoscopic surgery in patients with advanced G-NECs. The clinicopathological data of 175G-NECs patients who underwent radical gastrectomy in a high-volume centre were collected. One hundred fifty-one cases with advanced G-NECs (laparoscopic gastrectomy [LG]=30, open gastrectomy [OG]=121) were finally selected for comparison of the short-term outcomes and oncologic efficacy. In the postoperative recovery, when comparing the OG group, the time to ambulation (3.2d vs. 2.6d, respectively, p=0.049), the time to first flatus (4.1d vs. 3.6d, respectively, p=0.050), the time to first soft diet (7.9d vs. 6.7d, respectively, p=0.007), and the postoperative hospital stay (13.1d vs. 11.4d, respectively, p=0.047) of the LG group were shorter. There was no significant difference in the postoperative complication rates between the OG and LG groups (19.8% vs. 23.3%, p=0.671). The 3-year overall survival (OS) rate was 57.0% in the OG group and 64.4% in the LG group (p=0.349). The 3-year disease-free survival (DFS) rate was 51.7% in the OG group and 57.4% in the LG group (p=0.357). There was no significant difference in the 3-year OS and DFS rates between the LG and OG groups at each stage. The recurrence rate was 35.5% in the OG group and 33.0% in the LG group (p=0.821). The short-term outcomes and oncologic efficacy of laparoscopic gastrectomy and open gastrectomy for advanced G-NECs are comparable.

Mo1763 - Clinical Efficacy of Laparoscopic Surgery for T4 Colon Cancer Compared to Open Surgery

Mo1763 - Clinical Efficacy of Laparoscopic Surgery for T4 Colon Cancer Compared to Open Surgery

Management and Outcome of Heterotopic Pregnancy

Objective: The aim of this study was to investigate the clinical efficacy of laparoscopic surgery for women with heterotopic pregnancy. Method: The clinical outcomes of 12 patients with intrauterine and ectopic pregnancy undergoing laparoscopic operation were analyzed retrospectively. Results: The products of ectopic pregnancy were removed by laparoscopically. The median operation time was 12 minutes, and the average blood loss was 21.4 ml. There were no postoperative complications. The wounds recovered well in all cases. Among these women, ten delivered at term whereas two failed to continue their pregnancies, one had an abortion after 8 days of the surgery and another one had an abortion due to preterm premature rupture of the membrane at 15 gestational weeks. Conclusion: Laparoscopic surgery is an effective technique in successful management of heterotopic pregnancy.

Clinical effect of laparoscopic surgery combined with gonadotropin-releasing hormone agonist in the treatment of endometriosis

Objective To investigate the clinical efficacy of laparoscopic surgery combined with gonadotropin-releasing hormone agonist (GnRH-a) in the treatment of endometriosis (EMs). Methods 86 patients with EMs were selected as study subjects.The patients were divided into two groups by random number table.43 patients in the control group underwent laparoscopic surgery, while 43 patients in the observation grouop received GnRH-a treatment based on laparoscopic surgery, and the clinical effect was analyzed. Results The total effective rate was 93.02% in the observation group, which was significantly higher than 72.09% in the control group.The recurrence rate in the observation group was 11.63%, which was significantly lower than 32.56% in the control group, the difference was statistically significant (χ2=7.55, 8.41, all P<0.05). After treatment, the levels of FSH, LH, and E2 of the observation group were (1.71±0.64)U/L, (2.66±0.75)U/L, (96.72±14.51)pmol/L, respectively, which were significantly lower than before treatment (t=8.80, 7.80, 7.55, all P<0.05), and the differences were statistically significant compared with the control group (t=8.55, 7.48, 7.19, all P<0.05). The total pregnancy rate of the observation group was 70.59%, which was significantly higher than 38.71% of the control group, the difference was statistically significant (χ2=7.77, P<0.05). The pain relief rate, dysmenorrhea rate, remission rate of chronic pelvic pain in the observation group were 90.70%, 86.05%, 93.02%, which were significantly higher than those in the control group (χ2=6.55, 7.01, 7.88, all P<0.05). The incidence rate of adverse reactions in the observation group was 11.63%, which was significantly lower than 27.91% in the control group, the difference was statistically significant (χ2=7.06, P<0.05). The main adverse reactions were hot flashes sweating, vaginal dryness, insomnia, fatigue and other low estrogen symptoms, which could tolerate, after treatment to relieve or disappear, liver and kidney function tests had no abnormalities. Conclusion Laparoscopic surgery combined with GnRH-a in the treatment of endometriosis can improve the treatment effect, improve the symptoms and reproductive hormone levels, improve the postoperative pregnancy rate, reduce the recurrence rate, and with high safety, it is worthy of clinical promotion and application. Key words: Endometriosis; Laparoscopic surgery; Gonadotropin-releasing hormone agonists

Clinical efficacy of laparoscopic surgery for pelvic radiation induced enteritis

Objective To investigate the clinical efficacy of laparoscopic surgery for pelvic radiation induced enteritis (PRIE). Methods The retrospective cross-sectional study was conducted. The clinical data of 66 patients with PRIE who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2012 to December 2015 were collected. Laparoscopic surgery will be applied to patients based on patients′ clinical manifestations after completing relative examinations. Observation indicators: (1) surgical situations: surgical method, conversion to open surgery, reoperation, surgical incision length, grade of abdominal adhesions, surgical time, volume of intraoperative blood loss, duration of postoperative hospital stay; (2) occurrence of surgical complications; (3) follow-up situations. Follow-up using telephone interview was performed to detect patients′ survival and recurrence of PRIE up to April 2016. Measurement data with normal distribution were represented as ±s. Results (1) Surgical situations: ① of 59 patients with small intestinal obstruction, 11 underwent laparoscopic small intestinal resection or enterostomy, including 2 with conversion to open surgery due to dense adhesions, 1 due to uncertainty of tumor recurrence and 1 due to intestinal canal dilatation affected vision; 48 underwent laparoscopic resection of ileocecum, including 11 with conversion to open surgery due to dense adhesions, 2 due to iliac vessels injury and 4 due to injuries of sigmoid colon, rectum and bladder. Four patients with colonic obstruction and proctitis underwent laparoscopic colostomy, without conversion to open surgery. One patient received conversional open surgery and underwent intestinal resection of internal fistula+ exclusion of rectal stump due to intestine-rectum fistula induced dense adhesions. One patient with anal atresia underwent laparoscope-assisted resection of pelvic tissues and rectal stump. One patient with localized peritonitis underwent laparoscope-assisted ileostomy. ② Among 66 patients, 4 received reoperations, including 2 with cervical cancer and 2 with rectal cancer, reoperations of 4 patients were respectively caused by intestine-rectum fistula, rectovaginal fistula, anastomotic fistula and ostomy + stoma reversion. Of 4 patients with reoperations, 1 received conversion to open surgery due to dense adhesions and then underwent intestinal resection of internal fistula+ exclusion of rectal stump, 1 with rectovaginal fistula underwent laparoscopic colostomy, 1 with anastomotic fistula underwent resection and anastomosis of small intestine due to dense adhesions and 1 underwent laparoscopic ileostomy and stoma reversion. ③ Sixty-six patients received 70 operations, including 46 laparoscopic surgeries and 24 conversion to open surgeries. Surgical incision length and average length were respectively 3.0-6.0 cm, 4.0 cm in 46 laparoscopic surgeries and 8.0-25.0 cm, 15.5 cm in 24 conversion to open surgeries. Grade 0, 1, 2 and 3 of abdominal adhesions were detected respectively in 7, 13, 13, 13 laparoscopic surgeries and in 1, 1, 12, 10 conversion to open surgeries. Operation time, volume of intraoperative blood loss and duration of postoperative hospital stay were respectively (128±50)minutes, (108±56)mL, (30±15)days in 46 laparoscopic surgeries and (173±44)minutes, (222±105)mL, (38±19)days in 24 conversion to open surgeries. (2) Occurrence of surgical complications: 1 patient was complicated with bladder injury in 46 laparoscopic surgeries, and 2, 4 and 2 patients in 24 conversion to open surgeries were respectively complicated with bladder injury, colorectal injury and injury of right iliac vessels, they received intraoperative symptomatic treatment. Two, 3, 3, 6 and 1 patients were respectively complicated with pleural effusion, wound infection or dehiscence, venous catheter infection, anastomotic fistula and cholestatic cholecystitis after 46 laparoscopic surgeries. One, 5, 1, 4, 2 and 1 were respectively complicated with pleural effusion, wound infection or dehiscence, venous catheter infection, anastomotic fistula, cholestatic cholecystitis and abdominal wall hemorrhage after 24 conversion to open surgeries. They were improved by symptomatic treatment. (3) Follow-up situations: all the 66 patients were followed up for 4-50 months, with a median time of 26 months. During the follow-up, 3 patients died of intraperitoneal infection, short bowel syndrome and pulmonary infection, and 3 patients had PRIE. Conclusion The appropriate surgical method is selected based on clinical manifestations of patients, and laparoscopic surgery is safe and feasible for PRIE. Key words: Radiation enteritis; Intestinal obstruction; Surgical procedures, operative; Laparoscopy

Prospective, single-center cohort study analyzing the efficacy of complete laparoscopic resection on recurrent hepatocellular carcinoma.

BackgroundLaparoscopic hepatectomy is increasingly being used to treat hepatocellular carcinoma (HCC). However, few studies have examined the treatment of recurrent HCC in patients who received a prior hepatectomy. The present prospective study compared the clinical efficacy of laparoscopic surgery with conventional open surgery in HCC patients with postoperative tumor recurrence.MethodsWe conducted a prospective study of 64 patients, all of whom had undergone open surgery once before, who were diagnosed with recurrent HCC between June 2014 and November 2014. The laparoscopic group (n = 31) underwent laparoscopic hepatectomy, and the control group (n = 33) underwent conventional open surgery. Operation time, intraoperative blood loss, surgical margins, postoperative pain scores, postoperative time until the patient could walk, anal exsufflation time, length of hospital stay, and inpatient costs were compared between the two groups. The patients were followed up for 1 year after surgery, and relapse-free survival was compared between the two groups.ResultsAll surgeries were successfully completed. No conversion to open surgery occurred in the laparoscopic group, and no serious postoperative complications occurred in either group. No significant difference in inpatient costs was found between the laparoscopic group and the control group (P = 0.079), but significant differences between the two groups were observed for operation time (116.7 ± 37.5 vs. 148.2 ± 46.7 min, P = 0.031), intraoperative blood loss (117.5 ± 35.5 vs. 265.9 ± 70.3 mL, P = 0.012), postoperative time until the patient could walk (1.6 ± 0.6 vs. 2.2 ± 0.8 days, P < 0.05), anal exsufflation time (2.1 ± 0.3 vs. 2.8 ± 0.7 days, P = 0.041), visual analogue scale pain score (P < 0.05), postoperative hepatic function (P < 0.05), and length of hospital stay (4.5 ± 1.3 vs. 6.0 ± 1.2 days, P = 0.014). During the 1-year postoperative follow-up period, 6 patients in each group had recurrent HCC on the side of the initial operation, but no significant difference between groups was observed in the recurrence rate or relapse-free survival. In the laparoscopic group, operation time, postoperative time until the patient could walk, anal exsufflation time, and inpatient costs were not different (P > 0.05) between the patients with contralateral HCC recurrence (n = 18) and those with ipsilateral HCC recurrence (n = 13). However, intraoperative blood loss was significantly less (97.7 ± 14.0 vs. 186.3 ± 125.6 mL, P = 0.012) and the hospital stay was significantly shorter (4.2 ± 0.7 vs. 6.1 ± 1.7 days, P = 0.021) for the patients with contralateral recurrence than for those with ipsilateral recurrence.ConclusionsFor the patients who previously underwent conventional open surgical resection of HCC, complete laparoscopic resection was safe and effective for recurrent HCC and resulted in a shorter operation time, less intraoperative blood loss, and a faster postoperative recovery than conventional open surgery. Laparoscopic resection was especially advantageous for the patients with contralateral HCC recurrence.

Surgical and obstetric outcomes of laparoscopic management for women with heterotopic pregnancy

The aim of this study was to investigate the obstetric outcomes and clinical efficacy of laparoscopic surgery for women with heterotopic pregnancy. We conducted a retrospective study of women who had undergone laparoscopic surgery for heterotopic pregnancy. The primary outcome was the feasibility of laparoscopic surgery for the treatment of heterotopic pregnancy and the secondary outcomes were obstetric outcomes. Seventeen women underwent laparoscopic surgery for heterotopic pregnancy: 14 with tubal heterotopic pregnancies and three with cornual heterotopic pregnancies. There were no intraoperative or postoperative complications. Of these women, 13 delivered 14 healthy babies, whereas two failed to maintain their pregnancies; one had a missed abortion 2 weeks after the surgery and the other had a miscarriage due to preterm premature rupture of the membrane at 16 gestational weeks. The remaining two women have ongoing pregnancies. Laparoscopic surgery performed by experienced surgeons is a feasible and beneficial surgical modality for treating heterotopic pregnancy.