Intraoperative Perforation Research Articles

Mucosal snare resection-endoscopic submucosal excavation for gastric submucosal tumors: a retrospective study (with video)

AimsThis study aimed to compare the clinical outcomes of patients with submucosal tumors treated with endoscopic submucosal excavation (ESE) and those treated with mucosal snare resection-endoscopic submucosal excavation (MSR-ESE).MethodsWe retrospectively analyzed clinical data from patients who underwent ESE or MSR-ESE at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2023 and January 2024. Factors such as operation time, intraoperative perforation, postoperative adverse events, postoperative fasting time, antibiotic use, hospitalization duration, costs, and pathological diagnosis were compared between the two procedures.ResultsA total of 180 patients with submucosal tumors were included in this study. The MSR-ESE group consisted of 75 patients (41.7%), while the ESE group had 105 patients (58.3%). Propensity score matching (PSM) showed no significant differences in postoperative antibiotic use, fasting time, or intraoperative perforation between the two groups (P>0.05). However, the MSR-ESE group demonstrated shorter operation and hospitalization times, lower hospitalization costs, and a reduced incidence of postoperative peritonitis (P<0.05). Multivariate logistic regression analysis identified operation time as an independent risk factor for unplanned intraoperative perforation, with the likelihood of perforation increasing significantly as operation time increased (P=0.007, OR=1.015, 95% CI, 1.004 to 1.026).ConclusionMSR-ESE outperforms ESE with shorter operation times, lower costs, and fewer postoperative complications, making it a safe and effective treatment for gastric submucosal tumors.

Dehiscence rate and associated risk factors after gastrotomy for removal of foreign material in dogs and cats.

Identify rate and associated risk factors for dehiscence following gastrotomy for foreign material removal. Medical records from 2 private practice emergency and referral hospitals were reviewed, and history, laboratory values, intraoperative findings, and outcomes were collected on 271 dogs and 31 cats (n = 302). Hospital A performed 222 procedures and Hospital B performed 80 procedures. Three cats (3 of 31 [10%]) and 20 dogs (20 of 271 [7%]) had intraoperative intestinal perforations. Two cats (2 of 31 [6.5%]) and 7 dogs (7 of 271 [2.6%]) were diagnosed with preoperative septic peritonitis. Concurrent surgical procedures in felines included enterotomy (3 of 31 [10%]), multiple enterotomies (3 of 31 [10%]), intestinal resection and anastomosis (IR&A; 2 of 31 [6%]), and other (1 of 31 [3%]). Concurrent surgical procedures in canines included enterotomy (55 of 271 [20%]), multiple enterotomies (11 of 271 [4%]), IR&A (24 of 271 [9%]), IR&A and enterotomy (1 of 271 [0.4%]), splenectomy (11 of 271 [4%]), and other (50 of 271 [18%]). There was no proven gastrotomy dehiscence. Two patients that did not have follow-up surgery or necropsy before euthanasia developed postoperative septic peritonitis, and gastrotomy dehiscence could not be ruled out as a differential diagnosis. Assuming neither patient, 1 patient, or both patients had gastrotomy dehiscence, the gastrotomy dehiscence rate was 0% to 0.66%. However, these patients also had an IR&A. Two cases were presumed to have gastrotomy dehiscence, as the authors would rather overestimate the dehiscence rate. However, it is more likely that the IR&A was the dehiscence site rather than the gastrotomy. Gastrotomy dehiscence rate is low in cats and dogs, and the dehiscence rate reported in this study may be an overestimation.

Modified descemet's stripping automated endothelial keratoplasty (DSAEK) after failed visco‐assisted dalk: Case report

Aims/Purpose: This case report aims to describe the posterior lamellar approach to manage stromal interface irregularity after deep anterior lamellar keratoplasty (DALK).Methods: A 42‐year‐old woman previously underwent DALK with visco‐bubble failed for keratoconus associated with intraoperative perforation. One year after surgery, she presented to our center with loss visual acuity. The recipient bed appeared wrinkled and opaque. The anterior optical surface was regular, with low and regular astigmatism. Endothelial cell density (ECD) could not be assessed. The planned surgical procedure consisted of a modified small diameter (7mm) DSAEK technique, in which only the small optic zone was replaced, resulting in a two‐piece mushroom graft configuration.Results: Corneal clarity was restored and complete attachment of the donor lamella was achieved. Postoperative best‐ corrected visual acuity (BCVA) reached 20/20. No intraoperative or postoperative complications were reported.Conclusions: To achieve the clearance of the recipient bed in eyes that have undergone manual DALK, the least invasive surgical strategy should be planned, preserving the healthy corneal tissue of the patient. Small diameter posterior lamellar keratoplasty has a lower incidence of postoperative complications, decreases immunological risk and accelerates functional recovery

Giant gastric leiomyoma excision using endoscopic submucosal dissection with dental floss clip traction technique: a case report.

For gastric leiomyomas measuring ≥5 cm, endoscopic resection is necessary. The larger size of these tumors significantly impairs the resection field of view, increasing the risk of intraoperative bleeding and perforation and potentially leading to incomplete tumor removal. The combination of dental floss and tissue clip traction techniques is commonly used for resecting mucosal lesions but is rarely reported for submucosal tumors. We recently completed a case of endoscopic resection of a giant gastric leiomyoma in the body of the stomach, approximately 7 cm in length, using endoscopic submucosal dissection with dental floss clip traction. The dissection was carefully controlled within the muscularis propria layer, avoiding damage to the serosa. No bleeding or perforation occurred. A special technique was employed to avoid damage to the muscle layer. By combining this technique with tissue forceps, better traction stability may have been achieved. During the traction process, slight tension was consistently maintained between the swelling and the muscle layer, preventing perforation due to traction. The resection field remained clear throughout the procedure, which lasted 50 minutes in total. The final outcome was satisfactory. This method may be worthy of clinical application.

Outcomes of non-penetrating deep sclerectomy combined with mitomycin C in advanced open-angle glaucoma in Indian eyes.

To assess the safety and efficacy of non-penetrating deep sclerectomy (NPDS) in advanced open-angle glaucoma patients. Retrospective observational study. Forty-two eyes of 38 patients with advanced glaucoma who underwent NPDS surgery combined with mitomycin-C with or without phacoemulsification were evaluated for up to 12 months at a tertiary eye care center in South India. Patients with intraoperative perforation of the trabeculo-Descemet membrane who did not meet the follow-up criteria were excluded. The primary outcome measured was intraocular pressure (IOP) reduction postoperatively on day 1, week 2, and months 1, 3, 6, and 12. The secondary outcomes measured were the need for antiglaucoma medications (AGMs), postoperative complications, and interventions. Patients enrolled had a mean age of 61.08 ± 10.2 years. There was a statistically significant reduction (P < 0.001) of IOP from 29.48 ± 10.89 mmHg (baseline) to 11.58 ± 6.29, 11.90 ± 5.99, 13.60 ± 7.06, 14.03 ± 8.00, 13.94 ± 4.65, and 13.19 ± 3.29 mmHg at day 1, week 2, and months 1, 3, 6, and 12, respectively. The number of AGMs reduced from 3.14 ± 1.03 preoperatively to 1.85 ± 0.83 at 12 months postoperatively (P < 0.001). Nd: YAG laser goniopuncture was done in 21.4%, bleb needling in 11.9%, and one patient underwent 260° trabeculotomy after NPDS. There were no cases of choroidal detachment or wipeout. NPDS with or without phacoemulsification has good safety for managing advanced open-angle glaucoma.

Subtrochanteric shortening osteotomy in adult sickle cell disease patients with cemented total hip arthroplasty for hip deformities secondary to childhood osteonecrosis: is healing a challenge?

PurposeHip deformity is frequent after childhood osteonecrosis in patients with sickle cell disease (SCD). When they are adults, they present a challenge as candidates for total hip arthroplasty (THA) because of abnormal bone development, their relative youth, and also because of their disease. Performing subtrochanteric osteotomy associated with THA is technically challenging, and healing of osteotomies has never been reported in this population with frequent osteonecrotic bone, whether using cemented or uncemented arthroplasties.MethodsWe retrospectively analyzed 59 cemented THA with femoral corrective osteotomies (subtrochanteric shortening and transverse derotational osteotomy) performed on hip deformities between 1984 and 2018 in 59 sickle cell adult patients. The patient’s age at the onset of osteonecrosis was an average of 8.4 years (6 to 10 years), and at the time of the THA was 28.6 years (19 to 41 years). All the patients had a minimum followup period of six years. Endocrinopathy was frequently associated to SCD Data and consequences were evaluated on bone union. The mechanical variables, such as the length of the resected femur, limb lengthening, the location of the osteotomy site, the size of the stem bridging the osteotomy, and any complications, were also analyzed.ResultsThe average length of the resected femoral segment was 38.4 mm. The length of the femoral stem (bridging the osteotomy) was average 13 cm. The mean osteotomy union time was 10.6 months. Twenty-four osteotomies healed in six months, six in nine months, and 29 in twelve months, while five required bone grafts at nine months. The union time of the osteotomy was average 10.6 months. Complications included four cases of transient nerve palsy, and five intraoperative femur perforations. No statistically significant relationship was found between osteotomy union time and mechanical variables. The severity of endocrinopathy associated with sickle cell disease prolonged the healing time. In three cases, cement leakage into the osteotomy gap occurred without resulting in non-healing.ConclusionCemented THA, combined with a subtrochanteric femoral shortening with transverse derotational osteotomy, has a long union time but is effective for adult hip deformities of patients with sickle cell patients.

High Joule heat as a risk factor for post-endoscopic submucosal dissection electrocoagulation syndrome: A multicenter prospective study.

Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection (ESD). To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndrome (PECS). In this prospective study, PECS was characterized by in-hospital fever (white blood cell count: ≥ 10000 μ/L or body temperature ≥ 37.5 °C) and abdominal pain (visual analog scale score ≥ 30 mm during hospitalization or increased by ≥ 20 mm from baseline at admission). High Joule heat was defined as 15390 J. Between April 2020 and April 2024, 209 patients underwent colorectal ESD; those with intraoperative perforation or penetration were excluded. The remaining 202 patients were divided into the PECS and non-PECS groups. PECS occurred in 30 (14.9%) patients. Multivariate analysis revealed high Joule heat as an independent factor associated with PECS (odds ratio = 7.96; 95% confidence interval: 2.91-21.8, P < 0.01). The procedure time and presence of lesions in the right colon were not associated with PECS. Accumulated thermal damage on the peeled mucosal surface should be considered during PECS onset. This thermal damage is likely a major component of the mechanism underlying PECS.

Long-term outcomes with a partial neck-preserving cementless short stem in primary total hip arthroplasty for young patients: a single center first one hundred cases.

This study aimed to assess the long-term results of THA patients who received a cementless short stem regarding clinical outcomes, bone changes, complications, and incidence of femoral revision. A retrospective evaluation of the first 100 THA employing a type 2B cementless stem (Mini hip stem, Corin, Cirencester, United Kingdom) by the same surgeon at one institution. We only include patients with 18 years or more, and with a minimum follow up of 8 years. Patient's Harris hip score (HHS), the University of California, Los Angeles activity score (UCLA), and radiographic outcomes were evaluated. A total of 100 primary hip arthroplasties with Mini Hip stems were performed on 84 patients, with an average age of 47 years old. The median follow-up was 120 months (IQR 57.5-136.5), with 47 patients having a minimum 10-year follow-up. The patient's HHS improved significantly (p < 0.001) and UCLA's score was 7 (SD 1.7) at the final follow-up. Only one patient suffered an intraoperative lateral cortical perforation, which was treated on the same day with revision of the short stem to a conventional metaphysodiaphyseal fixation stem. Three incomplete fractures of the calcar occurred intraoperative, of which only one required wire cerclage and unloading partial during the 30 days after surgery. No osteolysis, radiolucency, thigh pain, periprosthetic or ceramic fractures were observed. Only 6% hips experience squeaking without the need for revision. Two acetabular components were revised early, but no stem failures were recorded, yielding an incidence density rate of 0% (95% CI 0-0.05%) over 10 years. This study showed that the MiniHip short stem is a reliable option for THA in younger patients, with a high implant survival rate and excellent functional outcomes over the long term.

New findings regarding predictors of Poor Corporal Integrity in Penile Implant Recipients: A Multicenter International Invesigation.

To evaluate the pre- and intraoperative variables that impact the integrity of the corporal bodies over time after inflatable penile prosthesis (IPP) placement, as predictors of intraoperative corporal perforation and delayed cylinder complications have not been well characterized. We retrospectively reviewed a 16-centre multi-institutional database of IPP surgeries performed by experienced implanters from 2016 to 2021. Poor corporal integrity (PCI) was defined as intraoperative (iPCI) corporal complications or postoperative (pPCI) corporal complications. Multivariable analysis was performed to identify independent predictors of PCI, iPCI, and pPCI. Primary outcomes included intra- and postoperative corporal complications. We identified 5153 patients for analysis from 5406 IPP cases, finding 152 (2.95%) cases of PCI. On multivariable analysis, predictors of PCI included revision IPP surgery (odds ratio [OR] 8.16, 95% confidence interval [CI] 5.15-12.92; P < 0.001), sequential dilatation (OR 2.12, 95% CI 1.32-3.39; P = 0.002), coronary artery disease (CAD)/peripheral vascular disease (PVD) (OR 1.81, 95% CI 1.18-2.77; P = 0.006), older age (OR 1.02, 95% CI 1.01-1.04; P = 0.013), and corporal scarring (OR 1.58, 95% CI 1.0-2.5; P = 0.049). Predictors of iPCI included revision IPP surgery (OR 7.34, 95% CI 4.18-12.88; P < 0.001), corporal scarring (OR 2.77, 95% CI 1.64-4.69; P < 0.001), radiation therapy (OR 2.25, 95% CI 1.0-5.04; P = 0.049), and older age (OR 1.03, 95% CI 1.0-1.05; P = 0.025). Revision IPP surgery (OR 7.92, 95% CI 3.69-17.01; P < 0.001), sequential dilatation (OR 3.4, 95% CI 1.61-7.19; P = 0.001), CAD/PVD (OR 2.98, 95% CI 1.56-5.72; P = 0.001), and history of priapism (OR 3.59, 95% CI 1.08-11.99; P = 0.038) were predictive of pPCI. Coronary artery disease/PVD, being of older age, having corporal scarring, undergoing IPP revision surgery and sequential dilatation were predictive risk factors for complications associated with PCI. Identifying patients who are at risk of having PCI may improve patient-specific counselling, consideration of referral to more experienced implanters, and surgical planning to potentially promote longer-term device viability.

The effect of Fiber Optic RealShape technology on perioperative and postoperative outcomes following complex abdominal aortic repair.

Ongoing innovations in the minimally invasive management of complex abdominal aortic aneurysms, including physician-modified endografts (PMEG) and, more recently, Fiber Optic RealShape (FORS) technology, have allowed vascular surgeons to expand the surgical indications for and complexity of care to this multifaceted patient population. Prior analyses have demonstrated intraoperative advantages of Fiber Optic RealShape in the management of complex abdominal aortic aneurysms for lower total procedural radiation and cannulation tasks; however, few analyses have evaluated the technology's effect on perioperative and postoperative outcomes. All PMEGs performed at our institution between 2020 and 2024 were reviewed retrospectively. Primary intraoperative and perioperative outcomes included fluoroscopy time and dose, target vessel cannulation failure, target vessel dissection or perforation, and perioperative complications. Primary postoperative (6-month) outcomes included target vessel related (type Ic or IIIc) endoleak and target vessel instability, defined as any branch-related complication leading to aneurysm rupture, death, occlusion, component separation, or reintervention. Inverse probability of treatment weighting was used to account for factors of clinical significance. The χ2 test, logistic regression, and Cox regression were used to evaluate perioperative outcomes in the weighted cohort. Between 2020 and 2024, 118 patients received a PMEG: 49 with Fiber Optic RealShape (FORS) and 69 using standard fluoroscopy. Baseline characteristics were similar between groups. After weighting, use of FORS exhibited lower fluoroscopy time (38minutes vs 56minutes; P< .01) and air Kerma (429mGy vs 655mGy; P= .01). Between FORS and standard fluoroscopy, there were no differences noted in target vessel cannulation failure (4.7% vs 1.0%) or in intraoperative or perioperative target vessel perforation (1.9% vs 1.0%) or dissection (6.7% vs 2.1%) (all P > .05). Perioperative complications were similar between groups (22% vs 21%), including spinal cord ischemia (temporary, 8.4% vs 6.1%; permanent, 2.0% vs 3.9%) and bowel ischemia (0% vs 2.6%). FORS use did demonstrate lower rates of target vessel instability (1.2% vs 10%; P= .02) at 6months; however, this difference did not persist on multivariable analysis. Since the implementation of FORS at our institution, when compared with standard fluoroscopy, there have been significantly lower intraoperative fluoroscopy times and total radiation doses, with no difference in target vessel cannulation failure, dissection, perforation, perioperative complications, or target vessel instability at 6months after a PMEG. Although these data may represent our institution's gradual improvement in expertise with this new technology, our results underscore the importance of additional analyses on this evolving technology as it becomes more integrated into the standard practice of the management of complex aortic pathologies.

Clinical outcome and long‑term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged 75 years or older: a retrospective observational study

PurposeTo determine the clinical outcomes of endoscopic submucosal dissection (ESD) for colorectal tumors in older patients and predictors of mortality.MethodsWe retrospectively evaluated 207 lesions in 195 consecutive older patients aged ≥ 75 years who underwent ESD for colorectal tumors between January 2007 and December 2018. Outcomes of ESD were evaluated, and the prognosis was assessed in terms of both curability and the patient’s baseline physical condition as determined by several indices. Cox regression analyses were performed to identify factors associated with reduced overall survival (OS).ResultsTreatment outcomes included a median procedure time of 55 min, en bloc resection rate of 97%, histological en bloc resection rate of 92%, postoperative bleeding rate of 2.4%, and intraoperative perforation rate of 3.4%. Postoperative bleeding and intraoperative perforation could be treated conservatively. Delayed perforation occurred in one patient and required emergency surgery. Three-year OS was 99.4% and 5-year OS was 95.8%. Overall, three patients experienced recurrence (one local, two distant metastasis), and one patient died of primary cancer. Multivariate analysis identified the Charlson Comorbidity Index (CCI) score ≥ 3 as the only independent predictor of reduced OS (hazard ratio 4.26; 95% confidence interval 1.60–11.38; P = 0.004).ConclusionOur results suggest that colorectal ESD is safe and effective in older patients aged ≥ 75 years. There was a significant independent association of reduced OS with high CCI score, but not with curability by ESD. The CCI score should be considered when determining the indications for ESD in older patients.

Retrospective Cohort Study of Associated Factors for Intestinal Complications in Pediatric Liver Transplantation.

Intestinal complications (IC) represent serious adverse events after liver transplantation (LT), however limited research has been conducted in pediatric cohorts. This study aims to describe IC after pediatric LT and to identify associated factors. Retrospective review of 153 patients having undergone LT, aged 0-18 years, treated in the Swiss Pediatric Liver Center in Geneva. Pre-, per- and postoperative data were analyzed. IC were defined as pathologies or lesions directly associated with LT and attributable to the surgical procedure. 16/153 (11%) patients developed IC: 10/16 mechanical obstructions, 4/16 intestinal perforations and 2/16 sub-mesocolic abscesses. IC patients had a significantly lower Body Mass Index (BMI) (15.5 vs. 16.4, p = 0.019). Children with IC had significantly higher incidence of previous Kasai hepatoportoenterostomy associated with Ladd procedure (13% vs. 2%, p = 0.055), a history of intraoperative iatrogenic intestinal perforation(s) (31% vs. 5%, p = 0.003) and prolonged LT surgery duration (536 vs. 415 min, p = 0.007). Significantly more children with IC had received basiliximab (69% vs. 40%, p = 0.048). Patients with IC exhibited a higher incidence of post-LT sub-occlusions (p < 0.001) and an increased requirement for post-LT parenteral nutrition (p = 0.027). Additionally, IC patients underwent significantly more reoperations (p < 0.001). One in 10 children post-LT experiences IC, which are associated with significant morbidity. Pre-LT nutritional status appears as an associated factor with IC, along with the necessity for adhesiolysis during LT, often leading to prolonged operative time. These associated factors should alert medical teams to promote early IC diagnosis in patients after LT.

Correlation of preoperative CT features with intra- and postoperative parameters of endoscopic resection in patients with gastric submucosal tumor (1~3cm).

Endoscopic resection of gastric submucosal tumors (SMTs) possesses minimal trauma, expedited recovery, and reduced costs. Nonetheless, intraoperative challenges, including imprecise surgical risk assessment, prevail. Hence, we investigated the correlation between preoperative CT observation features and perioperative parameters for predicting outcomes in SMT patients. Subjects diagnosed with SMT and undergoing endoscopic surgery conducted at West China Hospital's Endoscopy Center from September 2019 to October 2023 were retrospectively selected. Endoscopic ultrasonography (EUS) and computer tomography (CT) were utilized for evaluating SMT. The study assessed the correlation between preoperative CT findings and perioperative parameters. Increased lesion size on contrast-enhanced CT correlates with increased operative duration, hospital stay, postoperative antibiotic use. Of utmost significance, we observed a significantly higher intraoperative perforation rate for patients with tumor outgrowth compared to those with lesion involvement of the lumen (96.88% vs 29.11%, P < 0.001). These patients also demonstrated an increased risk of postoperative blood stream infections (P = 0.012), necessitating higher antibiotic grade (P = 0.048), along with prolonged gastrostomy tube retention (P = 0.001) and hospitalization (P = 0.018). In addition, CT provides a more accurate and comprehensive assessment of tumor size (P = 0.037) and growth pattern (P = 0.026) than EUS. CT assessment of tumor size closer to reality than EUS. Importantly, these features can assist in pinpointing lesions with elevated surgical complexity and high risk of complications, leading to improved preoperative preparation, thereby increasing anticipation of surgical risks and reducing incidence of complications.

Effectiveness of a novel ex vivo training model for gastric endoscopic submucosal dissection training: a prospective observational study conducted at a single center in Japan.

The efficacy of endoscopic submucosal dissection (ESD) for early-stage gastric cancer is well established. However, its acquisition is challenging owing to its complexity. In Japan, G-Master is a novel ex vivo gastric ESD training model. The effectiveness of training using G-Master is unknown. This study evaluated the efficacy of gastric ESD training using the G-Master to evaluate trainees' learning curves and performance. Four trainees completed 30 ESD training sessions using the G-Master, and procedure time, resection area, resection completion, en-bloc resection requirement, and perforation occurrence were measured. Resection speed was the primary endpoint, and learning curves were evaluated using the Cumulative Sum (CUSUM) method. All trainees completed the resection and en-bloc resection of the lesion without any intraoperative perforations. The learning curves covered three phases: initial growth, plateau, and late growth. The transition from phase 1 to phase 2 required a median of 10 sessions. Each trainee completed 30 training sessions in approximately 4 months. Gastric ESD training using the G-Master is a simple, fast, and effective method for pre-ESD training in clinical practice. It is recommended that at least 10 training sessions be conducted.

Efficacy and Safety of Single Clip Traction Assisted Endoscopic Submucosal Dissection for Colonic Neoplasms: A Propensity Score Matching Analysis.

Endoscopic submucosal dissection (ESD) for colonic neoplasms is a technically intricate procedure. Internal traction using a single clip has emerged as a promising supportive technique for colonic ESD. Therefore, this study aimed to comprehensively evaluate and compare the efficacy and safety of ESD with and without the aid of single-clip traction. This retrospective study encompassed 36 patients who underwent single clip traction-assisted colonic ESD and 66 who underwent the traditional method of colonic ESD at Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University. We employed the propensity score-matching method to mitigate disparities in resected specimen size and tumor location. Post-matching, we comprehensively assessed treatment outcomes and incidence of adverse events between the two treatment groups (single clip traction-assisted ESD (scESD) and conventional ESD (cESD)). After propensity score matching, we observed 34 matched pairs. There were no significant differences between the two treatment groups regarding the en bloc resection rate, complete resection rate, and curative rate. However, the procedure duration was significantly shorter in the single clip traction-assisted ESD group compared to the conventional ESD group (20.00 [Interquatile Range (IQR)] (16.00-32.50) minutes vs 31.50 [IQR] (17.00-54.00) minutes, p = 0.0474). Furthermore, there was a significant increase in dissection speed in the single clip traction-assisted ESD group compared to the conventional ESD group (0.29 [IQR] (0.20-0.45) mm2/min vs 0.19 [IQR] (0.11-0.35) mm2/min, p = 0.0015). All lesions were resected in a single piece. Among the propensity-score-matched patients, only those treated with single clip traction-assisted ESD exhibited faster dissection speeds (p = 0.015). Furthermore, there were no substantial differences in adverse events such as intraoperative perforation, delayed perforation, or delayed bleeding. Our findings suggest that single clip traction-assisted colonic ESD is preferable to traditional colonic ESD, owing to its shorter procedure duration and faster dissection speed.

Endoscopic "calabash" ligation and resection for small gastric mesenchymal tumors.

Gastric mesenchymal tumors (GMT) are identified as soft tissue neoplasms that arise from mesenchymal stem cells within the gastrointestinal tract. GMT primarily encompass gastric stromal tumors (GST), gastric leiomyomas, and gastric schwannomas. Although most GMT are benign, there are still potential malignant changes, especially GST. Thus, early surgical intervention is the primary treatment for GMT. We have designed a simple endoscopic "calabash" ligation and resection (ECLR) procedure to treat GMT. Its efficacy and safety need to be compared with those of traditional endoscopic techniques, such as endoscopic submucosal excavation (ESE). To assess the safety and effectiveness of ECLR in managing small GMT (sGMT) with a maximum diameter ≤ 20 mm by comparing to ESE. This retrospective analysis involved patients who were hospitalized in our institution between November 2021 and March 2023, underwent endoscopic resection, and received a pathological diagnosis of GMT. Cases with a tumor diameter ≤ 20 mm were chosen and categorized into two cohorts: Study and control groups. The study group was composed of patients treated with ECLR, whereas the control group was composed of those treated with ESE. Data on general clinical characteristics (gender, age, tumor diameter, tumor growth direction, tumor pathological type, and risk grade), surgery-related information (complete tumor resection rate, operation duration, hospitalization duration, hospitalization cost, and surgical complications), and postoperative follow-up were collected for both groups. The aforementioned data were subsequently analyzed and compared. Five hundred and eighty-nine individuals were included, with 297 cases in the control group and 292 in the study group. After propensity score matching, the final analysis incorporated 260 subjects in each cohort. The findings indicated that the study group exhibited shorter operation duration and lowered medical expenses relative to the control group. Furthermore, the study group reported less postoperative abdominal pain and had a lower incidence of intraoperative perforation and postoperative electrocoagulation syndrome than the control group. There were no substantial variations observed in other parameters among the two cohorts. ECLR is a viable and effective approach for managing sGMT.

Effect of spray COAG mode on hemostasis in colorectal endoscopic submucosal dissection using inverse probability of treatment weight analysis.

Swift and forced COAG with an electrosurgical knife are commonly used for intraoperative hemostasis in colorectal endoscopic submucosal dissection (ESD). If bleeding cannot be stopped using an electrosurgical knife, cauterization is attempted using hemostatic forceps. Since April 2022, our hospital has started using Spray COAG for intraoperative hemostasis for colorectal ESD. This study aimed to provide evidence of the efficacy of Spray COAG for intraoperative hemostasis. Colorectal ESD was performed for 320 lesions at our hospital. Of these, 307 were included; 145 and 162 lesions were operated before and after the introduction of Spray COAG, respectively. Spray COAG was used after the change. The primary endpoint was the change in the frequency of use of hemostatic forceps after the introduction of Spray COAG; the secondary endpoint was the change in the prevalence of postoperative complications after the introduction of Spray COAG. It should be noted that the Spray COAG mode was employed solely for hemostasis and not for dissection, while the Swift COAG mode was utilized for dissection in the After Spray COAG group. Statistical analysis was conducted using IPTW analysis. The frequency of use of hemostatic forceps was significantly decreased after the introduction of Spray COAG (odds ratio = 0.12, 95% confidence interval [95%CI]: 0.06-0.23, p < 0.001). The prevalence of post-ESD electrocoagulation syndrome significantly decreased (odds ratio = 0.43, 95%CI: 0.22-0.88, p = 0.02). No significant differences were observed between the intraoperative and postoperative perforations or rate of postoperative bleeding. Spray COAG reduced the frequency of hemostatic forceps use in colorectal ESD.

Oncological outcome following Hartmann's procedure compared with anterior resection and abdominoperineal resection for rectal cancer-The type of procedure does not influence local recurrence or distant metastasis: A population-based study.

The type of surgical procedure used in rectal cancer treatment may affect cancer recurrence. The aim of this study was to determine whether the type of procedure influences oncological outcomes in rectal cancer surgery. We gathered data from the Swedish Colorectal Cancer Registry regarding patients with TNM Stage I-III rectal cancer who underwent R0/R1 surgery from 2013 to 2017. The outcomes after Hartmann's procedure (HP), anterior resection (AR) and abdominoperineal resection (APR) were compared, and a multivariable Cox regression analysis was performed. The primary outcome of the study was the local recurrence rate. The secondary outcomes were distant metastasis, disease-free survival and overall survival at 5 years as well as risk factors for local recurrence. A total of 4741 patients were included in the study: 614 underwent HP, 3075 underwent AR and 1052 underwent APR. Multivariable Cox regression revealed no difference in local recurrence, distant metastasis or disease-free survival. Overall survival was higher following AR (OR 0.62, CI 0.54-0.72). Risk factors for local recurrence were intraoperative bowel perforation (OR 2.41, CI 1.33-4.40), a pT4 tumour (OR 1.93, CI 1.11-3.4) and a positive circumferential resection margin (OR 5.62, CI 3.28-9.61). This nationwide study showed that the type of procedure did not affect the local recurrence rate or distant metastasis. In patients who are unfit for restorative surgery, HP is a viable alternative with oncological outcomes similar to those of APR.

516. HELLER MYOTOMY FOR SYMPTOMATIC ACHALASIA: TRADITIONAL LAPAROSCOPY OR ROBOTICS? A SYSTEMATIC REVIEW WITH META-ANALYSIS

Abstract Background Laparoscopic Heller myotomy (LH) has been established as the gold standard for symptomatic achalasia; robotic-assisted laparoscopic myotomy (RH) has shown promising outcomes regarding safety and effectiveness. We aim to meta-analyse data comparing LH and RH surgical outcomes and complications. Methods A systematic search was conducted in February 2024 without restrictions according to PRISMA guidelines in PubMed, Web of Science, Scopus, and Cochrane Register. Studies comparing laparoscopic and robotic approach for Heller myotomy in adults with symptomatic achalasia were included for systematic review. Meta-analysis was performed trough generalized linear mixed model in R 4.3.2. Results 16 observational studies, out of 273, were included; reporting on 15076 patients. No statistically differences in preop characteristics were noted. RH had significantly fewer intraoperative esophageal perforations (OR=7.29, p&amp;lt; 0.0001, 95%), fewer subsequent myotomies and endoscopic treatments for recurrence (OR= 3.64, p=0.01 and OR= 3.38, p=0.03) and better symptom score improvement (OR=0.507, p=0.04). Although not clinically significant, RH had shorter hospital stays (MD=0.45 days, p= 0.005,) and reduced intraoperative blood loss (MD=10.46 ml, p=0.0002). Although not statistically significant, RH had fewer bleeding episodes, lower conversion, reintervention and mortality rates, comparable morbidity and postoperative GERD and higher operative time. Conclusion This updated meta-analysis suggests that RH is associated with lower regarding perforations, recurrence rates and symptom improvement compared to LH, with negligible lengthening of operative times. RH for symptomatic achalasia represents a feasible treatment for symptomatic achalasia, with a satisfying safety and effectiveness profile. RCTs on the topic and about cost-effectiveness evaluations are necessary to support the reported data.

Evaluation of learning curves for contact laser vaporization of the prostate using the 980 nm diode laser for benign prostatic hyperplasia.

We investigated the background of patients who underwent contact laser vaporization of the prostate (CVP) surgery and the learning curve of the operators. A total of 207 patients who underwent CVP surgery for benign prostatic hyperplasia between August 2018 and March 2023 were included in this study. Patient background, perioperative results, pre- and postoperative urinary flow tests, and complications were collected retrospectively. We enrolled 12 doctors who were divided into expert (five doctors) and novice (seven doctors) groups based on the number of TURP experiences before CVP. The median patient age was 73 years (51-92 years) and prostate volume was 56 cc (15-190 cc) with no difference between the expert and novice groups. Complications included urinary retention (eight cases), hematuria (four), urinary tract infection (four), intraoperative perforation (two), and postoperative stricture (one). Both cases of intraoperative perforation occurred in the novice group. The expert group had a significantly shorter operative time (38 vs. 66 min) and a higher operative efficacy of prostate volume divided by operative time (1.43 vs. 0.88 cc/min). Postoperatively, IPSS, quality of life scores, and postvoid residual urine volume decreased, and maximal flow rate increased; however, there was no significant difference between the groups. The expert group showed stable operative time and operative efficacy after about five to eight cases, while the novice group showed stable after about 15 cases. Our findings suggest that CVP was safely performed at our hospital, and operators with limited experience in TURP can achieve stable perioperative results.