Laparoscopic Surgery Group Research Articles

Effect of ultrasound-guided individualized positive end-expiratory pressure on the severity of postoperative atelectasis in elderly patients: a randomized controlled study.

Postoperative pulmonary complications (PPCs) are common in patients undergoing general anesthesia, with atelectasis being a key contributor that increases postoperative mortality and prolongs hospitalization. Our research hypothesis is that ultrasound-guided individualized PEEP titration can reduce postoperative atelectasis. This single-center randomized controlled trial recruited elderly patients for laparoscopic surgery. Patients were randomly assigned to two group: the study group (individualized PEEP groups, PEEP Ind group) and the control group (Fixed PEEP group, PEEP 5 group). All patients in these two groups received volume-controlled ventilation during general anesthesia. Patients in the study group were given ultrasound-guided PEEP, while those in the control group were given a fixed 5 cmH2O PEEP. Bedside ultrasound assessed lung ventilation. The primary outcome was the severity of atelectasis within seven days post-surgery. Eighty-nine patients scheduled for elective laparoscopic radical surgery for colorectal cancer were enrolled in our study. Lung ultrasound scores (LUSs) in the study group during postoperative seven days was significantly decreased compared with that in the control group (P < 0.05). The severity of postoperative atelectasis in the study group was significantly improved. The incidence of PPCs during postoperative 7 days in the study group was significantly less than that in the control group (48.6% vs. 77.8%; RR = 0.625; CI = 0.430-0.909; P = 0.01). In elderly patients undergoing laparoscopic radical resection, lung ultrasound-guided individualized PEEP can alleviate the severity of postoperative atelectasis.Clinical trial number and registry URL: No. ChiCTR2200062979 ( https://www.chictr.org.cn ).

Evaluation of intestinal wall closure using vessel-sealing technology versus conventional closure: an in vivo study.

Anastomotic leakage is a major postoperative complication of colorectal surgery. LigaSure™ is used commonly for vessel-sealing, but its use for intestinal anastomosis or closure, particularly the healing process, is underreported. We conducted this study to evaluate the feasibility of using LigaSure™ for intestinal wall closure, compared with hand-sewn methods. We performed intestinal wall closure of the cecum in rat laparotomy procedures, dividing subjects into a LigaSure™ group (LS) and a hand-sewn group (HS). We compared operation times, tissue structure changes, and pressure resistance from immediately post-operatively to postoperative day (POD) 14. No postoperative dehiscence or mortality occurred in either group. The LS group required significantly less closure time (113s) than the HS group (321 s, p < 0.001). The adhesion rates for a midline incision were not significantly different between the groups (LS: 26.7% vs. HS: 6.7%; p = 0.142), with adhesions at the closure site seen in all subjects. The LS group had a lower burst pressure than the HS group until POD 3, with no significant differences thereafter. Structural continuity was established by POD 5 in both groups. LigaSure™ provides effective intestinal wall closure with a more distinct healing process than with hand-sewn methods, suggesting the potential for staple-free anastomosis.

Metabolomic Analysis of Specific Metabolites in Codonopsis pilosula Soil Under Different Stubble Conditions

To investigate the soil-specific metabolites of Codonopsis pilosula under different stubble management practices, this study analyzed differentially abundant metabolites in the rhizosphere soils of rotational (DS) and continuous (LS) cropping systems via liquid chromatography–tandem mass spectrometry (LC–MS/MS)-based metabolomic approaches. The results revealed that 66 metabolites, including amino acids and their derivatives, nucleic acids, alcohols, organic acids, amines, fatty acids, purines, and sugars, were significantly different (p &lt; 0.05) between the DS and LS groups. Under continuous cropping, the levels of amines, fatty acids, organic acids, and sugars in the rhizosphere soil were significantly greater (p &lt; 0.05) than those under rotational cropping, whereas the levels of amino acids and their derivatives, nucleic acids, and purines and pyrimidines were significantly lower (p &lt; 0.05). KEGG pathway enrichment analysis revealed that these differentially abundant metabolites were enriched in metabolic pathways such as amino acid metabolism (e.g., alanine, aspartate, and glutamate metabolism), carbon metabolism, the cAMP signaling pathway, ABC transporter proteins, phenylalanine metabolism, and the biosynthesis of plant secondary metabolites. These metabolic pathways were involved in osmoregulation, energy supply, and resilience in plants. In conclusion, inter-root soil metabolites in rotational and continuous cropping of Codonopsis pilosula were able to influence soil physicochemical properties and microbial populations by participating in various biological processes.

Effects of Dietary Fiber and Copper on the Performance and Gut Microbiota of Finishing Pigs

This study aimed to investigate the effects of dietary fiber (DF) levels and copper concentrations on the production performance and cecal microbial diversity of finishing pigs. A 2 × 2 factorial experimental design was used, with different levels of dietary fiber (low [23% DF]: L and high [30% DF]: H) and copper concentrations (normal [25 mg/kg]: N and supplemented [45 mg/kg]: S) resulting in four diets (LN, LS, HN, and HS). Forty-eight hybrid barrows (Duroc × Landrace × Yorkshire), with an initial body weight of 76 kg ± 1.5 kg, were randomly assigned to four groups: LN, LS, HN, and HS, with 12 replicates per group and one pig per replicate. There was a 7-day adaptation period followed by a 56-day feeding trial, after which all pigs were slaughtered for sampling. Results indicated that in finishing pigs, the low dietary fiber group exhibited a higher final weight, a higher average daily gain, and a lower feed-to-gain ratio compared to the high fiber group (p &lt; 0.05). The LS group showed higher digestibility of dry matter, crude protein, crude fiber, ash, neutral detergent fiber, and DF than the HN and HS groups (p &lt; 0.05). Blood total protein levels were higher in the high fiber group, whereas blood Cu levels were higher in the supplemented copper group (p &lt; 0.05). High dietary fiber increased the activities of colonic carboxymethylcellulase and β-glucanase (p &lt; 0.05). Concentrations of acetic acid, propionic acid, and total volatile fatty acids were elevated in the high fiber group (p &lt; 0.05). Microbial α-diversity indices (observed species, Chao 1, and Shannon indices) increased with fiber but decreased with copper supplementation (p &lt; 0.05). The Firmicutes/Bacteroidetes ratio increased with fiber levels, with a higher relative abundance of Lactobacillus in the LS group. In conclusion, appropriate copper supplementation in diets can mitigate the negative effects of high fiber levels on finishing pig production performance by enhancing nutrient digestibility, fiber-degrading enzyme activity, regulating the microbial community, and its metabolic products.

Short- and long-term outcomes of robotic and laparoscopic surgery in rectal cancer: a propensity score-matched analysis.

The relative benefits of robotic surgery and laparoscopic surgery are controversial in rectal cancer. This study compared the short- and long-term outcomes of robotic surgery with those of laparoscopic surgery in patients with rectal cancer using propensity score analysis. This study analyzed consecutive patients who underwent minimally invasive surgery for stage I-III rectal cancer between April 2014 and October 2020. After propensity score matching (PSM), short-term outcomes, relapse-free survival, and overall survival were compared between the robotic surgery (RS) group and the laparoscopic surgery (LS) group. During the study period, 251 patients underwent laparoscopic surgery and 193 underwent robotic surgery. PSM resulted in 160 matched pairs (After PSM, the percentages of patients with stage I, II, and III disease were respectively 56%, 19%, and 24% in the LS group and 49%, 23%, and 28% in the RS group (P = 0.462). Median operation time was 239min in the LS group and 284min in the RS group (P = 0.001). The C-reactive protein level on postoperative day 3 was significantly lower in the RS group (4.63mg/mL vs. 5.86mg/mL, P = 0.013). Postoperative complications, including ileus and Clavien-Dindo grade II or higher complications, were 6% vs. 1% (P = 0.006) and 21% vs. 12% (P = 0.024) in the LS and RS groups, respectively. The 5-year relapse-free survival rate was 88.5% in the LS group and 90.5% in the RS group (P = 0.525); the respective 5-year overall survival rates were 97.3 and 93.8% (P = 0.283). The 5-year cumulative local and distant recurrence rates were 3.3% vs. 3.3% (P = 0.665) and 9.7% vs. 7.7% (P = 0.464) in the LS and RS groups, respectively CONCLUSION: Robotic surgery can be a feasible treatment modality for rectal cancer, with lower frequencies of postoperative ileus and Clavien-Dindo grade II or higher complications than laparoscopic surgery and no difference in long-term outcomes.

Laparoscopy-assisted versus open surgery for low rectal cancer (LASRE): 3-year survival outcomes of a multicentre, randomised, controlled, non-inferiority trial

Laparoscopic surgery is increasingly used for rectal cancer, but the long-term oncological outcomes for low rectal cancer have not been fully established. We aimed to evaluate the 3-year survival outcomes of laparoscopic surgery versus open surgery in the treatment of low rectal cancer. This multicentre, randomised, controlled, non-inferiority trial was conducted at 22 tertiary hospitals in China. Individuals aged 18-75 years with histologically confirmed cT1-2N0, cT3-4aN0, or cT1-4aN1-2 rectal adenocarcinoma within 5 cm from the dentate line were eligible for inclusion. Participants were randomly assigned (2:1) to undergo laparoscopic surgery or open surgery. Central randomisation was conducted using a web response system, and was stratified by clinical stage, age, sex, BMI, and American Society of Anesthesiologists classification. Investigators, patients and statisticians were not masked to group allocation. The primary outcome was 3-year disease-free survival, defined as the time from the date of surgery to the date of locoregional recurrence, distant metastasis, or death from any cause, whichever occurred first. Non-inferiority was defined as a lower limit of one-sided 97·5% CI for group difference (laparoscopic surgery group minus open surgery group) of greater than -10%. The primary analyses were performed in the modified intention-to-treat population, which excluded patients with distant metastasis discovered during surgery and those who did not undergo surgery or underwent local resection only. The trial is registered with ClinicalTrials.gov, NCT01899547, and has been completed. Between Nov 12, 2013, and June 6, 2018, 1070 patients were enrolled and randomly assigned to treatment. 1039 patients (685 in the laparoscopic surgery group and 354 in the open surgery group; median age 57 years, IQR 50 to 64; 620 [60%] male and 419 [40%] women) were included in the modified intention-to-treat analysis. 3-year disease-free survival was 81·4% (95% CI 78·2 to 84·1) in the laparoscopic surgery group and 79·8% (75·2 to 83·6) in the open surgery group (hazard ratio [HR] 0·92, 95% CI 0·69 to 1·23; p=0·56). The difference between groups was 1·60% (one-sided 97·5% CI -3·34 to ∞, p<0·0001 for non-inferiority). 3-year overall survival was 91·7% (95% CI 89·3 to 93·5) in the laparoscopic surgery group and 93·7% (90·6 to 95·8) in the open surgery group (HR 1·34, 95% CI 0·82 to 2·19; p=0·24). 3-year locoregional recurrence was 3·7% (95% CI 2·5 to 5·3) and 2·3% (1·1 to 4·3), respectively (HR 1·64, 95% CI 0·74 to 3·63; p=0·22). 5-year overall survival was 84·6% (95% CI 81·5 to 87·1) and 86·6% (82·5 to 89·8) in the open group (HR 1·16, 95% CI 0·82 to 1·64; p=0·41). Laparoscopic surgery performed by experienced surgeons is non-inferior to open surgery for 3-year disease-free survival among patients with low rectal cancer. These results support the use of laparoscopic surgery for low rectal cancer. The Key Clinical Specialty Discipline Construction Program of the National Health and Family Planning Commission of China; Minimally Invasive Medical Center Construction Program, Fujian Province, China; and Joint Funds for the Innovation of Science and Technology, Fujian Province, China.

Efficacy and safety of laparoscopic resection of colorectal cancer in non-elite cases.

To evaluate the outcomes of laparoscopic resection of colorectal cancer in non-elite cases. We defined patients whose clinical characteristics conformed to the criteria of the JCOG0404 trial as "elite" and those whose clinical characteristics did not conform to these criteria as "non-elite". Patients with Stage II/III colorectal cancer (n = 450) were analyzed. The elite (E) and non-elite (NE) groups were further divided into open (E-Open, NE-Open) and laparoscopic (E-Lap, NE-Lap) surgery groups. We compared the short- and long-term outcomes of these groups. Propensity score matching (PSM) was performed when comparing the NE groups. The E group included 163 patients and the NE group included 287 patients. Before and after PSM, the NE-Lap group had significantly longer operative times, lower postoperative complication rates, earlier recovery of bowel function, and shorter postoperative hospital stays than the NE-Open group. After PSM, the Clavien-Dindo classification Grade ≥ III complications and reoperation rates in the NE-Lap group were significantly lower than those in the NE-Open group. The short-term outcomes of the NE-Lap group were comparable with those of the E-Lap group. The 5-year overall survival rates were not significantly different among the groups. Laparoscopic resection of colorectal cancer is effective and safe, even in non-elite cases.

Comparison of double-port laparoscopic-assisted extracorporeal suture technique and open surgical repair for Morgagni hernia.

We aimed to compare the results of open surgery and double-port laparoscopic-assisted extracorporeal suturing repair for the treatment of Morgagni hernia (MH). Twenty-two patients with MH who were operated on in our clinic between January 2012 and January 2023 were included in the study. Patients were divided into two groups according to the surgical technique: open surgery (OS) (n = 14) or laparoscopic surgery (LS) (n = 8). Retrospective comparisons were made between the groups' demographic information, surgical method used, defect size, operation time, length of hospital stay, costs, postoperative problems, and recurrence. There were no statistically significant differences between the groups regarding sex, defect size, or costs. The mean age of the patients in the LS group (101 ± 68.3 months) was significantly higher than that of the OS group (23 ± 18.2 months) (p = 0.005). The operation time of the LS group (33.8 ± 3.6 min) was significantly shorter than that of the OS group (50.8 ± 6.5 min) (p < 0.01). Moreover, the LS group's mean length of hospitalization (1.6 ± 0.9 days) was significantly lower than that of the OS group (2.8 ± 0.7 days) (p = 0.027). Double-port laparoscopic-assisted extracorporeal suturing repair is a reliable technique preferred over open surgical repair due to its shorter operative time and hospital stay, ease of application, better cosmetic results, and no cost difference.

Beneficial Role of Heat-Treated Lactobacillus sakei HS-1 on Growth Performance, Nutritional Status and Gut Microbiota in Weaned Piglets.

In the swine industry, there is a strong need to replace an antibiotic growth promoter (AGP) used as feed additives in weaned piglets to enhance nutrient utilization in their diets and improve growth performance. Lactobacillus sakei HS-1 strain is a microbial preparation isolated from pickles. The study aim is to investigate the effectiveness of heat-treated L. sakei HS-1 strain (HT-LS) as a growth promoter in weaned piglets compared to colistin (CS), a widely used AGP. Eighteen crossbred weaned piglets (Landrace × Yorkshire × Duroc) of 21 days (average body weight [BW]: 7.06 ± 0.59 kg) were divided into three groups: fed the control diet (CT group), fed a diet supplemented with 30 ppm colistin sulphate (CS group), fed a diet supplemented with HT-LS at a concentration of 2.0 × 105 cells/g (LS group) until 49 days. The results indicated that LS group exhibited significantly higher average daily gain (p < 0.05) and higher BW (p < 0.1) compared with CT group, even higher than CS group. CS group showed higher growth performance compared to CT group but the differences were not statistically significant. In addition, LS group had higher (p < 0.05) or tended to higher (p < 0.1) concentrations of several plasma amino acids than the other two groups at 35 and 49 days. Faecal acetate concentration was higher (p < 0.1) in LS group than in CT group at 35 days. Blood immunoglobulin G concentration in LS group was significantly lower (p < 0.05) than in CT group at 35 and 49 days, and blood immunoglobulin A tended to be lower (p < 0.1) at 35 days than in CT group. LS group showed an increased abundance of g_Prevotella 7, g_Streptococcus and g_Lactobacillus (linear discriminant analysis [LDA] score ≥ 2.0). Predictive metagenomic analysis revealed an enrichment of the mixed acid fermentation pathway (LDA score ≥ 2.0). Furthermore, several gut microbes exhibited correlations with plasma amino acids (p < 0.01) and short-chain fatty acids in faeces (p < 0.01). These findings demonstrate that HT-LS improves the growth performance of weaned piglets by enhancing the efficient utilization of nutrients through gut microbiota modification.

Comparison of the frequency of complications resulting from open and laparoscopic surgery for hydatid cyst.

Hydatid cyst is a benign parasitic disease that is usually asymptomatic and is discovered incidentally. The gold standard for the treatment of this disease is surgery. Recently, a laparoscopic approach has been used to remove hydatid cysts. We decided to compare this new technique with an open conventional method. Patients-This retrospective analytical study was conducted on patients with hepatic hydatid cysts who underwent surgery in Kashan during 2013-2020. A total of 58 patients were included in this study, 18 of whom underwent laparoscopic surgery and 40 underwent open surgery. The comparison of the two groups was performed using chi-square and Fisher's exact tests. The average duration of surgery in the laparoscopic and open surgery groups was 135 and 151.6 min, respectively, which was not statistically significant (p-value = .179). There was no significant difference in terms of the need for blood transfusion, conversion of laparoscopic surgery to open surgery, anaphylactic shock, infection, and death between the two groups (p > .05). However, the laparoscopic surgery group had a significantly shorter hospital stay compared with the open surgery group (p-value < .001), and more favorite patients. Considering the lack of significant difference between the two surgical methods and the reduction in the duration of surgery by a laparoscopic approach, the reduction in hospital stay of patients, and consequently the reduction in the cost of patients, it is expected that this method is a more suitable method compared with open surgery.

Clinical Effects of Laparoscopic Surgery in Radical Surgery for Colorectal Cancer

Objective: To investigate the clinical application effect of laparoscopic surgery in radical surgery for colorectal cancer. Methods: 78 patients who were treated with radical surgery for colorectal cancer in a tertiary hospital during the period from January 2021 to December 2023 were selected as the study subjects in this study. According to the different surgical methods, the patients were divided into the laparoscopic surgery group (40 cases in the experimental group) and the traditional open surgery group (38 cases in the control group). The operation time, intraoperative bleeding, postoperative recovery (including postoperative anal exhaustion time, time to get out of bed, and hospitalization time), complication rate, and therapeutic effect were observed in the two groups. Results: Patients in the experimental group were better than the control group in terms of intraoperative blood loss, operation time, postoperative anal exhaust time, time to get out of bed, and postoperative hospitalization time (P &lt; 0.05). Patients in the experimental group had significantly better treatment effects and complication rates than those in the control group (P &lt; 0.05). Conclusion: Compared with the open group, the overall prognosis of laparoscopic colorectal cancer patients is better, and laparoscopy has a protective effect on tumor recurrence or metastasis after radical surgery for colorectal cancer, and it can reduce the incidence of postoperative abdominal infection.

Impact of Additives and Packing Density on Fermentation Weight Loss, Microbial Diversity, and Fermentation Quality of Rape Straw Silage

To investigate the effects of the combined addition of Lactiplantibacillus plantarum and sucrose on the fermentation weight loss (FWL), fermentation quality, and microbial community structure of ensiled rape straw under varying packing density conditions. After harvesting, the rapeseed straw was collected, cut into 1–2 cm pieces, and sprayed with sterile water to adjust the moisture content to 60%. The straw was then divided into two groups: one treated with additives (1 × 105 CFU/g fresh material of Lactiplantibacillus plantarum and 10 kg/t fresh material of sucrose), and the other sprayed with an equivalent amount of sterile water as the control (CK). The treated materials were thoroughly mixed and packed into silos at densities of 450, 500, and 550 kg/m3. FWL was recorded on days 1, 3, 6, 15, 20, and 45 of fermentation. On day 45, the samples were analyzed for fermentation quality, microbial counts, and microbial diversity. FWL increased significantly (p &lt; 0.05) in both the treated (LS) and control groups during fermentation. The LS group showed higher lactic acid (LA) levels (p &lt; 0.05) and lower ammonia nitrogen levels (p &lt; 0.05) compared to CK. The CK group had significantly higher (p &lt; 0.05) counts of Coliforms and lower bacterial counts (p &lt; 0.05) than LS. The dominant genera in the silage were Xanthomonas, Lactiplantibacillus plantarum, and Lentilactobacillus. In the LS group, the relative abundances of Lactiplantibacillus plantarum and Lentilactobacillus ranged from 16.93% to 20.43% and 15.63% to 27.46%, respectively, with their combined abundance being higher than in CK. At a packing density of 500 kg/m3, the relative abundances of Lactiplantibacillus plantarum and Lentilactobacillus in the LS group were significantly higher (p &lt; 0.05) than in CK. Increasing packing density and applying additives to rape straw silage effectively reduced FWL, improved fermentation quality, boosted the relative abundance of beneficial lactic acid bacteria, and decreased the presence of undesirable bacteria such as Enterobacter and Bacillus.

Analysis of characteristics of peripheral blood lymphocytes in endometrial carcinoma: a single-center study based on five-year clinical data

IntroductionThis study analyzed and discussed the characteristics of peripheral blood lymphocytes (PBLs) in patients with endometrial carcinoma (EC) to explore the PBLs’ clinical application value.MethodsThis single-center case‒control study analyzed the clinical data of patients with EC and uterine fibroids who underwent surgery at the First Affiliated Hospital of Chongqing Medical University between October 2018 and October 2023 retrospectively. The Center for Clinical Molecular Medical Detection of our hospital performed PBLs detection using flow cytometry, and recorded the detection results in the electronic medical records system. Between-group and subgroup comparisons of PBLs in patients with EC were analyzed using t-test or Mann–Whitney U test. The effect of surgery on PBLs in patients with EC was assessed using a paired t-test or the Wilcoxon signed rank test.ResultsThe immune function of patients with EC was significantly lower than that of healthy people (P < 0.05) and those with benign uterine diseases (P < 0.05) and was related to body mass index (BMI), hypertension, diabetes, and blood lipids (P < 0.05). In patients with EC, the PBLs counts decreased significantly after surgery (P < 0.05) and more kinds of lymphocytes were affected in the laparoscopic surgery group than in the open surgery group.ConclusionsWith the decrease of PBLs counts, the immune status of patients with EC is impaired. Metabolic syndrome (Mets), including obesity, hypertension, diabetes, and high blood lipids, also affects the immune function of patients with EC. And for EC patients, the effect of laparoscopic surgery is greater than that of open surgery. PBLs has the potential to be one of indicator during the diagnosis and treatment of EC.Trial registrationThis study was retrospectively registered by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (approval number K2023-578).

Pain and immune function in patients undergoing gastric cancer surgery following stellate ganglion block with total intravenous anesthesia.

Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity. To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer (GC) surgery to provide a reference basis for the formulation of anesthesia protocols for radical GC surgery. This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024. There was no restriction on sex. The patient grouping method used was a digital random table method, and the number of cases in each group was 56. The control group was administered total intravenous anesthesia, and the observation group compounded the stellate ganglion block according to the total intravenous anesthesia protocol. Postoperative hemodynamics, pain levels, and immune indices were compared between the groups. The heart rate and mean arterial pressure in the observation group after intubation were lower than those in the control group (P < 0.05). Pain levels were compared between the two groups at 2 hours, 12 hours, 24 hours, and 48 hours after surgery (P > 0.05). The number of CD3+, CD4+, and CD4+/CD8+ cells at the end of surgery was higher in the observation group than in the control group, and the number of CD8+ cells was lower in the observation group than in the control group (P < 0.05). There were no significant differences between the two groups in terms of propofol dosage, awakening time, extubation time, or postoperative adverse reactions (P > 0.05). The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery. However, it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.

Laparoscopic surgery: An effective alternative for managing severe blunt splenic injuries in patients who are ineligible for transcatheter arterial embolization

BackgroundTranscatheter arterial embolization (TAE) is an effective alternative to nonoperative management (NOM) to improve the spleen salvage rate for patients with blunt splenic injuries (BSIs), but it is not always available at some institutions. Moreover, laparoscopy has also been used to diagnose and treat trauma, including BSIs. MethodsWe present our 11-year experience in performing laparoscopic surgery for spleen salvage in patients with severe BSIs when TAE is infeasible. The outcomes of laparoscopic surgery or TAE for spleen salvage in hemodynamically stable patients with severe BSIs were compared. ResultsFifty-six patients underwent interventions for severe BSIs during this period. Twenty patients underwent laparoscopic surgery, and 36 underwent TAE. There were no significant differences in demographics, preoperative conditions, or clinical characteristics (all p > 0.05). In the laparoscopic surgery group, 15 patients (75%) underwent laparoscopic splenorrhaphy for spleen salvage surgery, and five (25%) required splenectomy. No complications requiring intervention were observed in the laparoscopic surgery group, whereas three patients in the TAE group required a late splenectomy for splenic abscess. No significant differences were detected in the splenic preservation rate, complication rate, or length of hospital stay between the groups (all p > 0.05). ConclusionLaparoscopy is feasible and safe for managing hemodynamically stable patients with severe BSIs, and the outcomes are comparable to those of TAE. When TAE is infeasible, laparoscopy can be considered an alternative to increase the spleen salvage rate.

Laparoscopic versus open colectomy for locally advanced colon cancer in obese patients: a nationwide, multicenter, propensity score-based analysis of short- and long-term outcomes

Abstract Objective This study evaluated the short-and long-term outcomes of laparoscopic colectomy versus open surgery in obese patients (body mass index ≥25 kg/m2) with locally advanced colon cancer to ascertain the non-inferiority of laparoscopic surgery to open surgery. Methods In this large cohort study (UMIN-ID: UMIN000033529), we retrospectively reviewed prospectively collected data from consecutive patients who underwent laparoscopic or open surgery for pathological stage II–III colon cancer between 2009 and 2013. A comparative analysis was performed after propensity score matching between the laparoscopic and open surgery groups. The primary endpoint was the 3-year relapse-free survival (RFS). Results We identified 1575 eligible patients from 46 institutions. Each group comprised 526 propensity score-matched patients. Comparing the laparoscopic versus open surgery group, laparoscopic surgery was significantly associated with increased median operating time (225 vs. 192.5 min; P &amp;lt; .0001) and decreased median estimated blood loss (20 vs. 140 ml; P &amp;lt; .0001). Lymph node retrieval (20 vs. 19; P = 0.4392) and postoperative complications (4.6% vs. 5.7%; P = 0.4851) were similar, postoperative hospital stay was shorter (10 vs. 12 days; P &amp;lt; .0001), and the 3-year RFS rates were similar (82.8 vs. 81.2%). The hazard ratio (HR) for relapse-free survival for laparoscopic versus open surgery was 0.927 (90% confidence interval [CI], 0.747–1.150, one-sided P for non-inferiority = .001), indicating that for obese patients with colon cancer, laparoscopic surgery was non-inferior to open surgery. Conclusion Laparoscopic surgery in obese patients with colon cancer offers advantages in terms of short-term outcomes and no disadvantages in terms of long-term outcomes.

Comparative Analysis of Laparoscopic and Open Tubal Ligation: Insights from a Retrospective Study in a Tertiary University Hospital

Background: Female sterilization remains a prevalent contraceptive method globally, despite a declining trend in prevalence over the past decades. Methods: To compare the outcomes of tubal ligation between laparoscopic and open surgical approaches, conducted at the Jordan University Hospital from 2010 to 2021. Results: 242 females underwent tubal ligation with 131 had open surgery and 111 had laparoscopic surgery. The median follow-up period for the cohort was 8 years. For the entire study cohort, the mean age at the time of surgery was 37.77 years (standard deviation (SD) = 4.589). A statistically significant (p &lt; 0.0001) difference in age was found, with mean age being older in the laparoscopy group. However, there were no significant differences between the two groups in terms of gravidity (p = 0.9499) or parity (p = 0.4867). Remarkably, only two pregnancies were documented during the follow-up period, both of which were observed in the laparoscopic surgery group. Overall free-from-pregnancy rate at 8 years was 98.79%; 97.59% in the laparoscopy group and 100% in the open surgery group. Conclusions: Both open and laparoscopic tubal sterilization are equally effective permanent contraceptives. While our study contributes to the understanding of tubal ligation outcomes, further research, particularly in developing countries like Jordan, is warranted to address the unique needs and challenges of diverse populations in reproductive healthcare.

Abstract P175: The Effect of TRF on Hypertension Development in Male Dahl Salt-Sensitive Rats

Time restricted feeding (TRF), or food consumption restricted to &lt;10 hrs/day, has been shown to improve blood pressure in various cardiometabolic diseases, yet there is limited data on the effect in SS hypertension. The goal of this study was to examine the effect of TRF on disease development in the Dahl SS rat. We hypothesized that implementing TRF during a critical timepoint in disease progression would reduce mean arterial blood pressure (MAP). To study this, femoral catheters were surgically implanted in male Dahl SS rats at 9±0.5 weeks of age (n=5-7/group), allowing for urine and arterial blood sample collection from conscious rats during continual blood pressure recording. After 1 week of recovery, rats either continued a low salt (LS;0.4% NaCl) diet or were switched to a high salt diet (HS;4% NaCl) with ad libitum (ad lib) access for 1 week. At the start of week 2, a subset of rats began TRF, in which food was provided for 8 hrs (10PM-6AM) during their active period for an additional week. Rats meeting the following criteria were included in analysis: pulse pressure &gt; 10 mmHg, baseline MAP of 115-130 mmHg, and a 10-20 mmHg increase in MAP after 1 week on HS. Differences in MAP were analyzed by 2-way ANOVA with Tukey multiple comparisons and data are reported as mean ± SEM. By the end of week 2, HS TRF rats trended toward lower average MAP compared to HS ad lib rats (141.51±3.41 vs 149.49±1.65 mmHg; p=0.07). However, we found that the HS TRF rats had reduced MAP during their active period (6PM-6AM), compared to the HS ad lib rats (142.60±2.99 vs 151.65±1.862 mmHg; p&lt;0.05), but no difference during the inactive period (6AM-6PM). At the end of the study, average MAP was calculated every 4 hrs to identify the timing at which TRF reduced MAP. We found that the HS TRF rats had lower MAP from 6PM to 10PM (134.61±2.34 vs 146.75±1.21 mmHg; p&lt;0.05) and 10PM to 2AM (144.58±2.79 vs 154.70±2.18 mmHg; p&lt;0.05) when compared to the HS ad lib rats. The LS TRF group also had lower pressure from 6PM-10PM compared to the LS ad lib group (124.93±1.19 vs 130.56±0.73 mmHg; p&lt;0.05), suggesting that this time-specific reduction in MAP may be due to fasting, as there were no other differences in MAP within the LS groups. This suggests that TRF may slow progression of hypertension development in the Dahl SS rat, primarily by affecting MAP during the active period. Future studies will examine how TRF affects Na + handling to further understand these time-dependent effects.

Robotic, laparoscopic and open surgery for gallbladder cancer: a systematic review and network meta-analysis.

Minimally invasive oncological resections have become increasingly widespread in the surgical management of cancers. However, the role of minimally invasive surgery (MIS) for gallbladder cancer (GBC) remains unclear. We aim to perform a systematic review and network meta-analysis of existing literature to evaluate the safety and feasibility of laparoscopic and robotic surgery in the management of GBC compared to open surgery (OS) by comparing outcomes. A literature search of the PubMed/MEDLINE (2000 to December 2021) and EMBASE (2000 to December 2021) databases was conducted. The primary outcome studied was overall survival, and secondary outcomes studied were postoperative morbidity, severe complications, incidence of bile leak, length of hospital stay, operation time, R0 resection rate, local recurrence and lymph node yield. Thirty-two full-text articles met the eligibility criteria and were included in the final analysis with a total of 5883 patients undergoing either OS or MIS (laparoscopic or robotic) for GBC. 1- and 2-stage meta-analyses did not reveal any significant differences between OS, laparoscopic and robotic surgery in terms of overall survival, R0 resection, lymph node harvest, local recurrence and post-operative complications. Patients who underwent OS had significantly longer hospitalization stay and intra-operative blood loss compared to those who underwent laparoscopic or robotic surgery. Network meta-analysis did not reveal any significant differences between post-operative and survival outcomes of laparoscopic vs robotic surgery groups. This network meta-analysis suggests that both laparoscopic and robotic surgery are safe and effective approaches in the surgical management of GBC, with post-operative and survival outcomes comparable to OS. An MIS approach may also lead to shorter hospitalization stay, less intraoperative blood loss and post-operative complications compared to OS. There was no obvious benefit of either MIS approach (laparoscopic versus robotic) over the other.

The effect of TCM triple rehabilitation and ear acupoint bean pressing on laparoscopic surgery for gastric cancer.

To explore the clinical value of the triple pre-rehabilitation nursing model in laparoscopic radical surgery for gastric cancer. Eighty-two gastric cancer patients admitted to a certain hospital from May 2020 to May 2023 are included in this study. Patients were divided into control group (CG) and treatment group according to different nursing methods. Comparisons were made by comparing perioperative indicators, immune indicators, sleep quality, nutritional indicators, and anxiety before and after patient care, as well as whether or not to utilize the acupoint patch combined with ear acupoint bean pressing burial in Chinese medicine care. Under the conditions of the triple pre-rehabilitation nursing model, the observation group (OG) patients had their first exhaust time, first bed activity time, first bowel movement time, and hospitalization time of 62.15 ± 5.93, 18.67 ± 7.55, 2.05 ± 0.58, and 7.21 ± 1.05, respectively. The postoperative values of ALB in the CG and OG were 31.59 ± 7.65 and 36.08 ± 8.27, respectively, while the postoperative values of prealbumin were 0.19 ± 0.05 and 0.27 ± 0.09, respectively. The sleep quality of the CG before nursing was 22.57 ± 3.66, and after nursing was 14.36 ± 3.72. The satisfaction rate of the OG was 56.10%, while that of the CG was 46.34%. Patients can better adapt to the treatment process, reduce anxiety, and improve the treatment effect and quality of life after the triple pre-rehabilitation nursing care model and acupoint paste combined with ear acupoint bean pressing burrowing in traditional Chinese medicine nursing.