Laparoscopic Technique Research Articles

Robotic-assisted reoperative benign foregut surgery

Foregut disorders including gastroesophageal reflux disease (GERD), hiatal hernia (HH), and achalasia are often treated operatively including anti-reflux surgery (ARS), fundoplication, and Heller myotomy (HM). Minimally invasive surgery has become the preferred technique to treat these disorders. These operations have an inherent risk of failure requiring reoperation. These redo operations are more difficult because adhesions and destruction of tissue planes impair visualization during dissection of the hiatus and the gastroesophageal junction (GEJ). Conventional laparoscopic techniques have been described for redo foregut surgery with good results. Surgical robotic systems provide an alternative minimally invasive approach that improves visualization, dexterity, and surgeon ergonomics in many operations. The robot can be used safely and effectively for redo foregut surgery. In this review, we discuss the robotic surgical technique for reoperative foregut surgery and discuss the approach to individual foregut diseases.

A comparative analysis of the impact of three distinct laparoscopic myomectomy techniques on ovarian reserve: a randomized clinical trial.

Laparoscopic myomectomy is one of the preferred surgical treatments for symptomatic uterine fibroids. This study aimed to compare the effects of laparoscopic myomectomy with temporary uterine artery occlusion (TUAO), permanent uterine artery occlusion (PUAO), and vasopressin injection (VPI) on ovarian reserve in women with symptomatic uterine leiomyomas. This randomized clinical trial (RCT) study was conducted on women with symptomatic uterine fibroids referred to Shahid Beheshti and Al-Zahra Hospitals in Isfahan, Iran, from January 2024 to July 2024. A total of 54 women were included, with 18 women in each group. The women were randomly grouped based on the used techniques of TUAO, PUAO, and VPI. Moreover, ovarian reserve marker, including anti-Mullerian hormone (AMH) level, were measured before and after surgery. This parameter was evaluated 3months after surgery for all patients. Also, the amount of hemoglobin was measured before and after 24h after surgery for participants in each method. TUAO, PUAO and VPI laparoscopic myomectomy techniques had almost similar effects on ovarian reserve. The AMH level before the surgery in TUAO, PUAO, and VPI groups was reported as 3.87ng/mL, 3.42ng/mL, and 3.57ng/mL, respectively. The AMH level (3month) after the surgery was 3.78ng/mL, 3.34ng/mL and 3.48ng/mL, respectively. No significant difference was reported between AMH levels among the methods before and after the surgery (P = 0.27, P = 0.12, and P = 0.29, respectively). The Hb level before the surgery in TUAO, PUAO, VPI was 11.23g/dL, 11.55g/dL and 11.67g/dL, respectively. The Hb level after the surgery (24h) was reported as 10.95g/dL, 11.31g/dL and 11.25g/dL, respectively. No significant difference was reported between Hb levels among the methods before and after the surgery (P = 0.36, P = 0.31, and P = 0.13, respectively). As the choice of technique may depend on the factors such as surgeon preference and patient-specific factors, findings of this study have important implications for women undergoing LM and also highlight the need for further studies on the long-term effects of these techniques on ovarian reserve with larger sample sizes.

A rare huge retroperitoneal accessory spleen mimicking right-sided sarcoma in a female patient: case report and review

Abstract Detecting retroperitoneal accessory spleen (AS) requires a high index of suspicion for proper and timely diagnosis. The AS can be found near the hilum of the spleen or wholly or partially embedded in the pancreatic tail, stomach, bowel, mesentery walls, or even in the pelvis. Left-sided retroperitoneal AS is common compared to the right-sided retroperitoneal location, which is very rare. The diagnosis of AS is not common preoperatively when investigating a mass in the other abdominal regions, and the surgical resection can thoroughly confirm the diagnosis. The management of AS is surgical excision through open, laparoscopic, or robotic-assisted techniques, depending on the patient status, the size and location of the mass, and the available treatment modality in the hospital. Here, we described a rare case presentation of a huge right retroperitoneal mass (AS) that was initially suspected as sarcoma and managed by laparotomy resection.

Trends and Outcomes of General Surgery in the Pakistani Population: A Retrospective Analysis

Background: General surgery in Pakistan addresses a broad spectrum of medical conditions. However, surgical outcomes in low- and middle-income countries (LMICs) are affected by resource limitations, disparities in healthcare access, and delayed presentations. Objectives: This study aims to evaluate trends, outcomes, and predictors of complications in general surgery over a two-year period in a tertiary care center in Pakistan. Methodology: A retrospective analysis was conducted on n=400 adult patients who underwent elective or emergency general surgical procedures from January 2022 to December 2024. Data on patient demographics, surgical approaches (open vs. laparoscopic), and postoperative outcomes were collected. Predictors of complications were analyzed using Chi-square tests, t-tests, and logistic regression. Results: The mean age of patients was 44.5 (±12.8) years, with 58% being male. Laparoscopic techniques were used in 52% of surgeries, with a 6% conversion rate. Overall, 14% of patients experienced complications, including surgical site infections (5%) and hemorrhage (4%). Emergency procedures were associated with higher complication rates (p<0.01). Significant predictors of complications included BMI >30 kg/m² (OR: 2.3, 95% CI: 1.5–3.2, p<0.001), operative time >90 minutes (OR: 2.7, 95% CI: 1.8–4.1, p<0.001), and emergency surgery (OR: 3.2, 95% CI: 2.1–4.8, p<0.001). The 30-day mortality rate was 2%, predominantly due to emergency cases. Conclusion: While laparoscopic techniques have improved surgical outcomes in Pakistan, disparities in emergency care and resource allocation persist. Addressing key predictors of complications through systemic reforms, enhanced training, and infrastructure improvements is crucial for aligning surgical outcomes with global standards.

Comparison of different surgical techniques and anastomosis methods in short-term outcomes of right colon cancer: a network meta-analysis of open surgery, laparoscopic, and robot-assisted techniques with extracorporeal and intracorporeal anastomosis.

With the rapid development of minimally invasive surgical techniques, there remains considerable controversy regarding the choice of surgical approach and anastomosis method for patients with right-sded colon cancer (RSCC). This meta-analysis compared the short-term outcomes of open right colectomies (ORC), laparoscopic right colectomies with intracorporeal and extracorporeal anastomosis (LRC-IA and LRC-EA), as well as robot right colectomies with intracorporeal and extracorporeal anastomosis (RRC-IA and RRC-EA). A systematic search was conducted across PubMed (n = 549), Web of Science (n = 821), Embase (n = 591), and the Cochrane Central Register (n = 86) from January 2000 to August 2024. Studies comparing at least two of the surgical techniques for RSCC were included. The primary outcomes evaluated were overall complications, wound infection, ileus, and reoperation rates. Secondary outcomes included operative time, blood loss, hospital stay, time to resume diet, and conversion rates. A Bayesian network meta-analysis was performed. A total of 39 studies comprising 6098 patients were included. The results indicated that LRC-IA had the lowest overall complication rate (OR 0.65; 95% CI [0.41, 1.07]), while ORC had the highest. RRC-IA was most effective in reducing wound infection (OR 0.77; 95% CI [0.39, 1.35]), blood loss (MD 18.01; 95% CI [4.62, 40.87]), and hospital stay (MD 0.93; 95% CI [0.67, 1.31]), while also demonstrating advantages in preventing postoperative ileus (OR 0.47; 95% CI [0.05, 1.31]) and ensuring faster bowel function recovery (OR 0.80; 95% CI [0.44, 1.53]). The analysis demonstrates that for patients with RSCC, RRC shows better short-term outcomes compared to LRC and ORC, while IA also surpasses EA.

Optimizing the Laparoscopic Vecchietti Procedure: Tips and Tricks

Background The Vecchietti procedure is a staged procedure that, through use of an acrylic olive, allows for expedited traction and dilation to create a neovagina in patients with congenital vaginal agenesis. Although the steps are fairly standardized for the laparoscopic Vecchietti procedure, we have appreciated specific nuances in technique that have optimized our surgical approach and efficiency. Case We present a case of congenital vaginal agenesis in a genetically female patient who completed neovaginal creation using the laparoscopic Vecchietti technique. During this case, we review each step of the procedure and offer technical strategies to enhance efficiency and effectiveness in the operating room. We also describe these specific preoperative, intraoperative, and postoperative considerations in a video. Conclusions This optimized Vecchietti procedure, or traction vaginoplasty, is an excellent option for neovagina creation in those patients with vaginal agenesis. With the use of our techniques, we have had successful cosmetic and functional outcomes.

Percutaneous inguinal canal semi-closure during laparoscopic repair for large indirect inguinal hernia.

Factors such as a large lateral hernia and insufficient prosthetic overlap have been associated with hernia recurrence after laparoscopic transabdominal preperitoneal (TAPP) repair. The effectiveness of defect closure in reducing recurrence during laparoscopic hernia repair has been previously reported. We developed a novel technique called percutaneous inguinal canal semi-closure (PICS) to reinforce laparoscopic mesh repair. To assess whether this technique is both safe and practical in a clinical setting, focusing on postoperative factors such as recurrence, complications, and postoperative pain. A retrospective analysis of consecutive patients undergoing TAPP for L3 hernia repair. In total, 58 patients who underwent TAPP for L3 inguinal hernias were included, 27 of whom (46.6%) underwent TAPP with PICS, while 31 (53.4%) underwent standard TAPP without PICS. No recurrences were observed in the PICS group, compared to two recurrences in the control group, although this difference did not reach statistical significance. The incidence of postoperative complications was comparable between groups (48.1% vs. 45.2%, respectively). The median procedure time of PICS was 7.3min. Patients in the PICS group reported higher pain scores than the control group for up to 21days postoperatively, but no chronic pain was observed in either group. The modified laparoscopic technique involving PICS for large indirect inguinal hernias appears safe and feasible.

Laparoscopic intracorporeal anastomosis vs open anastomosis for ileostomy reversal in Crohn's disease: A single center retrospective study.

There is an increased maturation of laparoscopic intracorporeal anastomosis techniques. However, research on its application for small bowel stoma reversal in patients with Crohn's disease (CD) is limited. Therefore, in this study, we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal (LIIR) and open ileostomy reversal (OIR). To compare the safety, feasibility, bowel function recovery, and short- and long-term LIIR and OIR outcomes in patients with CD. This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution. The baseline data, postoperative recovery, and complication indicators were retrospectively analyzed. Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms. Notably, 15 of the 45 patients in this study underwent OIR, and the remaining 30 received LIIR. Notably, no statistically significant differences were found between the two groups regarding clinical baseline characteristics, operation time, intraoperative hemorrhage, anastomotic site, enterolysis range, first postoperative flatus, postoperative complications, reoperation rate, or incidence of postoperative enteral nutrition intolerance. Compared with the OIR group, the LIIR group had a shorter postoperative hospital stay (P = 0.045), lower incidence of enteral nutrition intolerance symptoms (P = 0.019), and earlier postoperative total enteral nutrition initiation (P = 0.033); however, it incurred higher total hospital costs (P = 0.038). Furthermore, multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance (P < 0.05). Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible. Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.

Comparative efficacy analysis of laparoscopic-assisted transanal total mesorectal excision vs laparoscopic transanal mesorectal excision for low-lying rectal cancer.

With the continuous development of laparoscopic techniques in recent years, laparoscopic total mesorectal excision (LapTME) and laparoscopic-assisted transanal total mesorectal excision (TaTME) have gradually become important surgical techniques for treating low-lying rectal cancer (LRC). However, there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment. To compare the efficacy of LapTME vs TaTME in patients with LRC. Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME (n = 44) and TaTME (n = 50) groups. Clinical operation indexes, postoperative recovery indicators, and postoperative complications were recorded. The anal resting pressure (ARP), anal maximum systolic pressure (MSP), and maximum tolerated volume (MTV) of the anal canal were also measured. The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center (MSKCC) bowel function questionnaire. Serum norepinephrine (NE), adrenaline (AD), and cortisol (Cor) levels were measured. The Quality of Life Questionnaire Core 30 (QLQ-C30) was used for quality of life assessment. Compared with the LapTME group, the surgery time in the TaTME group was longer; intraoperative blood loss was low; time of anal exhaust, first postoperative ambulation, intestinal recovery, and hospital stay were shorter; and the distal incisal margin and specimen lengths were longer. The TaTME group also showed higher ARP, MSP, and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively. Cor, AD, and NE levels were lower in the TaTME group than those in the LapTME group during recovery. We demonstrated that TaTME better improved anal function, reduced postoperative stress, and accelerated postoperative recovery and, hence, was safer for patients with LRC.

Laparoscopic Management of Cholecystoduodenal Fistula Associated with Sclerotic Gallbladder: Case Report

Cholecystoduodenal fistula (CDF) is a rare and complex complication of chronic cholecystitis and gallstone disease, characterized by an abnormal communication between the gallbladder and duodenum. This report presents the case of a 31-year-old male who presented with right upper quadrant pain, nausea, and jaundice. Imaging studies confirmed a scleroatrophic gallbladder and a CFD. The patient underwent laparoscopic cholecystectomy with partial gallbladder excision, and the fistula was successfully repaired with laparoscopic techniques, including clip application and intracorporeal suturing to invaginate the defect. This case underscores the importance of advanced laparoscopic skills and multidisciplinary approaches in managing complex biliary pathologies.

10-year experience with single-site laparoscopic-assisted Soave operation for Hirschsprung disease

Background The aim of this study was to investigate the clinical outcomes after a transumbilical single-site laparoscopic-assisted Soave operation (TSLSO) for Hirschsprung disease (HD) in children, with a 10-year follow‑up results assessment. Methods We retrospectively analyzed the clinical data of 165 children with HD from January 2013 to January 2023. The operation method was a TSLSO. The operation time, intraoperative bleeding, postoperative abdominal drainage time, postoperative hospitalization time, and postoperative complications were analyzed. Results All 165 cases were successfully completed using the TSLSO. The median operative time was 160 (120–210) minutes, and the median volume of bleeding was 9 mL (3–15 mL). The median length of the resected intestine was 25 cm (20–32 cm), and the median postoperative peritoneal drainage time was 4.2 days (3–6 days). Postoperative defecation function generally recovered well, there was no recurrence of constipation. There were three cases of anal stenosis, 12 cases of perianal dermatitis, two cases of adhesive intestinal obstruction, 14 cases of soiling, and 18 cases of enterocolitis. Conclusion The TSLSO is a safe and feasible surgical method for the treatment of HD in children. It has the advantages of little bleeding, a good cosmetic effect, and fast postoperative recovery. However, it does require skilled laparoscopic technique by the surgeon.

BHSeP36 Laparoscopic mesh repair of sciatic hernia containing ureter and small bowel: a case report

Abstract Sciatic hernia is one of the rarest forms of pelvic hernia, accounting for around 0.01% of all abdominal wall hernias. They are more common in females, and the presentation can vary depending on the hernia contents. The literature initially suggested repair with open trans-gluteal or trans-abdominal approaches, though in more recent years there has been a shift towards laparoscopic techniques. We report our experience of performing laparoscopic mesh repair of a sciatic hernia in a 79 year old woman. The patient was experiencing abdominal pain and subsequent investigations revealed an off-baseline eGFR and a CT scan showing hydroureteronephrosis secondary to a sciatic hernia containing ureter and non-obstructed small bowel. Laparoscopic repair of the sciatic hernia was performed using placement of a self-expanding polypropylene mesh patch; cyanoacrylate glue was used to fix the mesh in place and to close the peritoneum. The patient made a good post-operative recovery and was discharged home the same day. In conclusion, this rare form of hernia was successfully treated using a laparoscopic approach with placement of a mesh patch and cyanoacrylate glue.

Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb.

Perihilar cholangiocarcinoma (pCCA) is a highly malignant and aggressive tumor, with radical resection being the only curative treatment available. With continuous advancements in laparoscopic techniques and instruments, laparoscopic radical surgery for pCCA is now considered technically safe and feasible. However, due to the high complexity of the surgery and the lack of evidence-based clinical support, laparoscopic radical surgery for type IIIb pCCA is performed only in a few large hepatobiliary centers. Current guidelines recommend left hemihepatectomy combined with total caudate lobectomy and standardized lymphadenectomy for resectable type IIIb pCCA. Therefore, in this article, we provide a detailed description of the surgical steps and technical points of complete laparoscopic left hemihepatectomy combined with total caudate lobectomy, regional lymphadenectomy, and right hepatic duct-jejunal Roux-en-Y anastomosis in patients with type IIIb pCCA, using fluorescence navigation technology to enhance surgical precision and safety. By adhering to standardized surgical procedures and precise intraoperative techniques, we offer an effective means to improve patient outcomes.

Laparoscopic robotic-assisted ileo-caecal resection with intracorporeal anastomosis in children with Crohn disease: initial experience of a paediatric center and surgical feasibility

PurposePediatric-onset Crohn's disease (CD) presents with a more aggressive course than adults. Surgical treatment is still necessary in many patients. The laparoscopic technique for treating terminal ileal CD is deemed safe and feasible, with the advantage to perform an intra-corporeal anastomosis (ICA). The robotic platform facilitates ICA creation thanks to 3D-visualization, tenfold magnification and better dexterity. The aim of this study was to report our initial experience of robotic ileocecal resection (RICR) with ICA in children with CD.MethodsSix patients underwent RICR for CD. Patient characteristics, intraoperative details, and postoperative outcomes were collected. The surgical technique consisted in an intra-corporeal ICR with a stapled side-to-side ileo-colic anastomosis.ResultsThe mean age at surgery was 14.8 years. The mean operative time was 210.8 min. No intraoperative complications or conversions were recorded. Bowel function returned on postoperative day 3 and the mean hospital stay was 8 days. Two minor complications were treated conservatively and 1 major (anastomotic dehiscence) required reoperation.ConclusionRICR is a safe and feasible technique in pediatric CD of terminal ileum. The robot offers advantages over other techniques for the precision of the suture, avoiding extracorporeal anastomosis. However, larger studies are needed to confirm these preliminary results.

Advancing surgical education: An evaluation of laparoscopic simulation training for medical students.

To examine the medical students' awareness of laparoscopic surgery as well as assess the perceived importance of laparoscopic simulation training, and its impact on students' confidence, career aspirations, proficiency, spatial skills, and physical tolerance. Descriptive and comparative study using pre- and post-training assessments. Simulation training sessions centred on laparoscopic surgery techniques. Medical students in year three (n = 49) participated in laparoscopic simulation training sessions. Before the simulation training, 85.7% of students were unaware of laparoscopy, with females being less familiar than males (96.3% vs. 72.8%). 85.7% believed mastering laparoscopy was crucial before training, and 81.6% believed simulation training could enhance surgical skills. A disparity existed in this belief between the sexes, with 91% of males and 74.1% of females seeing the value in such training for skill improvement. Pretraining, males (54.5%) were more confident than females (26%) in mastering laparoscopy. Post-training, confidence increased for both groups, and the percentage of students wishing to pursue a surgical career also rose from 50% to 72.7%. Despite initial disparities in the time spent on training modules between males and females, both groups achieved similar proficiency levels by the end of the training. Although females initially lagged in spatial awareness and skills, post-training results showed significant improvement, matching their male counterparts. 26.5% of students experienced physical fatigue post-training, with a higher percentage of females (33.3%) reporting fatigue than males (18.2%). Regarding concentration during simulations, 81.8% of males could maintain focus compared to 48.2% of females. Laparoscopic simulation training effectively improved the understanding, confidence, and surgical skills of medical students, with evident benefits in shaping their career aspirations. While both genders exhibited significant gains, female students faced challenges in terms of physical tolerance and initial spatial awareness. However, their post-training achievements mirrored those of their male peers, highlighting the effectiveness and importance of such simulation training programmes.

A Systematic Review and Meta-analysis of Randomized Controlled Trials on Comparing Transabdominal Preperitoneal Versus Lichtenstein Operations for Primary Inguinal Hernia Repair

Background: Inguinal hernia repair is a common surgical operation being performed worldwide, and the primary objective of hernia repair is to reduce recurrence, minimize complications, and robust recovery. This systematic review and meta-analysis reviewed and compared two widely used surgical techniques: the Trans-abdominal Pre-peritoneal (TAPP) repair, a minimally invasive laparoscopic surgical technique, and the Lichtenstein operation, which is an open repair. Methods: A thorough search was conducted across several databases, including PubMed, Cochrane Library, Google Scholar, and Web of Science, from 2004 to August 2024. We searched a combination of keywords and medical subject-related headings related to "trans abdominal Pre-peritoneal," "TAPP Surgical Technique," "Lichtenstein open repair operation," "primary inguinal hernia," and "randomized controlled trials (RCTs)." Studies included in the meta-analysis were grouped based on the primary outcomes of interest to elaborate a comprehensive analysis. In addition to the surgical operation and hospital stay duration, acute post-operative pain, return to work time, hematoma, wound infection, and seroma incidence were also measured. The Randomized controlled trials (RCTs) comparing TAPP and Lichtenstein operations for primary inguinal hernia repair and studies reporting on at least one of the above-mentioned outcomes were included. The studies with patients having incarcerated hernia, femoral or bilateral hernias were excluded. The risk of bias for included studies was assessed using the Cochrane Risk of Bias tool and sed on odds ratios (ORs), standardized mean differences (SMDs) and confidence intervals (CIs), a quantitative meta-analysis study was conducted. Results: Nine Randomized Controlled Trials (RCTs) comparing the TAPP and Lichtenstein technique for primary inguinal hernia repair were included in the meta-analysis. The duration of the surgical procedure was longer in the TAPP group (46.3 to 96.12 minutes), compared to the Lichtenstein group (27.8 to 54.2 min). In terms of acute post-operative pain, the TAPP group reported lower pain scores (mean: 5.66) compared to the Lichtenstein group (mean: 8.53). The overall complication rate was lower for the TAPP group (Odds Ratio = 0.461) as compared to Lichtenstein repair. Conclusion: The meta-analysis concluded that TAPP tops out with benefits like less post-operative pain and a robust recovery period. However, the Lichtenstein technique remains a widely used option, especially in settings where access to advanced Laparoscopic facilities and expertise might not be available.

COMPARISION BETWEEN EARLY AND DELAYED CHOLECYSTECTOMY IN ACUTE BILIARY PANCREATITIS

Background: Acute biliary pancreatitis is a common surgical emergency requiring inpatient conservative management. Cholecystectomy is critical in preventing recurrent episodes and minimizing additional biliary complications. However, the optimal timing for cholecystectomy remains a matter of ongoing debate. Early laparoscopic cholecystectomy has been suggested to improve outcomes, but further evidence is required to validate its benefits compared to delayed surgery in patients with mild to moderate acute biliary pancreatitis. Objective: This study aimed to compare the outcomes of early versus delayed laparoscopic cholecystectomy for acute biliary pancreatitis in a tertiary care hospital setting. Methods: A randomized controlled trial was conducted in the General Surgery Department of Fauji Foundation Hospital, Rawalpindi, from July 2024 to December 2024. A total of 100 patients, aged 20–60 years, with mild to moderate acute biliary pancreatitis (ASA grades I or II), were enrolled and randomized into two groups. Group A (early cholecystectomy) underwent surgery within 7 days of symptom onset, whereas Group B (delayed cholecystectomy) underwent surgery between 8 days and 6 weeks after symptom onset. Cholecystectomy was performed following a standardized laparoscopic technique. Data were analyzed using SPSS version 17, with Chi-square tests applied to compare outcomes such as intraoperative bleeding, postoperative fever, severe abdominal pain, and atelectasis. A p-value ≤0.05 was considered statistically significant. Results: The mean age of patients in the early cholecystectomy group was 43.94 ± 11.26 years, while it was 46.38 ± 9.23 years in the delayed group. Females predominated in both groups (72% in early and 70% in delayed groups). Intraoperative bleeding occurred in 20% of early cholecystectomy patients compared to 34% in the delayed group (p=0.115). Postoperative severe abdominal pain was significantly lower in the early group (18% vs. 36%; p=0.043), as was postoperative fever (22% vs. 48%; p=0.006). Atelectasis occurred in 12% of early group patients and 22% of delayed group patients, with a statistically significant difference between the groups (p=0.183). Conclusion: Early laparoscopic cholecystectomy significantly reduces postoperative complications such as severe abdominal pain and fever in patients with acute biliary pancreatitis. The findings particularly highlight the benefits for patients with elevated BMI and advanced age, advocating for individualized treatment strategies. Future studies with larger sample sizes and longer follow-up periods are recommended to confirm these results and optimize management protocols.

Role of laparoscopic surgery in blunt abdominal trauma; retrospective analysis in a tertiary trauma center

PurposeTrauma is a significant health concern globally and is one of the leading causes of illness and death. The laparoscopic approach has gained popularity in trauma care since its inception, becoming increasingly favored for both diagnostic and therapeutic purposes. This study aims to reduce unnecessary laparotomies and assess the effectiveness of laparoscopy in managing patients with blunt abdominal trauma.MethodsThe study is a descriptive retrospective study using the medical records of patients with blunt abdominal trauma who were managed with laparoscopy in the Department of General Surgery, King Abdulaziz Medical City in Riyadh. The study period was from 2019 to 2023 and included patients > 18 years with abdominal blunt injury, hemodynamically stable patients, and responding to resuscitation. The relationship between laparoscopic procedures according to the patient’s demographic and characteristics was conducted using the Fischer Exact test and independent sample t-test. Values were considered significant with a p-value of less than 0.05.ResultsIn this study, 74 patients were included, with 94.6% being males. The average age of the patients was 36.3 years (standard deviation of 12.5 years). The primary cause of trauma was motor vehicle accidents (MVAs), accounting for 91.9% of cases. The most common surgical approach used was laparotomy, performed in 71.6% of patients. Additionally, CT scans revealed that solid organ injuries were the most frequently detected type of injury, occurring in 41.9% of cases. Following surgery, 78.4% of the patients underwent therapeutic procedures after laparotomy, while 37.8% received therapeutic interventions post-laparoscopy.ConclusionWhile laparoscopic techniques have been used for decades in abdominal surgeries, a consensus on their effectiveness and accuracy in diagnosing blunt abdominal injuries in trauma settings is still lacking. Laparoscopy is considered safe and feasible for hemodynamically stable patients, and our findings suggest it is equally effective in trauma cases for those who can tolerate the procedure. We recommend conducting further studies with larger sample sizes and more variables to provide sufficient data to accurately assess the efficacy and safety of laparoscopy in trauma situations.

COMPARISON OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS TENCKHOFF CATHETER INSERTION (OPEN SURGERY VS LAPAROSCOPIC) – A CASE CONTROL STUDY

Objective: This study aims to investigate post-operative complication rate of Tenckhoff catheter placement methods between open surgery and laparoscopic. Material &amp; Methods: This is a case control comparative study reviewed from the medical records of patients who required insertion, removal, or repairment of Tenckhoff catheter for the provision of CAPD at Hasan Sadikin Bandung general hospital between January 2015 to December 2020. Clinical outcome and complication were compared between the open surgery and laparoscopic group. Results: We obtained 30 patients who required insertion of a Tenckhoff catheter for the provision of CAPD, 15 patients by open surgery and 15 patients by laparoscopic technique. Insertion of Tenckhoff catheter using open surgery have a higher risk of catheter migration (p=0.049; O R=3.25) and infection (p=0.014; OR=12.25) compared to laparoscopic. Discussion: Laparoscopic technique facilitates omentectomy, allows better fixation under direct visualisation, and for lysis of adhesions to increase peritoneal surface. Conclusion: Tenckhoff catheter insertion by using laparoscopic surgery tend to have better outcome compared to open surgery, with lower risk of catheter migration and infection. Keywords: Tenckhoff catheter, laparoscopic, CAPD.

KLASS (Korean Laparoendoscopic Gastrointestinal Surgery Study Group) trials: a 20-year great journey in advancing surgical clinical research for gastric cancer.

The Korean Laparoendoscopic Gastrointestinal Surgery Study Group (KLASS) trial series represents a comprehensive body of surgical clinical trials and studies focused on laparoscopic techniques in the treatment of gastric cancer. These trials, conducted and overseen by the KLASS, began with KLASS 01 in 2006 and have progressed to their 14th series as of December 2024. To date, approximately 36 papers, including pivotal publications, have been featured in high-impact journals, significantly advancing the field of gastric cancer treatment. Their findings have been incorporated into gastric cancer treatment guidelines in Korea, Japan, and China, underscoring their influence and clinical relevance. I take immense pride in being part of this remarkable journey, alongside esteemed seniors, colleagues, and numerous clinical researchers who initiated KLASS in 2004. This paper aims to review the studies conducted within the KLASS series to date and provide insights insight into the ongoing the ongoing research initiatives being developed by this esteemed group on their behalf.