Laparoscopic Treatment Group Research Articles

Rectovaginal Fistulas: Comparative Analysis of Laparoscopic Assisted Pullthrough and Posterior Sagittal Anorectoplasty

AimCompare the laparoscopic treatment (LT) and the posterior sagittal anorectoplasty treatment (ST) of the rectovaginal fistulas (RvaF) in a single center. We have previously reported feasibility and results of LT in this rare variety of anorectal malformations (ARM) [1–3]. Material and methods19 patients were treated between February 2000 and November 2020. Nine underwent a LT and 10 a ST. Both surgical techniques were previously described. [2][4][5] The distal posterior wall of the vagina was kept intact in the LT. A technical change was introduced in the ST for that purpose. The fistula was treated from the inside of the rectum, avoiding the opening of the distal vagina as described for the treatment of a urethra rectal bulbar fistula in males. Age at operation, associated anomalies, sacral ratio index (SR), complications, urinary continence, presence of spontaneous intestinal movements, constipation, soiling and requirements of bowel management program (BMP) were analyzed. ResultsAssociated anomalies occurred in 17 patients (89.5 %), 63 % of which were urological. Five (26 %) had a SR below 0.4; 4 in the LT group and 1 in the ST group. The mean age at the time of operation was 23.2 (8–59) in ST and 17.6 months (4–32) in LT. Average operative time was 190.4 min for ST (120–334) and 195.8 min (90–270) for LT (p 0.13). One patient in the LT group presented a mild rectal prolapse and 2 a partial wound dehiscence after the ST. Only 15 patients were evaluable for functional results (8 in ST and 7 in LT). Mean follow up was 83 months (12–197). All patients are clean with a bowel management program. Five of the 7 patients undergoing a LT had a bad prognosis (SR < 0,4). Three (43 %) are clean with diet or any treatment, 3 (43 %) using laxatives or enemas and 1 (14 %) with a trans anal irrigation system. Only 1 of the 8 patients in the STgroup had a bad prognosis. Six (40 %) needed a diet; 4 (50 %) laxatives or enemas and 1 (10 %) a cecostomy button for antegrade enemas. ConclusionsPatients with RvaF had a high index of associated anomalies. The difference of operative time was not statistically significative. No differences in functional results between both groups were observed. LT is a valid option to treat RvaF.

Laparoscopic Completion Total Gastrectomy as a Standardized Procedure for Gastric Stump Cancer: A Case Control Study

Objective Complete gastrectomy for gastric stump cancer (GSC) can be challenging due to severe adhesions; therefore, advanced techniques are required when being performed by laparoscopic surgery. This study aimed to evaluate the clinical outcomes of laparoscopic completion total gastrectomy (LCTG) for the treatment of GSC. Methods Patient records from January 2010 to October 2018 were retrospectively evaluated. The patients were classified into 2 groups depending on whether they underwent open or laparoscopic gastrectomy. We compared patient characteristics; operative, clinical, and pathological data between the groups. Results Twenty open and 17 LCTGs were performed. Laparoscopic gastrectomy resulted in a significantly longer operation time (230 versus 182.5 min; P = 0.026), lower blood loss (14 versus 105 mL; P &amp;lt; 0.001), and shorter period to the first flatus passage (2 versus 3 days; P &amp;lt; 0.001) than open gastrectomy. No significant differences in the number of retrieved lymph nodes, duration of hospital stay, complication rate, and postoperative analgesic usage between the 2 groups were observed. No patients required conversion to open surgery in the laparoscopic-treatment group. Pathologic findings revealed that the laparoscopic group had a smaller tumor size (not pathologic T category) and fewer metastatic lymph nodes than the open group, leading to an earlier distribution of the pathologic stage in the laparoscopic group. Conclusions LCTG for the treatment of GSC was safely conducted with fewer complications and mortalities than previously reported results. Advanced technologies and sophistication of laparoscopic skills may further yield minimal invasiveness with better short-term outcome.

A controlled clinical study of a two-trocar mini-laparoscopic technique versus the standard laparoscopic technique in treatment of adult renal cysts.

IntroductionLaparoscopic renal cyst decortication is currently the best choice for the treatment of simple renal cysts and is widely used in clinical practiceAimTo investigate the safety and clinical efficacy of two-trocar mini-laparoscopic decortication of adult renal cysts.Material and methodsA total of 90 patients were enrolled in the study and randomly divided into two groups: a two-trocar mini-laparoscopic treatment group (M group) and a three-trocar standard laparoscopic treatment group (S group), with 45 patients in each group.ResultsThe average length of hospital stay was shorter, and the demand for postoperative analgesics was less in the M group than in the S group (p < 0.05). The proportion of “very satisfied” patients in the patient physical recovery satisfaction survey was significantly higher in the M group than in the S group (p < 0.05). Of the 45 patients in the M group, 40 successfully underwent surgery. In 3 patients, the two-trocar procedure was converted to a three-trocar procedure due to difficulty in separating perirenal adhesion for visualization. Mini-laparoscopic surgery was converted to classic laparoscopic surgery in 2 patients. In the S group, 44 patients successfully underwent the renal cyst decortication procedure. One patient underwent partial renal resection due to an intraoperative diagnosis of multilocular cystic renal cell carcinoma. Postoperative urine leakage was reported in 3 patients in the M group and two in the S group.ConclusionsTwo-trocar mini-laparoscopic treatment of renal cysts is as safe and effective as traditional laparoscopy but is associated with less cosmetic damage, leading to a better physical appearance.

Clinical value of early laparoscopic therapy in the management of tubo‑ovarian or pelvic abscess

Broad-spectrum antibiotics are the conservative treatment for tubo-ovarian abscess (TOA) or pelvic abscess, but the failure rate of antibiotic therapy remains higher in patients with a larger abscess. The present study aimed to evaluate the clinical value of early laparoscopic therapy in the management of TOA or pelvic abscess. A total of 100 patients were enrolled and their medical records were retrospectively analyzed after excluding 6 patients with malignant diseases. Based on the treatment they had received, the patients were divided into a conservative treatment group (n=41) and an early laparoscopic treatment group (n=53). In the conservative treatment group, 21 patients (51.2%) finally received laparoscopic exploration (late laparoscopic treatment group), and 20 patients (48.8%) achieved a success of antibiotic therapy (successful antibiotic therapy group). The cut-off value of abscess size for predicting antibiotic treatment failure was determined using receiver operating characteristic curve analysis. Multivariate logistic regression analyses were used to explore the association between the clinical variables and antibiotic therapy failure in conservative treatment group. The durations of elevated temperature >38.0°C and hospitalization were significantly longer in the conservative treatment group than those in the early laparoscopic treatment group (all P<0.001). The patients in the late laparoscopic treatment group had a larger abscess size than those in the successful antibiotic therapy group (6.2±1.8 cm vs. 4.8±1.4 cm, P=0.008). An abscess diameter of 5.5 cm was obtained as the cut-off of antibiotic failure, and the sensitivity and specificity were 81.0 and 85.0%, respectively. An abscess diameter of ≥5.5 cm was independently associated with antibiotic failure (odds ratio=5.724; 95%CI: 2.025–16.182; P=0.001). In conclusion, early laparoscopic treatment was associated with a better clinical prognosis than conservative treatment and late laparoscopic therapy for TOA or pelvic abscess patients.

The evolving influence of laparoscopy and laparoscopic ultrasonography on patients with hepatocellular carcinoma

Background With the recent introduction of laparoscopic partial hepatectomy and laparoscopic/open radiofrequency ablation for hepatocellular carcinoma (HCC), the role of preoperative laparoscopic staging may be expanded. The objective of this study was to determine the role of preoperative laparoscopy and laparoscopic ultrasonography (USG) in patients with HCC. Methods From January 2001 to April 2007, a cohort of 122 consecutive patients with a diagnosis of potentially resectable HCC underwent staging laparoscopy with laparoscopic USG before performing a major laparotomy in a tertiary referral center. The patients' data were collected prospectively. We have retrospectively analyzed the effect of implementation of this staging technique in our center. Results Preoperative laparoscopy and laparoscopic USG was successful in 119 patients (97.5%). Forty-four patients were found to be unresectable after laparoscopic staging, whereas 2 patients were found to be unresectable after exploratory laparotomy. The total number of patients who underwent curative liver resection was 73 (laparoscopic partial hepatectomy, 22 patients; open partial hepatectomy, 51 patients). The median hospital stay of the laparoscopic liver resection group was significantly shorter than that of the open resection group (8 vs 13 d; P = .002). Intraoperative treatment for patients with unresectable HCC, including local ablative therapy, or combined liver resection and local ablative therapy, was performed in 27 of 45 inoperable patients (60%) (laparoscopic approach, 8 patients; open approach, 19 patients). The median hospital stay of the laparoscopic treatment group was significantly shorter than for the open treatment group for patients with unresectable HCC (5 vs 7 d; P = .003). In this study, a laparoscopic treatment approach for HCC was performed in 25.2% of the study population. Conclusions Laparoscopy and laparoscopic USG have a significant effect both on identifying surgically untreatable disease and in selecting the optimal treatment strategy. Some patients will benefit from a laparoscopic therapy approach. Therefore, it argues for more widespread use in laparoscopic staging procedures for patients with potentially resectable HCC.