Open Laparotomy Research Articles

Complications and outcomes associated with laparoscopic-assisted splenectomy in dogs.

To report the perioperative characteristics and outcomes of dogs undergoing laparoscopic-assisted splenectomy (LAS). 136 client-owned dogs. Multicentric retrospective study. Medical records of dogs undergoing LAS for treatment of naturally occurring splenic disease from January 1, 2014, to July 31, 2020, were reviewed. History, signalment, physical examination and preoperative diagnostic test results, procedural information, complications, duration of hospitalization, histopathologic diagnosis, and perioperative outcomes were recorded. Perioperative complications were defined using the Veterinary Cooperative Oncology Group - Common Terminology Criteria for Adverse Events (VCOG-CTCAE v2) guidelines. LAS was performed for treatment of a splenic mass (124/136 [91%]), immune-mediated disease (7/136 [5%]), splenomegaly (4/136 [3%]), or immune-mediated disease in conjunction with a splenic mass (1/136 [1%]). Median splenic mass size was 1.3 cm3/kg body weight. Conversion to open laparotomy occurred in 5.9% (8/136) of dogs. Complications occurred in 78 dogs, with all being grade 2 or lower. Median surgical time was 47 minutes, and median postoperative hospital stay was 28 hours. All but 1 dog survived to discharge, the exception being postoperative death due to a suspected portal vein thrombus. In the dogs of this report, LAS was associated with low rates of major complications, morbidity, and mortality when performed for a variety of splenic pathologies. Minimally invasive surgeons can consider the LAS technique to perform total splenectomy in dogs without hemoabdomen and with spleens with modest-sized splenic masses up to 55.2 cm3/kg, with minimal rates of complications, morbidity, and mortality.

Robotic assisted primary cytoreductive surgery for treatment of advanced stage ovarian cancer: A pilot study (553)

Robotic assisted primary cytoreductive surgery for treatment of advanced stage ovarian cancer: A pilot study (553)

Jinekolojik Cerrahide Taze Gaz Akımının Derlenme Ajitasyonu Üzerine Etkileri: Klinik Bir Çalışma

ABSTRACT Objective: This prospective study aimed to determine whether low flow anesthesia (LFA) has an effect on emergence agitation in women who underwent laparotomic gynecologic surgeries. Method: Sixty four female patients were enrolled in this prospective randomized study. The patients were randomly allocated into two groups: Group 2 and Group 0.5. The fresh gas flow (FGF) rate was set at 4 L min-1 in both groups, initially. When all patients reached 1 minimum alveolar concentration of sevoflurane, the FGF rate was reduced to 2 L min-1 in Group 2 and 0.5 L min-1 in Group 0.5. For Group 0.5, vapor was closed 15 minutes before the end of surgery, while it was closed at the end of the operation for Group 2. At the end of the surgery, the FGF rate was increased to 4 L min-1. Emergence agitation was assessed using the Riker Sedation Agitation Scale (SAS) in the post-anesthesia care unit at 5, 10, 20 and 30th minutes. Results: Emergence agitation was observed in 5 patients, no significant difference was found between two groups. For all evaluation times, number of patients with SAS=4 was significantly higher in Group 0.5, while the number of patients with SAS<4 was significantly higher in Group 2 (p<0.05). Conclusion: The number of patients who are calm and cooperative was higher in LFA. Keywords: Emergence agitation, general anesthesia, fresh gas flow

Chylothorax and mediastinal haematoma by central venous catheter post-duodenal ulcer and pyloroplasty surgery: a case report

In handling critically ill patients, central venous catheterization is a fundamental procedure. Incidence of pleural effusion and mediastinal haematoma following central venous placement is rare, with a rate between 0.17% and 1%. We report a frail elderly man who was started on parenteral nutrition administered by left internal jugular vein catheter post-emergency laparotomy surgery for a perforated duodenal ulcer. He developed bilateral chylothorax immediately on the first day of parenteral nutrition supplement. Contrast-enhanced computed tomography of the thorax as part of chylothorax workouts incidentally revealed anterior mediastinal haematoma in communication with the catheter tip, implying likely an iatrogenic injury. Rapid onset of chylothorax may indicate a thoracic duct injury and concurrent parenteral nutrition content leakage from the extravasated catheter. The anatomical connection between the pleural and mediastinal cavities has not been clearly illustrated in the literature. Bilateral chest drains were inserted and the catheter was removed at bedside without complications. Despite using ultrasound guidance, clinical methods and post-procedure chest X-ray, the catheter malposition was not detected before initiation of parenteral nutrition. The learning point is for the clinician to remain vigilant for potential catheter-related complications.

Minimally Invasive Approaches for Traumatic Rupture of the Pancreas in Children—A Case Series

Pancreatic trauma in children is rare; therefore, both scientific knowledge and clinical experience regarding its management are limited. Abdominal sonography and subsequent computed tomography (CT) imaging are the diagnostic mainstay after severe abdominal trauma in many pediatric trauma centers. However, the diagnosis of pancreatic injury is missed on the initial imaging in approximately one third of cases, with even higher numbers in young children. While conservative treatment is preferred in low-grade injuries, surgical interventions may be indicated in more severe injuries. We present a case series including four patients with high-grade pancreatic injury. Two patients were treated surgically with open laparotomy and primary suture of the head of the pancreas and pancreatico-enterostomy, one patient underwent endoscopic stenting of the pancreatic duct and one received conservative management including observation and secondary endoscopic treatment. We want to emphasize the fact that using a minimally invasive approach can be a feasible option in high-grade pancreatic injury in selected cases. Therefore, we advocate the necessity of fully staffed and equipped high-level pediatric trauma centers.

Differences in serum lactate levels, AKI incidence, and intraoperative fluid therapy based on GDFT and standards in major laparotomy surgery patients

This study aimed to analyze the differences in serum lactate levels and the incidence of Acute Kidney Injury (AKI) in GDFT-based and standard liquid therapy in major laparotomy surgery with general anesthesia at Dr Soetomo Hospital. The type of research and research design used is a randomized clinical trials. The research design is an experimental study design. The observed study variables were then followed during surgery up to 48 hours after surgery for data retrieval and measurement. Patients covered by the study were patients who underwent elective major laparotomy at GBPT of Dr Soetomo Hospital. The results revealed that the administration of crystalloid solutions in the standard group was more than that of the GDFT group, while the administration of colloidal solutions in the standard group was less than that of the GDFT group. Intraoperative fluid balance in the standard group were larger compared to the GDFT group. The standard group had higher levels of postoperative serum lactate than the GDFT group (p < 0.001). The incidence of AKI in the standard group was 4 (18.2%) and no AKI incidence was found in the GDFT group.

Comparison of complications in very obese women undergoing hysterectomy – Abdominal vs laparoscopic approach with short- and long-term follow-up

BackgroundSurgical treatment of obese female patients represents a real challenge. Over the last decade, minimally invasive techniques for hysterectomy have emerged. These approaches reduce the invasiveness of standard surgical procedures while maintaining efficacy and feasibility. ObjectiveTo evaluate the rates of perioperative, early, mid-term and late postoperative complications in very obese [body mass index (BMI) ≥ 35 and < 40 kg/m2] and severely obese (BMI ≥ 40 kg/m2) women who underwent total (non-radical) hysterectomy.Design: A prospective comparative multi-centre non-randomized study. MethodsIn total, 328 consecutive total (non-radical) hysterectomies were performed at seven teaching gynaecological centres. Of these, 153 (46.6%) were performed using an open laparotomy (LT) approach and 175 (53.4%) were performed laparoscopically (LS). All data were collected by medical specialists at the pre-operative examination prior to surgery, during surgery and three times postoperatively (during hospital stay, at 6-week follow-up and 6 months following surgery). Another analysis considered a total of 206 women who underwent laparoscopic hysterectomy. The subjects were divided according to BMI into 120 very obese women (BMI ≥ 35 and < 40 kg/m2) and 86 severely obese women (BMI ≥ 40 kg/m2). ResultsThe total number of composite perioperative complications was significantly lower in the LS group (p = 0.006). Composite complications occurred significantly more often in patients in the LT group compared with the LS group in the early (p < 0.001) and mid-term (p < 0.001) postoperative periods. In the late postoperative period, the total number of composite postoperative complications did not differ significantly between the groups (p < 0.396). Among 206 patients who underwent laparoscopic hysterectomy, the number of complications was generally low; the rates of composite perioperative (p = 0.393), early (p = 0.642), mid-term (p = 0.738) and late (p = 1) postoperative complications were generally low; and frequency did not differ significantly with BMI. ConclusionThe LS approach does not increase intra-operative morbidity associated with surgery, and has significantly better outcomes in terms of the postoperative complication rate.

Infected urachal cyst in an adult, report of two observations.

IntroductionUrachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure gives embryologic malformation like an urachal cyst. Infection or malignancy degeneration can complicated it.Case presentationCase 1: We report 20 years old female patient consulted with acute abdominal pain. Clinical examination showed fever and infra-umbilical tender mass. The abdominal Computerized Tomography showed pelvic mass between umbilicus and bladder. The open laparotomy found infra-abdominal semi-solid mass. A complete resection was done and histological exam confirmed infected urachal cyst.Case 2: A 19 years old male patient presented with abdominal pain and fever. Physical examination found tenderness in lower abdomen. Biology revealed leukocytosis, and Ultrasonography found a heterogeneous infra-umbilical mass. Surgical exploration by mini-laparotomy found an abscess urachal cyst that is confirm by histological exam after complete resection.Clinical discussionUrachal cyst in adult patient is rare. Clinical symptoms without complications are insignificant. Because of malignancy risk, adult urachal cyst are managed by surgery.ConclusionInfection cyst is the most common complication of urachal cyst. Complete resection is recommended because of malignancy degeneration risk.

Systematic Review and Meta-Analysis of Complications after Laparoscopic Surgery and Open Surgery in the Treatment of Pelvic Abscess.

Background Pelvic abscess surgery consists mostly of open laparotomy and laparoscopic surgery. Open surgery is regarded as a classic procedure. With the rise and promotion of laparoscopic indications in recent years, comparative studies of the two's postoperative effectiveness have been limited. Objective To compare the clinical effects of laparoscopic exploratory surgery and open surgery in the treatment of pelvic abscess. Methods Through computer searches of PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases, we found publicly available case-control research on laparoscopic surgery and open surgery for treating pelvic abscess. The papers that met the evaluation criteria were screened, and meta-analysis was used to look at 8 papers on laparoscopic surgery and open surgery for treating pelvic abscess from 2010 to 2021. Results The results of this study showed that compared with the open laparotomy group, the incidence of laparoscopic group in the incision infection rate (RR = 0.29, 95% CI (0.20, 0.41), and P < 0.00001), the incidence of intestinal injury (RR = 0.08, 95% CI (0.04, 0.14), and P < 0.00001), incidence of intestinal obstruction (RR = 0.26, 95% CI (0.08, 0.90), and P = 0.03 < 0.05), and postoperative pelvic abscess recurrence rate (RR = 0.34, 95% CI (0.13, 0.86), and P = 0.02 < 0.05) are lower than open surgery, and the difference of these four items is statistically significant. There was no difference in the risk of urinary tract injury between laparoscopic surgery and open surgery (RR = 0.92, 95% CI (0.27, 3.17), and P = 0.89 > 0.05). Conclusion In terms of incision infection, intestinal damage, intestinal obstruction, and recurrence of pelvic abscess, the laparoscopic group clearly outperforms the open group, and it merits clinical promotion and use.

Reproducibility and Step-By-Step Learning Curve of Retroperitoneal Video-Assisted Mini-Laparotomy Surgery for Living Donor Nephrectomy: A Single-Center Experience.

Living donor transplant techniques must ensure donor safety and minimize complications. To achieve this goal, in 2003, we developed a new surgical procedure named video-assisted mini-laparotomy surgery for living donor nephrectomy. Video-assisted mini-laparotomy surgery standardizes the retroperitoneal mini-laparotomy technique as an alternative to open surgery. We have previously reported on video-assisted mini-laparotomy surgery techniques for use in kidney surgery. However, there are no reports of video-assisted mini-laparotomy surgery performed at other institutions. Therefore, we introduced video-assisted mini-laparotomy surgery at another institution, and here, we report on our experience. We evaluated a consecutive series of 38 donors who underwent video-assisted mini-laparotomy living donor nephrectomy at National Health Insurance Service Ilsan Hospital from August 2016 to November 2019. All 38 patients were enrolled. Perioperative data and outcomes were retrospectively analyzed. We recorded perioperative and postoperative data, including operative time, estimated blood loss, and duration of hospital stay. The mean operative time was 144.35 ± 22.79 minutes, and the mean warm ischemia time was 184.35 ± 4.97 seconds. Mean estimated blood loss was 72.85 ± 60.81 mL. At 12 months after video-assisted mini-laparotomy surgery, the mean posttransplant serum creatinine level was 1.05 ± 0.18 mg/dL, and estimated glomerular filtration rate (according to the Modification of Diet in Renal Disease study equation) was 71.9 ± 10.34 mL/min/1.73 m2. There was no intraoperative or postoperative complication. Previous studies reported that video- assisted mini-laparotomy surgery has a steep learning curve and is difficult to reproduce. However, video- assisted mini-laparotomy surgery is a feasible and safe technique at our institution. Video-assisted mini- laparotomy surgery is a solo surgery that can be safely performed by any surgeon with prior kidney surgery experience.

ROLE OF MINIMAL INVASIVE INTERVENTIONS IN GRADE 1,2, 3 LIVER AND SPLEEN INJURY

INTRODUCTION : Blunt trauma abdomen is very common in India. In our institute in K.D Medical College Mathura we manage liver and spleen injury with (NOM), MIS and Open laparotomy . The aim of this study was to compare NOM and MIS and RS in Grade1,2,3 liver and spleen injuries . We managed 27 cases of blunt trauma abdomen in K.D.Medical college. Mathura from Nov 2019 –MATERIAL AND METHOD: June 2022 with Grade 1,2,3 liver and spleen injury.It is retrospective Comparative Analytical study in Grade 1,2,3 liver and spleen injury between the 2 groups of treatment NOM and f NOM . It was hypothesize in our study that NOM is comparatively more benecial inRESULT: liver and spleen injury than in comparison to MIS,RS but hypothesis was rejected and p value was .018 signicant at p&lt; .05 . InCONCLUSION : our institute, various treatment options, Nonoperative conservative management, f NOM depends upon the patient hemodynamic status , haemoperitoneum, grade of liver and spleen injury.

Эндоваскулярная эмболизация яичковой вены при варикоцеле. Клинический случай

Varicocele is a pathology characterized by dilation of the venous veins of the seminal canal. Currently, the incidence of varicocele among adolescent men aged 12-20 years is 10-20%, and among men suffering from infertility, it is detected in 45%. In clinical practice, there are several methods of treating varicocele: open or microsurgical laparotomy, surgical embolization and laparoscopic varicocelectomy. However, the frequency of relapses of varicocele varies and depends on the method of its treatment. Embolization performed using venography helps to accurately determine the condition of the vessels of the testicles. Therefore, in our article we will describe the advantages and possibilities of modern minimally invasive treatment of varicocele embolization, possible complications and results.

Peutz–Jeghers Syndrome which Develops into Descending Sigmoid Colon Adenocarcinoma

Introduction: Peutz–Jeghers Syndrome (PJS) is an autosomal dominant hereditary condition mainly characterized by hamartomatous gastrointestinal (GI) polyps. Medical treatment is often sought due to complications that arise from the polyps. PJS polyps tend to be accompanied by freckling or hyperpigmentation on the lips, buccal mucosa, vulva, fingers, and toes. PJS is also associated with an increased risk for colorectal or extraintestinal tumors. Case Presentation: A 24-year-old female complained about a lump in her abdomen and constipation. The physical examination found hyperpigmentation on the lips and a hard and mobile mass on the left quadrant abdomen. We found a descending-sigmoid colon tumor with multiple polyps on all colon mucous and performed total colectomy and ileorectal anastomosis on the laparotomy operation. Two months later, Esophagogastroduodenoscopy revealed multiple polyps on Duodenum 1, II, and gaster. The colon tumor pathology result showed welldifferentiated adenocarcinoma. Conclusions: Peutz–Jeghers Syndrome (PJS) can develop into malignant intestinal tumors that require surgery for resection of the tumor.

The Multidisciplinary Approach of Rectal Cancer: The Experience of "COMRE Group" Model.

Background: Total mesorectal excision (TME) is the gold standard to treat locally advanced rectal cancer. This monocentric retrospective study evaluates the results of laparotomic, laparoscopic and robotic surgery in “COMRE GROUP” (REctalCOMmittee). Methods: 327 selected stage I-II-III patients (pts) underwent TME between November 2005 and April 2020 for low or middle rectal cancer; 91 pts underwent open, 200 laparoscopic and 36 robotic TME. Of these, we analyzed the anthropomorphic, intraoperative, anatomopathological parameters and outcome during the follow up. Results: The length of hospital stay was significantly different between robotic TME and the other two groups (8.47 ± 3.54 days robotic vs. 11.93 ± 5.71 laparotomic, p < 0.001; 8.47 ± 3.54 robotic vs. 11.10 ± 7.99 laparoscopic, p < 0.05). The mean number of harvested nodes was higher in the laparotomic group compared to the other two groups (19 ± 9 laparotomic vs. 15 ± 8 laparoscopic, p < 0.001; 19 ± 9 laparotomic vs. 15 ± 7 robotic, p < 0.05). Median follow-up was 52 months (range: 1–169). Overall survival was significantly shorter in the open TME group compared with the laparoscopic one (Chi2 = 13.36, p < 0.001). Conclusions: In the experience of the “COMRE” group, laparoscopic TME for rectal cancer is a better choice than laparotomy in a multidisciplinary context. Robotic TME has a significant difference in terms of hospital stay compared to the other two groups.

Minimal access endoscopic debridement of right hepatic necrosis

Introduction: Hepatic necrosis secondary to hepatic artery injuries can be devastating and will often require surgical debridement. Conventionally this is done as an open laparotomy with washout and debridement. We report the first case of significant hepatic necrosis for which a minimal access hepatic necrosectomy was performed via an endoscopic approach, hence reducing morbidity and mortality for the patient. Case Report: A 63-year-old female with type 5 choledochal cyst underwent a left hepatectomy and Roux-en-y biliary reconstruction. This was complicated by an arterial injury with pseudoaneurysm requiring radiological embolization and subsequent right hepatic thrombosis leading to hepatic necrosis. She had a prolong intensive care unit (ICU) admission with percutaneous drainage and intravenous antibiotics for two months. A minimal access necrosectomy was eventually required as an elective day surgery procedure. The patient improved significantly and has been well apart from recurrent cholangitis from a possible hepatic duct stenosis from the initial hepatectomy. Conclusion: Hepatectomies complicated postoperatively by infected hepatic necrosis can be successfully managed via minimal access hepatic necrosectomies. This has multiple benefits such as decreased hospital stay and quicker recovery time.

Short- and long-term outcomes of robotic-assisted laparoscopic surgery for rectal cancer: A single-center retrospective cohort study.

Whether rectal cancer surgery by robotic-assisted laparoscopic surgery provides beneficial advantages remains controversial. Although favorable outcomes in terms of the safety and technical feasibility of robotic-assisted laparoscopic surgery have been demonstrated for rectal cancer, long-term oncological outcomes for robotic-assisted laparoscopic surgery have only been examined in a few studies. This retrospective study of subjects who underwent robotic-assisted laparoscopic surgery evaluated short- and long-term outcomes of consecutive rectal cancer patients. Between November 2016 and January 2020, we analyzed the records of 62 consecutive patients who underwent robotic-assisted laparoscopic surgery for rectal adenocarcinoma without distant metastasis to evaluate short- and long-term outcomes. Tumors were located in the lower or mid-rectum (88.7%) in most patients. The median operative time was 357 min. No patient received transfusions, and the median blood loss was 10.5ml. Open laparotomy was not required in any patient. A Clavien-Dindo classification of all grades was observed in 12 patients (19.4%). Positive radial margin was not observed in any patient. Duration of median follow-up was 40.5mo, while 3-y overall survival and 3-y relapse-free survival rates were 96.8% and 85.0%, respectively. The local recurrence rate was 3.4%. Favorable short- and long-term outcomes demonstrated robotic-assisted laparoscopic surgery was safe and technically feasible for rectal cancer.

Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis.

Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was reviewed, as well as the authors’ own experiences, concerning the clinical importance of IAH and its treatment in SAP. The principal observations confirmed that IAH is a frequent consequence of SAP but is practically absent in mild disease. Common manifestations of AP such as pain, abdominal distension, and paralytic ileus contribute to increased abdominal pressure, as well as fluid loss in third space and aggressive fluid replacement therapy. A severe increase in IAP can evolve to abdominal compartment syndrome and new onset organ failure. Conservative measures are useful, but invasive interventions are necessary in several cases. Percutaneous drainage of major collections is preferred when possible, but open decompressive laparotomy is the final possibility in some cases in order to definitively reduce abdominal pressure. Intra-abdominal pressure should be measured in all SAP cases that worsen despite adequate treatment in critical care units. Conservative measures must be introduced to treat IAH, including negative fluid balance, digestive decompression by gastric–rectal tube, and prokinetics, including neostigmine. In the case of insufficient responses to these measures, minimally invasive interventions should be preferred.

Analysis of the Characteristics of Colonoscopy Perforation and Risk Factors for Failure of Endoscopic Treatment.

Background: Many studies have been done regarding perforation after colonoscopy, but few studies analyzed the risk factors of endoscopic treatment failure after colonoscopy perforation. This study aimed to analyze the clinical characteristics and treatment plan of those patients with perforation after colonoscopy diagnosis and the treatment and risk factors of failure to endoscopic treatment.Method: This was a retrospective observational study of patients who underwent colonoscopy examination and treatment at the Affiliated Hospital of Yangzhou University, from 04/2009 to 03/2020. The patients were grouped as perforation, treatment success, or failure (required laparoscopy or laparotomy).Results: From April 2009 to March 2020, 43,470 patients were examined and treated with colonoscopy. There were 35 cases of intestinal perforation, for an incidence of 0.081%. Four patients had immediate surgical intervention (two patients with laparoscopic surgery and two with laparotomy surgery). Thirty-one (88.57%) patients underwent endoscopic treatment. Endoscopic treatment was successful in 20 patients and failed in 11. Compared with the failure group, the perforation size in the success group was smaller (7.60±4.85 vs. 14.4±7.03 mm, P=0.004), hospital stay was shorter (26.6±13.1 vs. 14.2±3.0, P=0.011), and hospitalization costs were lower (30,208±9506 vs. 23,053±6227 RMB, P=0.002). Multivariable logistic stepwise analysis showed that the absence of abdominal pain after therapeutic colonoscopy was independently associated with the success of endoscopic treatment.Conclusions: Endoscopic treatment is logically the preferred modality for perforation management, leading to good recovery, shorter hospital stay, and lower costs of treatment. Postoperative abdominal pain is significantly related to the failure of endoscopic treatment.

Time to source control and outcome in community-acquired intra-abdominal infections: The multicentre observational PERICOM study.

Optimal management of community-acquired intra-abdominal infections (IAI) requires timely surgical source control and adequate anti-infective treatment. To describe the initial management of community-acquired IAI admitted to the emergency department and assess the association between the length of time to either diagnosis or therapeutic procedures and patient outcomes. A prospective, multicentre, observational study. Thirteen teaching hospitals in France between April 2018 and February 2019. Two hundred and five patients aged at least 18 years diagnosed with community-acquired IAI. The primary outcome was hospital length of stay. The secondary outcome was hospital mortality. Patients had a mean age of 56 (± 21) years and a median [interquartile] SAPS II of 26 [17 to 34]. Among the study cohort, 18% were postoperatively transferred to intensive care unit and 7% had died by day 28. Median [IQR] time to imaging, antibiotic therapy and surgery were 4 [2 to 6], 7.5 [4 to 12.5] and 9 [5.5 to 17] hours, respectively. The length of time to surgical source control [0.99, 95% confidence interval (CI), 0.98 to 0.99], SOFA greater than 2 [0.36 (95% CI, 0.26 to 0.651)], age greater than 60 years [0.65 (95% CI, 0.45 to 0.94)], generalized peritonitis [0.7 (95% CI, 0.56 to 0.89)] and laparotomy surgery [0.657 (95% CI, 0.42 to 0.78)] were associated with longer hospital length of stay. The duration of time to surgical source control [1.02 (95% CI, 1.01 to 1.04)], generalized peritonitis [2.41 (95% CI, 1.27 to 4.61)], and SOFA score greater than 2 [6.14 (95% CI, 1.40 to 26.88)] were identified as independent risk factors for 28-day mortality. This multicentre observational study revealed that the time to surgical source control, patient severity and generalized peritonitis were identified as independent risk factors for increased hospital LOS and mortality in community-acquired IAI. Organisational strategies to reduce the time to surgical management of intra-abdominal infections should be further evaluated. ClinicalTrials.gov on 1 April 2018, NCT03544203.

Comparison of short-term outcomes of robotic-assisted and conventional laparoscopic surgery for rectal cancer: A propensity score-matched analysis.

The advantages of robotic-assisted laparoscopic surgery (RALS) for rectal cancer remain controversial. This study clarified and compared the short-term outcomes of RALS for rectal cancer with those of conventional laparoscopic surgery (CLS). The records of 303 consecutive patients who underwent RALS or CLS for rectal adenocarcinoma between November 2016 and November 2021 were analyzed using propensity score-matched analysis. After matching, 188 patients were enrolled in our study to compare short-term outcomes, such as operative results, postoperative complications, and pathological findings, in each group. After matching, baseline characteristics were comparable between groups. Although operative time in the RALS group was significantly longer than in the CLS group (p < 0.0001), the conversion rate to open laparotomy and the postoperative complication rate in the RALS group were significantly lower than in the CLS group (p=0.0240 and p=0.0109, respectively). Blood loss was comparable between groups. In the RALS group, postoperative hospital stay and days to soft diet were significantly shorter than those in the CLS group (p=0.0464 and p < 0.0001, respectively). No postoperative mortality was observed in either group and significant differences were observed in resection margins and number of lymph nodes harvested. Robotic-assisted laparoscopic surgery for rectal cancer was safe, technically feasible, and had acceptable short-term outcomes. Further studies are required to validate long-term oncological outcomes.