Background
In elderly patients with external full-thickness rectal prolapse (EFTRP), the exact differences in postoperative recurrence and functional outcomes between laparoscopic ventral mesh ...rectopexy (LVMR) and perineal stapler resection (PSR) have not yet been investigated.
Methods
We conducted a retrospective multicenter study on 330 elderly patients divided into LVMR group (
n
= 250) and PSR (
n
= 80) from April 2012 to April 2019. Patients were evaluated before and after surgery by Wexner incontinence scale, Altomare constipation scale, and patient satisfaction questionnaire. The primary outcomes were incidence and risk factors for EFTRP recurrence. Secondary outcomes were postoperative incontinence, constipation, and patient satisfaction.
Results
LVMR was associated with fewer postoperative complications (
p
< 0.001), lower prolapse recurrence (
p
< 0.001), lower Wexner incontinence score (
p
= 0.03), and lower Altomare’s score (
p
= 0.047). Furthermore, LVMR demonstrated a significantly higher surgery–recurrence interval (
p
< 0.001), incontinence improvement (
p
= 0.019), and patient satisfaction (
p
< 0.001) than PSR. Three and 13 patients developed new symptoms in LVMR and PSR, respectively. The predictors for prolapse recurrence were LVMR (associated with 93% risk reduction of recurrence, OR 0.067, 95% CI 0.03–0.347,
p
= 0.001), symptom duration (prolonged duration was associated with an increased risk of recurrence, OR 1.131, 95% CI 1.036–1.236,
p
= 0.006), and length of prolapse (increased length was associated with a high recurrence risk (OR = 1.407, 95% CI = 1.197–1.655,
p
< 0.001).
Conclusions
LVMR is safe for EFTRP treatment in elderly patients with low recurrence, and improved postoperative functional outcomes.
Trial registration
Clinical Trial.gov (NCT05915936), retrospectively registered on June 14, 2023.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Back ground Closure of the cystic duct (CD) is a must during laparoscopic cholecystectomy (LC). Metal clips were the standard technique used before. Now there are different methods used to occlude ...the CD (endoloop, suturing with absorbable materials, and endo-GIA stapling devices).
Aim To assess different methods used in closure of dilated CD during laparoscopic cholecystectomy.
Patients and methods This was a retrospective study done on 169 patients with difficult cholecystectomies of 3645 patients who had laparoscopic cholecystectomy in the General Surgery Department, Zagazig University Hospitals, in the period from January 2011 till March 2020.
Results A total of 169 patients were included, comprising 98 females and 71 males, with an average age of 45±17.2 years. All patients had dilated CD during laparoscopic cholecystectomy that was occluded by different methods: large metal clips in 39 patients, ligature in 43 patients, endoloop in 33 patients, suturing to close the CD orifice in 30 patients, and endo-GIA devices in 24 patients.
Conclusion We should keep in mind different methods when facing dilated CD during laparoscopic cholecystectomy according to its diameter and the availability of equipment.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background:
Laparoscopic Nissen fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications ...affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (>5 cm) with severe GERD (DeMeester score >100).
Materials and methods:
This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery.
Results:
Three hundred sixty patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9 vs. 8.3%) and recurrent regurgitation (2.2 vs. 5%) showed a lower incidence in the LNF+ group (
P
=0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0 vs. 3.3% and 0 vs. 2.8% cases in the LNF+ and LNF groups, respectively (
P
=0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75 vs. 5.6% and 0 vs. 3.9% of patients (
P
=0.001). Score III postoperative persistent dysphagia was 0 vs. 2.8% in the two groups (
P
=0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3 vs. 86.7% in both cohorts, respectively (
P
=0.05).
Conclusions:
Intraoperative high-resolution manometry and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint.
Laparoscopic Nissen Fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting ...patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (> 5 cm) with severe GERD (DeMeester score >100).
This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery.
360 patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9% vs. 8.3%) and recurrent regurgitation (2.2% vs. 5%) showed a lower incidence in the LNF+ group (P=0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0% vs. 3.3% and 0% vs. 2.8% cases in the LNF+ and LNF groups, respectively (P=0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75% vs. 5.6% and 0% vs. 3.9% of patients (P=0.001). Score III postoperative persistent dysphagia was 0% vs. 2.8% in the two groups (P=0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3% vs. 86.7% in both cohorts, respectively (P=0.05).
Intraoperative high-resolution manometry (HRM) and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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