Background
The aim of this study was to reveal the short-term and long-term outcomes of single-incision laparoscopic colorectal resection (SILC) compared with multi-incision laparoscopic colorectal ...resection (MILC) for colorectal cancer using propensity score matching analysis.
Methods
The study group included 235 patients who underwent SILC and 730 patients who underwent MILC for colorectal cancer between April 2009 and September 2014. The propensity score matching for age, gender, body mass index, tumor location (right-sided colon/sigmoid colon/upper rectum), lymph node dissection (D1/D2/D3), pathologic T (≤T3) stage and TNM (0–I/II/III) stage produced 107 matched pairs. The exclusion criteria for SILC were as follows: (1) tumors located at the transverse, descending colon or lower rectum, (2) stage IV tumors, synchronous or previous malignancies, (3) locally advanced tumors >T4, (4) acute obstructions or previous major abdominal surgery and (5) obese patients: BMI > 30.
Results
No significant differences were observed in operating time, bleeding volumes, starting time of liquid diet and length of hospital stay between the SILC and MILC groups. However, the SILC group showed less analgesic requirements (1.1 vs. 1.9 times;
p
= 0.0006) and shorter length of incision (2.7 vs. 4.3 cm;
p
= 0.0000) compared to MILC group. The overall rate of postoperative complications was similar in both groups (2.8 vs. 3.7 %,
p
= 0.70). The 5-year overall survival rate of SILC and MILC was 100 and 95 % (
p
= 0.125) and 5-year disease-free survival rates in stages 0–III were 97 and 94 % (
p
= 0.189), 100 and 92 % in stage II and 90 and 85 % in stage III, respectively.
Conclusions
This study suggests that SILC for colorectal cancer is a safe and feasible option with better cosmetic results and less pain in strictly selected patients. SILC can also produce good oncological results with similar postoperative outcomes to MILC.
Purpose
The question as to whether laparoscopic surgery should be applied for inguinal hernia after radical prostatectomy remains a debate due to surgical difficulty arising from adhesions in the ...prevesical space. We report the surgical technique used in our department, its outcomes, and its safety and effectiveness compared with the surgical outcomes of primary transabdominal preperitoneal inguinal hernia repair (TAPP) cases.
Methods and materials
From February 2013 to January 2017, 30 patients with inguinal hernia were treated with TAPP after radical prostatectomy. At our institution, to avoid bladder injury, we dissect the prevesical space with the layer between the transversalis fascia and superficial layers of the preperitoneal fascia as the dissection plane. The practitioners were three qualified surgeons. Surgical outcome were compared with those of primary TAPP cases. For statistical analyses, we used
t
test to compare the mean operative durations and Chi square test to compare all other surgical outcomes.
Results
The median observation period was 19 months. Intraoperative and postoperative complications did not occur; no onset of recurrence and chronic pain was observed. The mean operative duration was 116.2 min, which was significantly longer than that of primary TAPP patients (87.9 min). However, the operative duration for the last 14 patients had reduced to 101.6 min, which was not significantly different from that of primary TAPP patients.
Conclusion
In TAPP for patients following prostatectomy, surgery can be performed safely and reliably without prolonging the operative duration by selecting a skilled practitioner and standardizing the technique.
Purpose
Post-operative paralytic ileus (POI) occurs after surgery because of gastrointestinal dysfunction caused by surgical invasion. We therefore investigated the frequency of POI after ...laparoscopic colorectal surgery in patients with colorectal cancer using a strictly defined POI diagnosis and identified associated risk factors.
Methods
Patients who underwent initial laparoscopic surgery for colorectal cancer between January 2014 and December 2018 were included. The primary end point was the incidence of POI. A multivariate logistic regression analysis revealed the contributing risk factors for POI.
Results
Of the 436 patients, 94 (21.6%) had POI. Compared with the non-POI group, the POI group had significantly higher frequencies of infectious complications (
p
< 0.001), pneumonia (
p
< 0.001), intra-abdominal abscess (
p
= 0.012), anastomotic leakage (
p
= 0.016), and post-operative bleeding (
p
= 0.001). In the multivariate analysis, the right colon (odds ratio OR 2.180,
p
= 0.005), pre-operative chemotherapy (OR 2.530,
p
= 0.047), pre-operative antithrombotic drug (OR 2.210,
p
= 0.032), and post-operative complications of CD grade ≥ 3 (OR 12.90,
p
< 0.001) were independent risk factors for POI.
Conclusion
Post-operative management considering the risk of post-operative bowel palsy may be necessary for patients with right colon, pre-operative chemotherapy, pre-operative antithrombotic drug or severe post-operative complications.
Although inguinal hernia occurs frequently after radical prostatectomy, transabdominal preperitoneal (TAPP) inguinal hernia repair occasionally poses challenges due to fibrosis of the preperitoneal ...cavity. In patients with severe intrapelvic fibrosis, we have adopted a modified intraperitoneal onlay mesh (IPOM) technique. The surgical factors were compared between patients who underwent modified IPOM and those who underwent TAPP for inguinal hernia repair.
In total, 57 patients underwent laparoscopic surgery for inguinal hernias after radical prostatectomy between February 2013 and January 2020. TAPP was successfully completed in 44 patients, whereas 13 patients underwent modified IPOM converted from TAPP. The surgical results were retrospectively compared.
The median follow-up duration was 36.0 months (range, 1-84 months). Intraoperative complications, recurrence of hernia, and chronic pain were not observed in both groups. The average duration of surgery in the modified IPOM group was longer than that in the TAPP group (137 versus 107 minutes,
< .05). There was no significant difference in the incidence of the inguinal-related complications such as inguinal pain or inguinal swelling.
Postoperative complications including recurrence of hernia after modified IPOM are comparable to those after TAPP hernia repair. Modified IPOM repair is a surgical option for repairing inguinal hernias following radical prostatectomy.
A 62-year-old woman had received pylorus-preserving gastrectomy for early gastric cancer. She was admitted to our hospital because of abdominal pain and nausea. Computed tomogram showed small bowel ...obstruction due to a low-density mass containing air bubbles, characteristic of gastrolithiasis. Although an ileus tube was inserted and dissolution of the gastrolithiasis by Coca-Cola® was carried out, the obstruction did not improve. She underwent single-port laparoscopic surgery. The gastrolithiasis of about 40 mm diameter was blocking the small intestine at about 30 cm from the ileocolic valve, and the distended part was extracted from the abdominal cavity. An incision of the small bowel was made, and the stone was removed. Finally, the incisional site was closed. Although she had prolonged high fever postoperatively, she improved with administration of antibiotics. She was discharged 29 days after the operation. On analysis of the components of the stone, 98% of it was tannic acid, and a diagnosis of gastrolithiasis was confirmed. After pyloric-preserving gastrectomy, the frequency of gastrolithiasis is higher than that after distal gastrectomy. If gastrolithiasis remains in the stomach, endoscopic extraction, dissolution therapy by Coca·Cola® or surgical treatment should be tried. In rare cases, gastrolithiasis could cause intestinal obstruction. Since dissolution therapy for a stone in the small intestine is rarely effective, surgical treatment should be considered at an early stage.
The appropriate surgical treatment for inguinal hernia in patients with liver cirrhosis and ascites remains controversial. A 79-year-old male undergoing treatment for Child-Pugh B hepatitis C-induced ...liver cirrhosis and hepatocellular carcinoma complicated with bilateral inguinal hernia underwent transabdominal preperitoneal (TAPP) repair. During surgery, barbed sutures were used to facilitate appropriate peritoneal closure. His postoperative course was uneventful. Information on TAPP repair for inguinal hernia in patients with liver cirrhosis and ascites is limited. The International Guidelines for Inguinal Hernia Management recommend Lichtenstein repair for patients with ascites. TAPP repair requires peritonectomy via a posterior endoscopic approach; therefore, proper peritoneal closure is important to prevent the leakage of ascitic fluid. Herein, TAPP repair was safely and successfully completed using barbed sutures to achieve proper and strong peritoneal closure. TAPP repair using barbed sutures can be an effective treatment option for patients with liver cirrhosis and ascites.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
【Background and Purposes】Although patients who are expected to survive more than 2 months are considered to be candidates for palliative surgery, it is difficult to predict the prognosis of the ...end-stage patients. We examined the significance of the palliative prognostic index (PPI), prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and controlling nutritional status (CONUT) as 60-day prognostic indicators for patients undergoing palliative surgery.【Patients and Methods】In a total of 94 patients who underwent palliative surgery, we compared the accuracy of the prognostic prediction of the postoperative 60-day survival rate in each prognostic index. A cut-off value was set for each index, and the patients were classified into two groups according to the index and statistically examined.【Results】PPI, PNI, and CONUT were significantly correlated with the 60-day survival after palliative surgery. The 60-day survival rate was significantly better in patients with PPI ≦4 than in those with PPI >4. It was also significantly better in patients with the PNI >31.5 group than in those with PNI ≦31.5. Similarly, patients with the CONUT ≦7 group were significantly better than those with CONUT above 7. PPI is the best indicator for prognostic accuracy.【Conclusions】PPI, PNI and CONUT can be good indicators to predict the 60-day survival in patients undergoing palliative surgery.
We studied 386 patients (453 lesions) with inguinal hernia that was treated via the transabdominal preperitoneal (TAPP) approach using ParietexTM anatomical mesh M (13 × 9cm). The surgical outcomes ...were as follows : 1) The mean surgery time was 98.7 minutes for one side and 136.3 minutes for both sides, the mean bleeding volume was 3.7 mL, and the mean frequency of analgesic use was 1.4. 2) At the time of the first medical examination as outpatients, among 352 patients, 29 patients (8.2%) had pain in the diseased area, 4 patients (6.8%) had discomfort, 29 patients (8.2%) had seroma, and 5 patients (1.4%) had wound infection. 3) A questionnaire survey of 291 patients who were evaluated at more than 3 months after surgery revealed that 8 patients (2.7%) had chronic pain, 34 patients (11.6%) had discomfort, and 1 patient (0.3%) had swelling. None of the patients showed relapse. 4) Patient satisfaction considering the outcome was very good (a score of 5) in 219 patients (75.2%) and quite good (a score of 4) in 69 patients (31.5%). Until now, as there was no serious complication or recurrence and a low incidence of adverse events after surgery, it is suggested that the TAPP approach is useful and makes it possible to reinforce the diseased site in Japanese patients by using a 13 × 9cm mesh.
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