BACKGROUND:Mirizzi syndrome (MS) with cholecystobiliary fistula (type II McSherry classification) is a rare complication of cholelithiasis. Accurate diagnosis is important in the management of MS type II. ERCP provides biliary decompression, and in some cases, endoscopic lithoextraction can be achieved. Surgery is the primary method in the management of MS type II. The aim of this study was to report and assess our experience of MS type II management in terms of different treatment modalities, such as endoscopic lithoextraction, open surgery, and laparoscopy. METHODS:A retrospective review of a prospectively maintained database of 30 patients with MS type II between January 2009 and May 2025 was performed. Demographic, clinical, laboratory, visualization, operative, and postoperative data were recorded. RESULTS:ERCP was done in all 30 cases. Complete endoscopic stone removal was achieved in 9 (30%). Endoscopic decompression was not successful in 1 (3.3%) case. Adverse events after ERCP occurred in 4 (13.3%) cases. Nineteen patients were operated on, 8 (42%) by laparoscopy. Partial cholecystectomy with choledochoplasty by remaining gallbladder tissue in 8 cases; cholecystofistulolithotomy in 8; partial cholecystectomy with choledocholithotomy in 2; partial cholecystectomy with fistulolithotomy in 1. Minor adverse events were reported in 3 (15.6%) cases: wound infection in 2 after open procedures and pneumonia in 1 after laparoscopy. CONCLUSION:Precise visualization data are the key to MS type II management. ERCP allows restoration of the bile outflow, and in a subset of patients, complete endoscopic stone extraction can be achieved. Surgical management of MS type II consists of stone removal through the gallbladder and/or fistula incision. With sufficient experience, laparoscopy can be applied. Cholecystofistulolithotomy without gallbladder removal may be a procedure of choice in MS type II management.
Objective: Bile duct injury (BDI) following cholecystectomy represents a significant surgical complication, often associated with hepatobiliary dysfunction, increased morbidity, and the need for complex reconstruction. Advances in tissue engineering and biomaterials have introduced novel strategies aimed at bile duct regeneration. This systematic review evaluates current evidence on biomaterial-based approaches for the treatment of BDI in experimental animal models. Methods: A systematic search was conducted between October 2025 and January 2026 in PubMed, Web of Science, and Ovid, following the PRISMA 2020 checklist. The selected studies explored a range of regenerative strategies applied to experimental animal models, including polymeric scaffolds, decellularized grafts, bioabsorbable stents, hydrogels, and bioactive systems incorporating growth factors or stem cells. Results: A total of 1141 records were identified from Web of Science (578), PubMed (459), and Ovid (104). After removal of 413 duplicates, 667 records were excluded during title and abstract screening. Fifty-eight articles underwent full text assessment, and 20 studies met the inclusion criteria for data extraction. These studies explored diverse biomaterial-based strategies aimed at promoting biliary regeneration and functional repair in experimental models. These approaches include decellularized and autologous grafts, polymeric scaffolds, bioactive systems, stents, and other natural materials, each with a unique set of advantages. Conclusion: Current evidence highlights the growing potential of biomaterial-based and bioactive platforms for bile duct regeneration in experimental models, underscoring the importance of continued research to optimize these strategies and facilitate their future translation to clinical approaches.
BACKGROUND:Small bowel obstruction following laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is rare and most often results from internal herniation through a peritoneal defect. Data describing its presentation and management are limited. This study aimed to characterize this complication. METHODS:A single-center retrospective study was conducted, including all patients who underwent elective laparoscopic TAPP inguinal hernia repair between January 2021 and January 2026. Patients who developed postoperative small bowel obstruction due to internal herniation through a peritoneal defect were identified. Clinical presentation, imaging, operative findings, and outcomes were analyzed using descriptive statistics. RESULTS:A total of 1927 unilateral and 531 bilateral repairs were performed. Five patients (0.2%) developed small bowel obstruction due to peritoneal defect herniation. All cases occurred after bilateral repair. Median age was 60 years (range: 37 to 77), and all patients were discharged on postoperative day 1 after an initially uneventful course. Most patients presented within the first few postoperative days with abdominal pain, nausea, and vomiting; one patient presented on day 23. Diagnosis was established by computed tomography in 4 cases and by clinical and abdominal x-ray findings in 1 patient. All patients underwent urgent laparoscopic exploration within 6 hours. The herniated bowel was reduced without resection, and the defect was closed laparoscopically. Median operative time was 49 minutes (range: 31 to 57). Recovery was uneventful, with a median hospital stay of 3 days (range: 2 to 4). At a median follow-up of 38 months (range: 2 to 62), no recurrence or readmissions were observed. CONCLUSIONS:Small bowel obstruction due to internal herniation through a peritoneal defect is a rare but likely underreported and preventable complication after TAPP repair. It typically presents early after an initially uneventful course. Meticulous peritoneal closure may reduce risk. Early laparoscopic re-exploration is both diagnostic and therapeutic and is associated with excellent outcomes.
BACKGROUND:Walled-off necrosis (WON) is a complex sequela of acute pancreatitis that often necessitates interventional management. Endoscopic transmural drainage has emerged as the preferred first-line approach, especially with the increasing availability of endoscopic ultrasonography (EUS) guidance. This study aimed to evaluate endoscopic management of WON and identify factors associated with technical and clinical success. METHODS:Patients who underwent endoscopic transmural drainage for symptomatic WON were analyzed retrospectively. Two different techniques-conventional and EUS-guided-were used as endoscopic drainage modalities. Baseline characteristics, procedural details, and outcomes were collected, and the impact of drainage modality and anatomic factors-including paracolic extension, disconnected pancreatic duct syndrome (DPDS), and colonic fistula-on clinical outcomes and adverse events was analyzed. RESULTS:A total of 73 patients (mean age: 54.6±13.9 y; 46.6% male) underwent a total of 76 transmural drainage procedures. The median size of WON collections was 14 cm (IQR: 11-17 cm), and the most common indication was infection (62.5%). Colonic fistula and DPDS were identified in 5 (6.8%) and 38 (52.1%) patients, respectively. Technical success was assessed per procedure. Overall technical success was 97.4% (74/76), with 100% (36/36) success in the conventional group and 95.0% (38/40) in the EUS group. Clinical success was achieved in 84.9% (62/73) of patients, with similar outcomes between conventional (83.3%) and EUS-guided (86.5%) drainage (P=0.961). Reintervention was required in 67.1%, and direct endoscopic necrosectomy was performed in 31.5%. Complications occurred in 28.7% of patients, most commonly bleeding (15.1%), generally managed endoscopically. CONCLUSIONS:Endoscopic transmural drainage is an effective and safe intervention for the management of WON, with high technical and clinical success. EUS-guided drainage offers significant advantages by allowing intervention in patients without luminal bulging and in those with smaller collections, thereby expanding treatment eligibility to a broader patient population.
BACKGROUND:Despite advances in addressing sex disparities, inequities persist in the surgical field. Although some medical specialties have achieved a more balanced sex representation, female surgeons continue to face challenges. This study aimed to determine if a surgeon's sex influences surgical performance by comparing surgical outcomes between male and female surgeons performing laparoscopic appendectomy. METHODS:We conducted a retrospective analysis of adult patients (>16 y) undergoing laparoscopic appendectomy for acute appendicitis at our institution from 2014 to 2022. Patients were categorized based on the surgeon's sex: female (FS) or male (MS). We examined demographics, intraoperative variables, and postoperative outcomes. A multivariable logistic regression analysis assessed the independent effect of the surgeon's sex on conversion to open surgery. RESULTS:A total of 1426 patients were analyzed; 1034 (72.51%) operated by MS and 392 (27.48%) by FS. Female surgeons had longer operative times (61.1 vs. 51.6 min, P<0.0001) and a higher conversion rate to open surgery (2.80% vs. 1.06%, P=0.01). Overall morbidity (12.0% vs. 13.8%, P=0.36) and major morbidity (5.1% vs. 4.8%, P=0.83) were similar between FS and MS. Length of hospital stay and readmission rates were also comparable. Multivariable analysis identified female surgeon as an independent risk factor for conversion (OR: 3.62, 95% CI: 1.39-9.36). CONCLUSIONS:Although FS and ML showed similar postoperative outcomes, differences in operative times and conversion rates suggest a need for further investigation into factors affecting surgical performance. Efforts to address gender disparities in surgical training and leadership are essential for ensuring equal opportunities for all surgeons.
BACKGROUND:Published regional data on right-sided colon cancer surgery from Azerbaijan are limited. This study reports perioperative, pathologic, and exploratory survival outcomes after standard and extended right colectomy in a consecutive institutional series. METHODS:A retrospective cohort study was performed using a prospectively maintained operative database of 89 patients who underwent superior mesenteric vein (SMV)-first right colectomy or extended right colectomy between August 2017 and April 2026. Both benign and malignant cases were included for perioperative safety analysis; oncological analyses were restricted to malignant disease. RESULTS:Median age was 66.0 (57.0-71.0) years, and 47 (52.8%) patients were male. Malignant disease was present in 83 (93.3%). Standard right colectomy was performed in 69 (77.5%) and extended right colectomy in 20 (22.5%). Median operative time was 260.0 (210.0-315.0) minutes. Any recorded Clavien-Dindo complication occurred in 8 (9.0%), major morbidity in 4 (4.5%), reoperation in 4 (4.5%), and anastomotic leak in 3 (3.4%). Median lymph-node harvest was 33.0 (28.0-39.8); 81 (98.8%) evaluable patients had at least 12 nodes examined. Among malignant cases, stages I, II, III, and IV were reconstructed in 5, 30, 35, and 13 patients, respectively. In 83 malignant cases with analyzable survival time, estimated overall survival at 1, 3, and 5 years was 88.4%, 80.5%, and 72.7%, respectively, while exploratory disease-free survival was 87.5%, 80.9%, and 65.6%. CONCLUSIONS:In this institutional series, an SMV-first approach to right colectomy and extended right colectomy was associated with acceptable perioperative morbidity, a low anastomotic leak rate, and high lymph-node retrieval. The large proportion of stage III-IV disease underscores the need for earlier diagnosis and structured follow-up.
BACKGROUND:The role of laparoscopic Heller myotomy (LHM) in elderly patients remains controversial due to concerns regarding safety and morbidity. This study aimed to evaluate the perioperative safety and effectiveness of LHM in elderly patients. METHODS:A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed and Cochrane databases were searched for studies reporting outcomes of LHM in patients aged 65 years or older. The primary endpoint was perioperative safety, including intraoperative complications, overall morbidity, and mortality. Secondary endpoints were dysphagia improvement and reintervention. A meta-analysis of proportions was performed to calculate weighted pooled estimates with 95% CIs. RESULTS:A total of 6 studies, including 275 patients, were analyzed. The mean age of patients was 76 (65 to 97) years. The mean follow-up across studies was 32 months. Intraoperative complications occurred in 6% (95% CI: 1%-24%), all mucosal perforations, and conversion to open surgery was required in 4% (95% CI: 1%-11%). The overall morbidity rate was 8% (95% CI: 3%-20%), and no perioperative mortality was reported. Dysphagia improvement was achieved in 96% of patients (95% CI: 26%-100%), with the need for postoperative reintervention in only 14% (95% CI: 5%-33%) of patients at a mean interval of 17.6 months (79.4% endoscopic procedures and 20.6% surgical interventions). CONCLUSIONS:Laparoscopic Heller myotomy is safe and highly effective in elderly patients with achalasia. Surgical treatment should be considered as a first-line therapy in those without prohibitive surgical risks.
BACKGROUND:Failure to achieve the critical view of safety (CVS) during laparoscopic cholecystectomy is an uncommon but clinically significant intraoperative scenario that necessitates alternative strategies to prevent bile duct injury. Although preoperative models are widely used to predict difficult cholecystectomy, their ability to identify cases in which safe dissection becomes unachievable remains unclear. METHODS:This retrospective cohort study included 1001 consecutive patients undergoing laparoscopic cholecystectomy. CVS failure was defined as the inability to safely complete standard dissection, requiring transition to a bailout strategy. Clinical, laboratory, imaging, and intraoperative variables, including the Nassar difficulty score, were analyzed. Independent predictors were assessed using Firth penalized logistic regression. RESULTS:CVS failure occurred in 19 patients (1.9%), reflecting the rarity but clinical significance of this intraoperative endpoint. Patients with CVS failure had significantly higher Nassar scores and more frequently underwent emergency surgery. In multivariable analysis, intraoperative difficulty, as measured by the Nassar score, was the strongest independent predictor of CVS failure (OR=18.44, 95% CI: 7.79-62.67; P<0.001), whereas preoperative variables were not independently associated with CVS failure. CONCLUSION:Failure to achieve CVS is primarily driven by intraoperative difficulty rather than preoperative factors. These findings highlight CVS failure as a distinct intraoperative threshold and support the importance of structured intraoperative assessment to guide the timely adoption of bailout strategies and enhance surgical safety.
BACKGROUND:Endoscopic submucosal dissection (ESD) is the standard organ-preserving treatment for selected patients with early gastric cancer (EGC). However, certain tumor locations, lesion size, technical complexity, or limited availability of advanced endoscopic expertise may render ESD unsuitable or unavailable. In these scenarios, formal gastric resection often becomes the conventional alternative despite its functional consequences. To describe the laparoscopic intragastric submucosal dissection (LISD) technique and report our initial South American experience using LISD as an organ-preserving surgical option in selected patients with EGC. METHODS:A retrospective consecutive case series was conducted at 2 Chilean institutions between 2022 and 2024. Consecutive patients with EGC underwent LISD when ESD was considered technically unsuitable or unavailable. The procedure consisted of intragastric laparoscopic submucosal resection using transgastric trocar access. Outcomes included operative details, perioperative morbidity, pathologic findings, hospital stay, and oncologic follow-up. RESULTS:Three male patients aged 65, 76, and 81 years underwent LISD. Indications included limited access to ESD resources in one case and technical limitations for curative ESD related to lesion size or location in 2 cases. En bloc resection was achieved in all patients without conversion to gastrectomy during the index procedure. Final pathology demonstrated well-to-moderately differentiated gastric adenocarcinoma in all cases, including one mucosal and 2 submucosal lesions. One patient underwent additional subtotal gastrectomy due to a positive lateral margin, with no residual tumor identified in the surgical specimen. No major postoperative morbidity or mortality occurred, and all patients were discharged on postoperative day 5. Maximum follow-up approached 3 years, with no tumor recurrence or procedure-related late complications identified to date. CONCLUSIONS:LISD appears to be a feasible organ-preserving alternative for selected patients with EGC when ESD is unsuitable or unavailable. LISD may represent a promising organ-preserving surgical option for selected patients when ESD is unsuitable or unavailable.
Obesity is a well-known risk factor for surgical complications. Laparoscopic adrenalectomy is now preferred over open surgery for adrenal masses of <6 cm without high malignancy suspicion. This study evaluates the impact of obesity on surgical complication rates in laparoscopic adrenalectomy. Patients who underwent laparoscopic transabdominal adrenalectomy between 2013 and 2024 were retrospectively analyzed. They were divided into two groups: obese (BMI ≥30 kg/m 2 ) and nonobese (BMI <30 kg/m 2 ). Demographic data, perioperative, and postoperative outcomes were compared. A total of 110 patients (75 females, 35 males) were included, with 40 in the obese group and 70 in the nonobese group. The mean age was 46.6±12.4 years, and the mean BMI was 28.7±5.5 kg/m 2 . Surgery was performed on the right side in 58 patients (52.7%), left side in 51 (46.4%), and bilaterally in 1 (0.9%). The most common indications were Cushing syndrome (38 patients), pheochromocytoma (31), Conn syndrome (11), and incidentaloma (28). There were no significant differences between groups in terms of operative time, blood loss, tumor size, pathology, and hospital stay. Postoperative complications occurred in 6/40 obese (15.0%) and 3/70 nonobese (4.3%) patients, without a statistically significant difference ( P =0.07). Complications in the obese group included wound infection (4 cases), toxic hepatitis (1), atrial fibrillation (1), and respiratory infection (1). Obesity was associated with a trend toward higher postoperative complication rates, while operative time and length of stay were not significantly different. These findings emphasize the importance of surgical expertise and careful perioperative planning in obese patients.
BACKGROUND:Ultrasound-guided thermal ablation has become an established alternative to surgery for benign thyroid nodules. Hydrodissection is routinely used to protect adjacent critical structures; however, assessment of its adequacy remains subjective, with no standardized imaging marker to confirm procedural readiness before energy delivery. This prompted us to describe and evaluate a novel ultrasound imaging marker, the ring of protection (RoP) sign, designed to confirm complete circumferential hydrodissection and enhance procedural safety during microwave ablation (MWA) of benign thyroid nodules. METHODS:The ring of protection sign is defined as a continuous circumferential anechoic fluid rim completely surrounding the target thyroid nodule, visible in 2 orthogonal ultrasound planes, persisting during gentle probe compression, and eliminating direct contact between the nodule and adjacent critical structures. We detail the technical methodology, sonographic criteria, and clinical application of the ring of protection sign during ultrasound-guided MWA. Outcomes of patients treated using ring of protection-guided hydrodissection (RoP group) were compared with those undergoing standard hydrodissection (HD group). RESULTS:Sixty-three patients were included (HD: n=28; RoP: n=35), with comparable baseline demographic and nodule characteristics. Mean procedure time was significantly shorter in the RoP group (20±10 vs. 26±13 min; P=0.049). No major complications occurred in either group. Minor complications, volume reduction ratios (at 6 and 12 mo), postprocedural pain, and cosmetic outcomes were similar between groups. CONCLUSION:The ring of protection sign is a simple, reproducible, and clinically meaningful ultrasound marker that provides objective confirmation of adequate hydrodissection before thyroid thermal ablation. Its adoption may help standardize procedural readiness assessment, improve training consistency, and further enhance the safety profile of thyroid ablation techniques.
Background: Paraesophageal hernias are a prevalent medical condition often treated with surgical intervention, and decisions regarding hernia sac management are involved. Sac excision during PEH repair has emerged as a viable and safe management strategy, with potential implications for patient outcomes. This study aimed to assess the impact of sac excision on hernia recurrence, reoperation rates, and postoperative gastroesophageal reflux disease (GERD) in patients undergoing hernia repair. Methods: A retrospective analysis was conducted on patients who underwent paraesophageal hernia repair between 2014 and 2022. Data on patient demographics, preoperative evaluation, surgical technique, and long-term follow-up were collected and analyzed. Primary outcomes included hernia recurrence, reoperation rates, and postoperative GERD assessed over a mean follow-up of 1.8 years. Results: Analysis of a 1154-patient cohort revealed that sac excision during paraesophageal hernia repair did not significantly affect hernia recurrence ( P =0.27). Notably, the reoperation rate was similar between patients with and without sac excision ( P =0.28), indicating no significant difference in the need for reoperation. However, sac excision was associated with a lower incidence of persistent postoperative gastroesophageal reflux disease (GERD) ( P =0.03). Conclusions: Sac excision during paraesophageal hernia repair does not significantly impact hernia recurrence or reoperation rates but may be associated with a lower incidence of persistent postoperative GERD.
BACKGROUND:This study aimed to assess the diagnostic performance of positron emission tomography/computed tomography (PET/CT) in detecting synchronous malignant lesions in the proximal colon in endoscopically obstructive left-sided colorectal cancer. MATERIALS AND METHODS:All patients with a biopsy-proven left-sided endoscopically obstructive colorectal cancer who had a preoperative PET/CT scan and a postoperative total colonoscopy within 6 months after the index surgery between January 2015 and July 2024 at a comprehensive cancer center were enrolled into the study. The synchronous malignant lesions on PET/CT were confirmed with the pathologic examination of the subtotal/total colectomy specimen and postoperative total colonoscopy. The primary endpoint was to evaluate the diagnostic performance of PET/CT in detecting synchronous malignant lesions, and the second endpoint was to determine the ability of PET/CT to distinguish malignant lesions from advanced adenomas. RESULTS:Out of 90 patients, 50 (55.6%) were male with a mean age of 62.46±10.81 years. The obstructing malignant lesions detected on colonoscopy were located in the rectum, n=8 (8.9%), rectosigmoid junction, n=29 (32.2%), sigmoid colon, n=31 (34.4%), descending colon, n=16 (17.8%), and distal part of the transverse colon, n=6 (6.7%). Nine areas of abnormal fluorodeoxyglucose (FDG) uptake on PET/CT in the proximal part of the colon with a mean SUVmax value of 19.23 (range: 6.4-42) were identified in 6 patients. Four patients with synchronous lesions on PET/CT underwent a total colectomy. Two patients with synchronous lesions on PET/CT were treated with segmental resection with subsequent postoperative endoscopic submucosal dissection (ESD) for the synchronous lesion. The detection rate of PET/CT for synchronous malignant lesions was 4.4% (n=4) with a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 100%, 94.4%, 44.4%, 100%, and 94.6%, respectively. CONCLUSIONS:PET/CT demonstrated a high sensitivity and a high negative predictive value in detecting synchronous malignant lesions located in the proximal colon distal to the obstructing left-sided colorectal cancer. As a result, patients underwent a single-stage surgery and were spared from an unnecessary second surgical intervention.
BACKGROUND:Transanal minimally invasive surgery (TAMIS) emerged as a validated technique for local excision of rectal adenomas and early-stage adenocarcinomas. In organ preservation protocols, TAMIS is increasingly used for mid- and low-rectal cancers, achieving complete or major clinical response (cCR/cMR) following neoadjuvant chemoradiotherapy, complementing Watch-and-Wait strategies with low morbidity and favorable outcomes. Robotic platforms, particularly the Da Vinci SP, have improved surgical dexterity and visualization in confined pelvic spaces. Despite CE approval and encouraging feasibility data, widespread adoption of SP-TAMIS remains limited due to docking constraints. This study reports the first European series of rectal cancer cases treated with SP-TAMIS (SPrTAMIS) using a novel small FishBowl docking system and evaluates its feasibility, safety, and short-term outcomes. MATERIALS AND METHODS:Five patients with rectal adenocarcinoma, selected based on organ preservation criteria, underwent SPrTAMIS using the Da Vinci SP system. Preoperative assessment included endoscopy, MRI, CT, and bowel preparation. Procedures were performed under general anesthesia with CO 2 pneumorectum (12 mm Hg) and robotic instrumentation via the FishBowl docking system. Data collected included tumor characteristics, surgical duration, estimated blood loss (EBL), morbidity, mortality, length of stay (LOS), and functional outcomes (LARS and MSKCC scores). RESULTS:All procedures were completed robotically without conversion. The mean lesion size was 8.8 mm, located 50 mm from the anal verge and 16 mm from the anorectal junction. Mean operative time was 85 minutes. No intraoperative complications or mortality occurred. GI function resumed by postoperative day (POD) 1; all patients were discharged by POD 2. One minor, asymptomatic suture dehiscence was observed. Histology confirmed complete excision with negative margins. The median follow-up was 68 days, and functional and quality-of-life outcomes were favorable. CONCLUSIONS:SPrTAMIS using Da Vinci SP and the FishBowl system is feasible and safe for rectal excision, offering ergonomic advantages and minimal anal canal trauma. Further studies are warranted to assess long-term oncologic and functional outcomes.
PURPOSE:Since laparoscopic surgery is performed with carbon dioxide (CO 2 ) insufflation, it is known to have some metabolic consequences. Due to these metabolic changes, some clinicians may prefer open surgery for inguinal hernia in patients with pulmonary comorbidities. Our study aimed to compare the metabolic and systemic perioperative effects of preperitoneal insufflation with those of intraperitoneal insufflation. METHODS:This prospective controlled study included 20 patients who underwent totally extraperitoneal (TEP) inguinal hernia repair and 20 patients who underwent laparoscopic cholecystectomy. End-tidal carbon dioxide (ETCO 2 ), peak inspiratory pressure (PIP), vital parameters, and arterial blood gas analysis results [pH, bicarbonate (HCO 3- ), partial pressure of carbon dioxide (PCO 2 ), and lactate] were recorded before insufflation and at 10 and 20 minutes after insufflation. These parameters were compared between the 2 groups. RESULTS:In comparison between groups, no statistically significant differences were found in terms of age, gender, ASA score, or BMI ( P >0.05). In both groups, within-group analyses of HCO 3 , ETCO 2 , and PCO 2 showed that 10-minute measurements were significantly higher than preinsufflation and 20-minute measurements ( P <0.05), whereas lactate levels did not show significant variation. When vital parameters were evaluated within-group analysis, diastolic blood pressure and pulse were observed to be lower in both groups at preinsufflation compared with the 10- and 20-minute measurements ( P >0.05). No statistically significant difference was observed between the groups when preinsufflation 10-minute and 20-minute analyses were evaluated for all parameters ( P <0.05). CONCLUSION:On the basis of the standardized intergroup analyses of pulmonary and metabolic parameters, preperitoneal and intraperitoneal CO 2 insufflation demonstrated similar perioperative respiratory and metabolic effects. Laparoscopic inguinal hernia repair, which offers rapid postoperative recovery, does not appear to impose a greater metabolic burden than laparoscopic cholecystectomy. Therefore, laparoscopy may be considered a primary surgical approach for inguinal hernia repair, similar to cholecystectomy.
BACKGROUND:Infected necrotizing pancreatitis (INP) requires effective drainage management. We introduce a novel technique, Trocar-Assisted Percutaneous Abscess Drainage (TAPAD), for direct placement of a double-lumen irrigation-suction tube and compare it with conventional 2-stage drainage. METHODS:This retrospective cohort study included INP patients treated with the 2-stage method (n=98) or TAPAD (n=88). Outcomes included subsequent surgical requirements, complications, mortality, inflammatory markers, and ICU length of stay. RESULTS:TAPAD significantly reduced the need for subsequent surgical intervention (OR=0.36, 95% CI: 0.16-0.82; P=0.02), abdominal bleeding (OR=0.41, 95% CI: 0.20-0.85; P=0.02), and ICU length of stay (HR=2.76, 95% CI: 1.89-4.02; P<0.001). Patients in the TAPAD group exhibited lower inflammatory marker levels on days 7 and 14 postintervention. CONCLUSION:TAPAD represents a promising alternative to conventional 2-stage drainage, offering reduced complications and improved clinical outcomes in the management of INP.
Background: Comorbidity burden may influence perioperative outcomes in elderly patients undergoing minimally invasive resection for colorectal cancer (CRC). This study evaluated the association between the Charlson Weighted Comorbidity Index (CCI) and short-term postoperative outcomes in this population. Methods: A retrospective review of 894 consecutive patients aged 65 years or older who underwent curative minimally invasive resection for CRC at a single institution between January 2014 and August 2023. Surgical approaches included pure laparoscopic, robotic-assisted, and converted-to-open procedures. Comorbidity burden was quantified using the CCI, excluding age and the index colorectal malignancy from score calculation. Patients with and without postoperative complications were compared, and multivariable logistic regression was performed to identify independent factors associated with complications. Patients were divided into 2 groups [low CCI (≤2; n=637) and high CCI (≥3; n=257)] to investigate the relationship between an increased CCI score and the patients’ short-term outcomes. Results: Postoperative complications occurred in 319 patients (36%). Age, American Society of Anesthesiologists Physical Status (ASA) score, conversion to open surgery, rectal tumor location, and CCI score were significantly higher in patients with postoperative complications. On multivariable analysis, age 75 years or older, ASA score ≥4, conversion to open surgery, rectal tumor location, and CCI ≥3 were independently associated with an increased risk of postoperative complications. The discriminatory ability of CCI alone was modest (AUC: 0.578). Compared with the low-CCI group, the high-CCI group had higher rates of transfusion (13% vs. 8%, P =0.016), overall complications (46% vs. 31%, P <0.001), and 30-day mortality (2% vs. 1%, P =0.024), as well as a longer postoperative length of stay (6.4 vs. 5.2 days, P <0.001). Conclusion: Higher comorbidity burden, as measured by CCI, was associated with worse short-term postoperative outcomes after minimally invasive CRC surgery in elderly patients. Although CCI alone showed limited discriminatory performance for individual prediction, a CCI score ≥3 identified a subgroup with substantially higher postoperative risk and may potentially be useful as a simple adjunct in preoperative risk assessment.
