Langenbeck's Archives of Surgery最新文献

{"title":"Modified prediction model for poor short-term prognosis in patients with chronic subdural hematoma after burr hole drainage: a retrospective cohort study.","authors":"Naima Amir Zaman, Muniba Tahir, Umer Iqbal","doi":"10.1007/s00423-024-03587-3","DOIUrl":"https://doi.org/10.1007/s00423-024-03587-3","url":null,"abstract":"<p><p>To the Editor,I would like to acknowledge the valuable efforts taken to enhance the knowledge through the article \"Prediction model for poor short-term prognosis in patients with chronic subdural hematoma (CSDH) after burr hole drainage: a retrospective cohort study\" [1]. We thoroughly read this article published in your journal and learned the aim behind this study. This article has described every aspect of determining prognosis postoperatively in patients after evacuation of chronic subdural hematoma via a single burr hole. This research has immense potential to add valuable insights into preexisting literature. Nonetheless, we still have some uncertainties to address, for which I would like to offer a few critical reflections that could be very valuable in further research in this aspect. Incorporating these additional factors could significantly enhance the comprehensiveness of this model.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"19"},"PeriodicalIF":2.1,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of robotic and laparoscopic approaches in short- and long-term outcomes of lateral pelvic lymph node dissection for advanced rectal cancer: a Japanese multicenter study.","authors":"Mitsutoshi Ishii, Tetsuro Tominaga, Takashi Nonaka, Yuma Takamura, Kaido Oishi, Shintaro Hashimoto, Toshio Shiraishi, Keisuke Noda, Rika Ono, Makoto Hisanaga, Hiroaki Takeshita, Hidetoshi Fukuoka, Shosaburo Oyama, Terumitsu Sawai, Keitaro Matsumoto","doi":"10.1007/s00423-024-03596-2","DOIUrl":"10.1007/s00423-024-03596-2","url":null,"abstract":"<p><strong>Background: </strong>Lateral pelvic lymph node dissection (LPND) is a challenging surgical technique with complex anatomy and narrow pelvic manipulation. The outcomes of robotic and laparoscopic surgery for LPND are still unclear.</p><p><strong>Methods: </strong>We retrospectively reviewed 169 consecutive patients who underwent rectal cancer surgery with LPND between 2016 and 2023. Patients were divided into two groups according to whether LPND was performed by robotic surgery (R group, n = 40) or laparoscopic surgery (L group, n = 129). Clinicopathological feature and outcomes were compared between groups.</p><p><strong>Results: </strong>Frequency of surgery with combined resection of adjacent structures (5.0% vs. 19.4%, p = 0.023), frequency of patients with distant metastasis (5.0% vs. 19.4%, p = 0.028), and estimated blood loss from bilateral LPND (74 mL vs. 132 mL, p = 0.013) were all lower in the R group than in the L group. Type of surgical approach did not correlate with postoperative complications. Median follow-up was 31.0 months (range, 1.0-69.0 months). No patients in the R group experienced local recurrence, compared to 4.6% in the L group. Multivariate analysis revealed laparoscopic surgery (odds ratio 3.687, 95% confidence interval 1.505-6.033; p = 0.004) as an independent predictor of poor relapse-free survival.</p><p><strong>Conclusions: </strong>Robotic surgery for LPND appears to have good prognostic value in some, but not all, oncologic cases. However, large prospective studies are desirable to validate these findings.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"18"},"PeriodicalIF":2.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: The application of autofluorescence system contributes to the preservation of parathyroid function during thyroid surgery.","authors":"XianBiao Shi, Guan Lv, JiaBo Qin, Yixuan Li, Lulu Zheng, Haoran Ding, JianFeng Sang","doi":"10.1007/s00423-024-03580-w","DOIUrl":"10.1007/s00423-024-03580-w","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"17"},"PeriodicalIF":2.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11680637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of surgical approach in recovery from extrahepatic cholangiocarcinoma: hemihepatectomy vs. pancreatoduodenectomy.","authors":"Shimpei Otsuka, Teiichi Sugiura, Ryo Ashida, Katsuhisa Ohgi, Mihoko Yamada, Yoshiyasu Kato, Katsuhiko Uesaka","doi":"10.1007/s00423-024-03591-7","DOIUrl":"https://doi.org/10.1007/s00423-024-03591-7","url":null,"abstract":"<p><strong>Background: </strong>This study compared short- and mid-term outcomes of hemihepatectomy (HH) and pancreatoduodenectomy (PD) in patients with extrahepatic cholangiocarcinoma, focusing on surgical outcomes, body composition, and nutritional status.</p><p><strong>Method: </strong>A retrospective review was conducted to assess short-term outcomes, including operative time, blood loss, complications, and mortality. Body composition and nutritional parameters were analyzed preoperatively and 1 year postoperatively. Multivariate analysis identified factors influencing outcomes.</p><p><strong>Result: </strong>Among 216 patients (HH: n = 94, PD: n = 122), HH was associated with younger age (median 72 vs. 74 years, p = 0.041), longer operative times (p = 0.008), and greater blood loss (p < 0.001) compared to PD. Despite this, HH had fewer severe complications (42.6% vs. 75.4%, p < 0.001), lower rates of pancreatic fistula (5.3% vs. 60.7%, p < 0.001), and shorter postoperative hospital stays (p = 0.002). Mortality occurred in 3 HH patients (3.2%), all of whom underwent right hemihepatectomy, compared to none in PD (p = 0.081). One year postoperatively, HH patients had better preservation of skeletal muscle area (p = 0.139), body fat area (p = 0.319), and hemoglobin levels (p = 0.060) compared to significant declines observed in PD patients (all p < 0.001). Multivariate analysis indicated that HH was independently associated with better preservation of skeletal muscle area (β = 2.58, p < 0.001), body fat area (β = 20.86, p < 0.001), and hemoglobin levels (β = 0.81, p = 0.009) at one year postoperatively.</p><p><strong>Conclusion: </strong>HH was associated with better preservation of physical and nutritional status compared to PD. However, the higher perioperative mortality observed in HH, particularly right hemihepatectomy, necessitates careful consideration of the risks and benefits when selecting the surgical approach for patients with extrahepatic cholangiocarcinoma.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"16"},"PeriodicalIF":2.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient reported outcomes after laparoscopic appendectomy for acute appendicitis.","authors":"Emilie Schultz Hougaard, Lasse Kaalby Møller, Signe A Rønde Kristensen, Mai Elizabeth Høyer, Mark Bremholm Ellebaek, Issam Al-Najami","doi":"10.1007/s00423-024-03584-6","DOIUrl":"https://doi.org/10.1007/s00423-024-03584-6","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to establish more evidence to provide the clinicians with a greater knowledge on the patient reported outcomes and quality of life (QoL) after laparoscopic appendectomy (LA).</p><p><strong>Method: </strong>105 patients who had undergone LA for acute appendicitis regardless of severity, were included prospectively at Odense University Hospital, Svendborg. The patient reported consequence of surgery were assessed through the validated electronic survey from European-QoL questionnaire (5Q-5D-5L) including a self-reported VAS-score (0-100). The first survey was sent out the first day after surgery and the subsequent surveys at 7, 30 and 90 days. The replies was converted into an index-score expressing the QoL from 0 (death) to 1 (full health).</p><p><strong>Results: </strong>All patients experienced pain/discomfort at day 1. At day 7, 30 and 90 it was 95%, 45% and 25%, respectively. The median index-score at day 1, 7, 30 and 90 was 0.778, 0.840, 0.984 and 1.00, respectively.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"15"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective, multicentric, nationwide analysis of the impact of splenectomy on survival of pancreatic cancer patients.","authors":"Maximilian Kießler, Carsten Jäger, Carmen Mota Reyes, Ilaria Pergolini, Stephan Schorn, Rüdiger Göß, Okan Safak, Marc E Martignoni, Alexander R Novotny, Waldemar Uhl, Jens Werner, Michael Ghadimi, Werner Hartwig, Reinhard Ruppert, Tobias Keck, Christiane J Bruns, Karl-Jürgen Oldhafer, Andreas Schnitzbauer, Christoph-Thomas Germer, Florian Sommer, Sören Torge Mees, Maximilian Brunner, Jörg Köninger, Tim R Glowka, Jörg C Kalff, Christoph Reißfelder, Detlef K Bartsch, Thomas Kraus, Winfried Padberg, Pompiliu Piso, Bernhard J Lammers, Hagen Rudolph, Christian Moench, Stefan Farkas, Helmut Friess, Güralp O Ceyhan, Ihsan Ekin Demir","doi":"10.1007/s00423-024-03570-y","DOIUrl":"10.1007/s00423-024-03570-y","url":null,"abstract":"<p><strong>Objective: </strong>Splenectomy is regularly performed in total and distal pancreatectomy due to technical reasons, lymph node dissection and radicality of the operation. However, the spleen serves as an important organ for competent immune function, and its removal is associated with an increased incidence of cancer and a worse outcome in some cancer entities (Haematologica 99:392-398, 2014; Dis Colon Rectum 51:213-217, 2008; Dis Esophagus 21:334-339, 2008). The impact of splenectomy in pancreatic cancer is not fully resolved (J Am Coll Surg 188:516-521, 1999; J Surg Oncol 119:784-793, 2019).</p><p><strong>Methods: </strong>We therefore compared the outcome of 193 pancreatic cancer patients who underwent total or distal pancreatectomy with (Sp) or without splenectomy (NoSp) between 2015 and 2021 using the StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery. In addition, we integrated our data into the existing literature in a meta-analysis of studies on splenectomy in pancreatic cancer patients.</p><p><strong>Results: </strong>There was no difference between the Sp and NoSp groups regarding histopathological parameters, number of examined or affected lymph nodes, residual tumor status, or postoperative morbidity and mortality. We observed a significantly prolonged survival in pancreatic cancer patients who underwent total pancreatectomy, when a spleen-preserving operation was performed (median survival: 9.6 vs. 17.3 months, p = 0.03). In this group, splenectomy was identified as an independent risk factor for shorter overall survival [HR (95%CI): 2.38 (1.03 - 6.8)]. In a meta-analysis of the existing literature in combination with our data, we confirmed splenectomy as a risk factor for a shorter overall survival in pancreatic cancer patients undergoing total pancreatectomy, distal pancreatectomy, or pancreatic head resection [HR (95%CI): 1.53 (1.11 - 1.95)].</p><p><strong>Conclusion: </strong>Here, we report on a strong correlations between removal of the spleen and the survival of pancreatic cancer patients undergoing total pancreatectomy. This should encourage pancreatic surgeons to critically assess the role of splenectomy in total pancreatectomy and give rise to further investigations.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"14"},"PeriodicalIF":2.1,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11663811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative factors predicting outcomes in patients with suspected perihilar cholangiocarcinoma referred for curative resection- a single-center 10-year experience.","authors":"H A Al-Saffar, P N Larsen, N Schultz, T S Kristensen, D E Renteria, L A Knøfler, H C Pommergaard","doi":"10.1007/s00423-024-03583-7","DOIUrl":"https://doi.org/10.1007/s00423-024-03583-7","url":null,"abstract":"<p><strong>Purpose: </strong>Perihilar cholangiocarcinoma (pCCA) is a rare malignancy requiring resection of extrahepatic bile ducts with or without hepatectomy. Prognostic models for post-operative outcomes in pCCA are unusable in pre-operative decision-making as most are based on post-operative variables. Additionally, no pre-operative models include futile laparotomy or benign hilar stenosis (BHS) as possible outcomes. We investigated pre-operative predictive factors for non-resectability, disease-free survival (DFS), and overall survival (OS), in patients referred for resection of suspected pCCA.</p><p><strong>Methods: </strong>Patients with suspected pCCA evaluated at multidisciplinary team (MDT) conference and referred for curative resection at Rigshospitalet, from 2013-2023. Outcomes were preoperative factors related to OS, DFS and non-resectability.</p><p><strong>Results: </strong>Ninety-three patients with suspected pCCA were considered resectable at MDT, of which 84 (90.3 %) were confirmed pCCA. Nineteen (20.4 %) with pCCA were non-resectable. Patients with non-resectable pCCA had higher pre-operative p-bilirubin and ECOG-performance status (ECOG-PS) compared to resected pCCA and BHS (p=0.02 and 0.01). Portal vein embolization (PVE), higher ECOG-PS and elevated p-bilirubin were associated with worse OS in patients with pCCA undergoing surgical exploration [(HR 2.45 (95% CI 1.32-4.56), p=0.004), (HR 2.32 (95% CI 1.30-4.09), p=0.004) and (HR 2.03 (95% CI 1.17-3.51), p=0.01), respectively]. PVE and larger tumor size were associated with poorer DFS [HR 3.29 (95 % CI 1.64- 6.60), p=0.001) and (HR 1.02 (95% CI 1.00-1.04), p=0.003) respectively].</p><p><strong>Conclusion: </strong>Poor ECOG-PS, PVE, elevated p-bilirubin and larger tumor size were associated with adverse survival in patients with pCCA undergoing surgical exploration. Non-resectable pCCA were associated with higher rates of elevated p-bilirubin and larger tumor size.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"13"},"PeriodicalIF":2.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low vs. conventional intra-abdominal pressure in laparoscopic colorectal surgery: a prospective cohort study.","authors":"Mohammed Hamid, Shafquat Zaman, Omar Ezzat Saber Mostafa, Alex Deutsch, Jonty Bird, Anthony Kawesha, Michael Reay, Irmeet Banga, Anna Williams, Peter Waterland, Akinfemi Akingboye","doi":"10.1007/s00423-024-03579-3","DOIUrl":"10.1007/s00423-024-03579-3","url":null,"abstract":"<p><strong>Purpose: </strong>Low intraabdominal pressure (IAP) during laparoscopy is associated with improved post-operative outcomes across a variety of surgical specialties. A prospective cohort study was undertaken to assess post-operative outcomes in patients undergoing laparoscopic colorectal surgery (LCRS) with low (8mmHg) versus conventional (15mmHg) IAP.</p><p><strong>Methods: </strong>A prospective real-world observational study of patients undergoing LCRS in a single-centre, between June 2020 and June 2023 was performed. Operative procedures for diverse colonic pathology such as diverticular disease, inflammatory bowel disease (IBD), and colorectal cancers (CRC) were included. The evaluated primary outcomes were post-operative pain, return of gastrointestinal motility, and length of hospital stay. Secondary outcomes were the overall safety profile including intra- and post-operative complications and morbidity. Outcomes of interest were investigated using multivariate analysis.</p><p><strong>Results: </strong>A total of 120 patients were included of which 69 (57.5%) were male. Median age and BMI of the cohort was 67 years (51-75 years) and 27 kg/m² (24-32 kg/m²), respectively. 61 (50.8%) patients were categorised as an ASA grade 3. Two (1.7%) patients had diverticular disease; 31 (25.9%) had IBD, and 87 (72.4%) were operated on for colonic malignancy. Low IAP (8mmHg) was used in 53 (44.2%) cases, whilst the remainder (55.8%) had IAP set at 15mmHg (conventional). Low-pressure surgery was associated with improved intraoperative lung compliance (p < 0.001) and peak inspiratory pressures up to 6 h (p < 0.001); reduced analgesic requirement (p ≤ 0.028), and decreased postoperative pain both at rest (p = 0.001) and on exertion (p < 0.001). Moreover, low IAP was associated with an earlier time to pass flatus postoperatively (p = 0.047) with no significant difference in length of hospital stay (p = 0.574). Additionally, no significant difference was observed between the groups for outcomes including median operating time (p = 0.089), conversion to open surgery (p = 0.056), overall complication rate (p = 0.102), and 90-day mortality (p = 0.381).</p><p><strong>Conclusion: </strong>Low IAP use during LCRS is feasible with a comparable safety profile to conventional laparoscopy. Intra-operative respiratory physiology is improved with reduced postoperative pain and analgesic requirement, and earlier time to pass flatus. Future rationally designed; well-powered, randomised trials are needed to understand the benefits of low intra-peritoneal pressure during laparoscopic colorectal resections.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"12"},"PeriodicalIF":2.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness totally endoscopic thyroidectomy via completely submental tri-hole approach and transoral endoscopic thyroidectomy without insufflation.","authors":"Yi Wang, Pan Li, Fei Fan, Yangyang Guan","doi":"10.1007/s00423-024-03566-8","DOIUrl":"10.1007/s00423-024-03566-8","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the therapeutic effectiveness of totally endoscopic thyroidectomy via the completely submental tri-hole approach and transoral endoscopic thyroidectomy without insufflation.</p><p><strong>Methods: </strong>A total of 60 patients with thyroid tumors who were admitted to Panyu College Affiliated Hospital from August 2022 to August 2023 were collected in this study. The patients were divided into two groups, the transoral endoscopic thyroidectomy group (20 cases) and the totally endoscopic thyroidectomy via the completely submental tri-hole approach group (40 cases). Then, we evaluated the difference of surgical data, operative details, postoperative complications, duration of postoperative swelling, cosmetic satisfaction, discomfort during eating, and pain scores between two groups.</p><p><strong>Results: </strong>There were no significant differences between two groups in terms of operation time, intraoperative blood loss, postoperative drainage, extubation time, length of hospital stay, autotransplantation of parathyroid glands, or postoperative swelling. And neither group experienced voice hoarseness, postoperative bleeding, or lymphatic leakage. The incidence of hypocalcemia did not differ significantly between two groups, although the transoral endoscopic thyroidectomy group had a significantly higher incidence of chin numbness (p<0.01). Futhermore, there was no obvious differences in neck pain scores or cosmetic satisfaction scores at 3 days, 7 days, 2 weeks, and 1 month postoperatively. However, the discomfort during eating score was markedly lower in the totally endoscopic thyroidectomy group compared to the transoral endoscopic thyroidectomy group (P < 0.05).</p><p><strong>Conclusion: </strong>Totally endoscopic thyroidectomy via the completely submental tri-hole approach offers advantages in reducing postoperative discomfort during eating compared to transoral endoscopic thyroidectomy, indicating promising prospects for clinical application.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"11"},"PeriodicalIF":2.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New purse-string suture clamp and multi-functional seal cap: a simple intracorporeal circular-stapled oesophagojejunostomy after laparoscopic total gastrectomy.","authors":"Jianjun Du, Junjie Liu, Lizhi Zhao, Haohai Jiang, Ziqiang Zhang","doi":"10.1007/s00423-024-03571-x","DOIUrl":"10.1007/s00423-024-03571-x","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic total gastrectomy (LTG) is still limited because intracorporeal oesophagojejunostomy is technically demanding and difficult in laparoscopic gastrectomy. Circular-stapled anastomosis is considered the \"gold standard\" method for oesophagojejunostomy in open total gastrectomy. A purse-string suture instrument is used to create a purse-string suture along the distal oesophagus as a standard technique for classic circular-stapled oesophagojejunostomy in the open total gastrectomy. However, a simple and optimal laparoscopic purse-string suture device or instrument with an appropriate and optimal tube in the abdomen remains to be developed as a standard procedure for simple intracorporeal oesophagojejunostomy.</p><p><strong>Study design: </strong>Between May 2023 and October 2023, a new laparoscopic purse-string suture clamp (Lap-PSC) and multi-functional seal cap (MSC) were applied to obtain a simple intracorporeal circular-stapled oesophagojejunostomy after laparoscopic total gastrectomy in 21 patients with gastric cancer in our hospital. The surgical details and postoperative outcomes were analyzed to evaluate this method.</p><p><strong>Results: </strong>The mean operation time was 203.8 ± 39.1 min. The mean time for the purse-string suture was 6.6 ± 2.8 min. An average of 13 min was required for purse-string creation and anvil placement. Tumor-free margins were obtained in 21 patients, with a median proximal margin length of 2 cm (range, 1.5-5 cm). Four postoperative complications occurred in this study. There was no mortality. During the median follow-up periods of 11 months, no anastomosis-related complications were observed.</p><p><strong>Conclusions: </strong>The standardized single-stapling end-to-side oesophagojejunostomy in open surgery can be easily and safely performed during LTG using both Lap-PSC and MSC. The procedure using Lap-PSC with MSC may be considered as a better procedure to option in LTG.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"9"},"PeriodicalIF":2.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}