Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

{"title":"Latest Outcomes in Robotic-Assisted Bariatric Surgery: Contemporary Analysis of Laparoscopic Versus Robotic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass.","authors":"Raul Sebastian, Oscar Tuesta, Adrian Riva, Jason Silvers, Gina Adrales, Hien Nguyen, Christina Li, Michael Schweitzer","doi":"10.1097/SLE.0000000000001518","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001518","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted bariatric surgery has expanded rapidly, but its advantages over conventional laparoscopy remain uncertain.</p><p><strong>Methods: </strong>We compared 30-day outcomes after robotic versus laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the MBSAQIP 2020 to 2023 database. Patients undergoing primary SG or RYGB were propensity score matched using 22 preoperative variables.</p><p><strong>Results: </strong>Among 502,645 SG and 194,300 RYGB procedures, robotic SG was associated with higher rates of emergency department visits, blood transfusions, readmissions, venous thromboembolism, surgical site infections, and postoperative bleeding than laparoscopic SG. In contrast, robotic RYGB demonstrated lower rates of blood transfusions, surgical site infections, postoperative bleeding, and strictures than laparoscopic RYGB.</p><p><strong>Conclusions: </strong>Our findings suggest that robotic assistance was associated with procedure-specific differences in 30-day outcomes, with worse outcomes after SG but modestly improved outcomes after RYGB compared with laparoscopy.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal Oral Water Immersion Method May Shorten Insertion Time During Unsedated Colonoscopy: A Randomized Controlled Trial.","authors":"Jinqing Wu, Haofeng Xu, Xue Li","doi":"10.1097/SLE.0000000000001516","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001516","url":null,"abstract":"<p><strong>Background and aims: </strong>Unsedated colonoscopy often increases procedural pain and prolongs insertion time, especially in the sigmoid colon with acute luminal angulation. This study aimed to evaluate the efficacy and safety of preprocedural enhanced oral water intake (PWI) for unsedated colonoscopy.</p><p><strong>Methods: </strong>This randomized controlled trial (RCT) enrolled 372 eligible patients. They were randomized to the conventional air colonoscopy (CAC), water-assisted colonoscopy (WAC), and PWI groups to receive the assigned interventions. Primary outcomes included insertion time, visual analog scale (VAS), cecal intubation rate, bowel cleanliness, and adenoma detection rate (ADR).</p><p><strong>Results: </strong>All 3 groups achieved a cecal intubation rate of 100.0%. The ADR was comparable among the 3 groups, with no statistically significant difference (P=0.702). VAS scores in the CAC group were significantly higher than those in the WAC and PWI groups (4.15±1.68 vs. 2.64±1.99 and 2.65±1.97; P<0.001, 95% CI: 1.049-1.968 and 95% CI: 1.035-1.949), whereas no statistically significant difference was found between the WAC and PWI groups (P=0.949, 95% CI: -0.510 to 0.478). Compared with CAC (2.00 min) and WAC (2.55 min), the PWI group exhibited a shorter median insertion time (1.60 min, all P<0.001). The Hodges-Lehmann median differences were -0.80 minutes (95% CI: -1.00 to -0.50 min, PWI vs. CAC) and 1.20 minutes (95% CI: 1.00-1.50 min, WAC vs. PWI). Willingness to undergo repeat colonoscopy was comparable between WAC and PWI (P=0.820), but significantly higher in these 2 groups than in the CAC group (P=0.017).</p><p><strong>Conclusions: </strong>PWI appears to be associated with shorter insertion time among patients undergoing unsedated colonoscopy.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple-Bite Cold Forceps Polypectomy for Diminutive Colorectal Polyps ≤5 mm: Outcomes in Patients on Antithrombotic Therapy.","authors":"Jinqing Wu, Xue Li","doi":"10.1097/SLE.0000000000001486","DOIUrl":"10.1097/SLE.0000000000001486","url":null,"abstract":"<p><strong>Background and aims: </strong>Although some studies have explored the efficacy of cold forceps polypectomy (CFP) for diminutive colorectal polyps (DCPs) ≤3 mm, data on the efficacy and safety of multiple-bite CFP (MB-CFP) in antithrombotic-treated patients with DCPs ≤5 mm remain scarce. This study aimed to investigate the efficacy and safety of MB-CFP in this patient cohort.</p><p><strong>Methods: </strong>This was a retrospective study conducted at a single academic hospital. A total of 1201 consecutive patients with 2344 eligible polyps were enrolled. To fully evaluate the efficacy of MB-CFP, we defined histologic polyp eradication specifically according to the present study protocol to enable quantitative comparison.</p><p><strong>Results: </strong>The mean number of bites in the MB-CFP group was 3.2. Both histologic and visual polyp eradication rates were comparable between the cold snare polypectomy (CSP) and MB-CFP groups ( P >0.05). MB-CFP and CSP exhibited comparable polyp recurrence rates ( P >0.05), both of which were lower than that in the single-bite CFP (SB-CFP) group ( P <0.05). Tissue retrieval failure was higher in the CSP group than in the MB-CFP and SB-CFP groups ( P <0.001). Adverse events (AEs) were comparable among the 3 groups ( P >0.05). Logistic regression analysis identified polyp resection method, colorectal polyp classification, and polyp size as independent predictors of incomplete histologic polyp eradication (OR=5.100, 95% CI=1.985-13.103; OR=34.484, 95% CI=24.500-48.536; OR=0.188, 95% CI=0.132-0.266; all P ≤0.001, respectively).</p><p><strong>Conclusions: </strong>MB-CFP was effective and safe for the treatment of DCPs in patients receiving antithrombotic therapy, with favorable outcomes regarding AEs and polyp recurrence.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-surgeon Transition From Laparoscopy to Robotic-assisted Bariatric and General Surgery: Throughput, Operative Times, and Learning-curve Trajectory Across 1664 Consecutive Cases.","authors":"Benjamin Clapp","doi":"10.1097/SLE.0000000000001492","DOIUrl":"10.1097/SLE.0000000000001492","url":null,"abstract":"<p><strong>Background: </strong>The operational impact of transitioning from laparoscopic to robotic surgery is incompletely characterized, particularly regarding throughput and nonconsole operative time.</p><p><strong>Methods: </strong>We analyzed 1664 consecutive cases performed by a single surgeon (2023-2026), comparing laparoscopic (n=632) and robotic eras (n=1032). Throughput, operative time, and robotic OR overhead (skin-to-skin minus console time) were assessed using EMR, MBSAQIP, and vendor-derived data sources.</p><p><strong>Results: </strong>Weekly case volume increased from 9.54 to 11.36 (+19.1%), with stable OR days and increased cases per OR day (+17%). Robotic cases had longer operative times (SG +14.0 min; RYGB +27.6 min, P <0.001). The mean robotic OR overhead was ~19 minutes and consistent across independent data sources. Over time, overhead decreased by 30% (23.2 to 16.3 min; P <0.001), demonstrating improved efficiency.</p><p><strong>Conclusions: </strong>Transition to robotic surgery increased throughput despite longer operative times. Robotic OR overhead is substantial but declines with experience, suggesting recoverable efficiency gains over time.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Robotic Gastrectomy in the Elderly Population: A Systematic Review With Meta-analysis.","authors":"Dimosthenis Chrysikos, Nikolaos Taprantzis, Amir Shihada, Theodore Troupis","doi":"10.1097/SLE.0000000000001515","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001515","url":null,"abstract":"<p><strong>Background: </strong>As the gastric cancer patient population ages, identifying safe surgical treatments for frail elderly patients is critical. This meta-analysis evaluates the surgical safety, recovery, and oncological efficacy of robotic gastrectomy (RG) in the elderly, comparing it to laparoscopic gastrectomy (LG) in the same demographic and RG in younger patients.</p><p><strong>Material and methods: </strong>A systematic search (PubMed, Embase, Web of Science, Scopus) identified relevant studies. Perioperative outcomes, complications, and oncological efficacy were analyzed, calculating pooled prevalences, odds ratios (ORs), and mean differences (MDs) using R.</p><p><strong>Results: </strong>In the elderly, RG demonstrated advantages over LG, including shorter hospital stays (MD = -0.83 d), faster liquid diet transition (MD = -0.19 d, exploratory), and higher lymph node retrieval (MD = 2.68). RG had significantly fewer overall (OR = 0.72) and grade I-II complications (OR = 0.66, exploratory), and lower medical morbidities (OR = 0.53, exploratory), but required a longer operative time (MD = 19.5 min). Blood loss, mortality, and severe complications were comparable. Compared with younger RG patients, the elderly had longer hospital stays (MD = 1.18 d) and more severe (grade III-IV) complications (OR = 2.20), with no significant differences in operative time, overall complications, or mortality.</p><p><strong>Conclusion: </strong>RG offers significant benefits for elderly gastric cancer patients, improving recovery and reducing mild complications compared with LG, without compromising oncological outcomes. Because the elderly remain inherently vulnerable to severe complications compared with younger cohorts, comprehensive preoperative functional assessment, rather than chronological age alone, is essential for optimal patient selection.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of PET/CT for the Detection of Synchronous Malignant Lesions in Patients With Endoscopically Obstructive Colorectal Cancer.","authors":"Cemil Burak Kulle, Mehmet Iskender Yıldırım, Halil Alper Bozkurt, Emine Göknur Işık, Melek Büyük, Neslihan Berker, İlker Özgür, Mehmet Türker Bulut, Metin Keskin, Adem Bayraktar","doi":"10.1097/SLE.0000000000001484","DOIUrl":"10.1097/SLE.0000000000001484","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified One Anastomosis Gastric Bypass (OAGB) Versus Duodenojejunostomy for Treatment of Superior Mesenteric Artery Syndrome: A Randomized Controlled Trial.","authors":"Ahmed A A Y Salem, Mohey R Elbanna, Amr A M Abdel-Alim, Mohammed A Hamed","doi":"10.1097/SLE.0000000000001488","DOIUrl":"10.1097/SLE.0000000000001488","url":null,"abstract":"<p><strong>Background: </strong>Superior mesenteric artery syndrome is a rare cause of upper gastrointestinal obstruction. Surgical treatment is indicated when conservative measures fail; duodenojejunostomy is the most commonly performed procedure, although persistent or recurrent symptoms have been reported. We propose a modified one anastomosis gastric bypass (OAGB) as a functional reconstructive bypass to relieve duodenal obstruction.</p><p><strong>Materials and methods: </strong>This prospective randomized controlled trial included 20 patients with SMA syndrome, randomized equally to modified OAGB or duodenojejunostomy. Symptom severity and quality of life were assessed preoperatively and at 1, 3, 6, and 12 months.</p><p><strong>Results: </strong>Modified OAGB resulted in higher WHOQOL-BREF scores at 12 months (59.3±10.0 vs. 42.7±15.9, P =0.014), lower rates of recurrent vomiting (20% vs. 50%), and shorter hospital stay (4.1±0.32 d vs. 6.8±2.94 d, P =0.017).</p><p><strong>Conclusion: </strong>Modified OAGB may represent a feasible and effective alternative to duodenojejunostomy for selected patients.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Intragastric Submucosal Dissection (LISD) for Early Gastric Cancer: An Organ-Preserving Alternative When ESD Is Not Feasible.","authors":"Jose Luis Quezada, Felipe Farfán, Ignacio Obaid, Paula Fluxá","doi":"10.1097/SLE.0000000000001483","DOIUrl":"10.1097/SLE.0000000000001483","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Bowel Obstruction After TAPP Inguinal Hernia Repair: The Hidden Risk of Peritoneal Defects.","authors":"Alon Schwartz, David Hazzan, Michael R Freund","doi":"10.1097/SLE.0000000000001491","DOIUrl":"10.1097/SLE.0000000000001491","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Safety and Effectiveness of Laparoscopic Heller Myotomy in Elderly Patients: Systematic Review and Meta-Analysis.","authors":"José Barros Sosa, Cristian A Angeramo, Josefina Príncipe, Juan J Baz Gallego, Fernando A M Herbella, Marco G Patti, Francisco Schlottmann","doi":"10.1097/SLE.0000000000001490","DOIUrl":"10.1097/SLE.0000000000001490","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}