Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

{"title":"Surgical Insight-guided Deep Learning for Colorectal Lesion Management.","authors":"Ozan Can Tatar, Anil Çubukçu","doi":"10.1097/SLE.0000000000001298","DOIUrl":"10.1097/SLE.0000000000001298","url":null,"abstract":"<p><strong>Background: </strong>Colonoscopy stands as a pivotal diagnostic tool in identifying gastrointestinal diseases, including potentially malignant tumors. The procedure, however, faces challenges in the precise identification of lesions during visual inspections. The recent strides in AI and machine learning technologies have opened avenues for enhanced medical imaging analysis, including in the field of colonoscopy.</p><p><strong>Methods: </strong>In this study, we developed and evaluated a deep learning (DL) model, ColoNet, for detecting lesions in colonoscopic images. We analyzed 1760 images from 306 patients who underwent colorectal surgery between 2009 and 2022, meeting specific inclusion criteria. These images were used to train and validate ColoNet, employing the YOLOv8 architecture and various data augmentation techniques. Deep learning metrics are assessed via YOLO architecture and trained model diagnostic accuracy was assessed via sensitivity, specifity, positive predictive value, and negative predictive value.</p><p><strong>Results: </strong>Our results from the validation dataset revealed a precision of 0.79604, a recall of 0.78086, an mAP50 of 0.83243, and an mAP50-95 of 0.4439. In addition, on a separate real-time dataset of 91 images consisting both healthy and suspect lesions, ColoNet achieved a sensitivity of 70.73%, specificity of 92.00%, positive predictive value (PPV) of 87.88%, and negative predictive value (NPV) of 79.31%. The positive and negative likelihood ratios were 8.84 and 0.32, respectively, with an overall accuracy of 82.42%.</p><p><strong>Conclusions: </strong>In conclusion, our model has demonstrated promising results, indicating its potential as a valuable tool to assist surgeons during colonoscopy procedures. Its ability to detect suspicious lesions with potential malignancy offers a noteworthy advancement in the early diagnosis and management of colorectal cancers. Further multicentric, prospective research and validation are warranted to fully realize its clinical applicability and impact.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":"34 6","pages":"559-565"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780750","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 Battle of Endoscopic Bariatric Therapies for Obesity: Endoscopic Sleeve Gastroplasty Versus Endoscopically Inserted Intragastric Balloon-A Pairwise Meta-Analysis of Comparative Studies and a Call for Randomized Controlled Trials.","authors":"Abdul-Rahman F Diab, Joseph A Sujka, Kathleen Mattingly, Mehak Sachdeva, Kenneth Hackbarth, Salvatore Docimo, Christopher G DuCoin","doi":"10.1097/SLE.0000000000001321","DOIUrl":"10.1097/SLE.0000000000001321","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic sleeve gastroplasty (ESG) represents the latest primary endoscopic intervention for managing obesity. Both ESG and intragastric balloons (IGBs) have demonstrated effectiveness and safety for weight loss. However, there is a paucity of high-quality evidence supporting the superiority of one over the other, and no pairwise meta-analysis of comparative studies has been published to date. Our aim was to conduct a pairwise meta-analysis of comparative studies directly comparing ESG and IGB.</p><p><strong>Methods: </strong>We systematically conducted a literature search on PubMed and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search used specific search terms. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) Tool was used to evaluate the quality of the included studies. Data were analyzed using Review Manager (RevMan) 5.4.1 software with a random-effects model. The statistical method used was the Mantel-Haenszel method. For dichotomous data, the effect size was represented using odds ratio (OR), while mean difference (MD) was utilized as the effect size for continuous data.</p><p><strong>Results: </strong>After screening 967 records, a total of 9 studies met the inclusion criteria for this meta-analysis (5302 patients). The quality assessment categorized 5 studies as having a moderate risk of bias, while 3 studies were classified as having a low risk of bias. Sufficient information was not available for one study to ascertain its overall quality. A statistically significant increase in total weight loss percentage (TWL%) at 1 and 6 months was observed with ESG compared with IGB. In addition, a statistically insignificant decrease in the incidence of adverse events and readmissions was observed with ESG. Furthermore, a statistically significant decrease in the incidence of reintervention was observed with ESG.</p><p><strong>Conclusions: </strong>While this study suggests a higher TWL% associated with ESG compared with IGB, drawing definitive conclusions is challenging due to limitations identified during a comprehensive quality assessment of the available literature. We advocate for randomized controlled trials (RCTs) directly comparing the newer IGB (with a 12-mo placement duration) with ESG. However, this study consistently reveals higher rates of early reintervention (re-endoscopy) within the IGB group, primarily necessitated by the removal or adjustment of the IGB due to intolerance. Given the additional intervention required at 6 or 12 months to remove the temporarily placed IGB, this trend may imply that IGB is less economically viable than ESG. Cost-effectiveness analyses comparing ESG and IGB are warranted to provide valuable scientific insights.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"638-646"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142295900","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":"Comparative Analysis of the Safety and Feasibility of Laparoscopic Versus Open Segment 7 Hepatectomy.","authors":"Haitao Zeng, Xiaoli Xiong, Song Huang, Jia Zhang, Hongliang Liu, Yong Huang","doi":"10.1097/SLE.0000000000001330","DOIUrl":"10.1097/SLE.0000000000001330","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic hepatectomy has been widely accepted owing to its advantages as a minimally invasive surgery; however, laparoscopic segment 7 (S7) hepatectomy (LSH) has been rarely reported. We aimed to explore the safety and feasibility of LSH by comparing it with open surgical approaches.</p><p><strong>Methods: </strong>Twenty-nine patients who underwent S7 hepatectomy between January 2016 and January 2023 were enrolled in this study. The patients' characteristics, intraoperative details, and postoperative outcomes were compared between the 2 groups.</p><p><strong>Results: </strong>No significant differences were observed in the preoperative data. The patients who underwent LSH had significantly shorter hospital stays ( P =0.016) but longer operative times ( P =0.034) than those who underwent open S7 hepatectomy. No significant differences in blood loss ( P =0.614), transfusion ( P =0.316), hospital expenses ( P =0.391), surgical margin ( P =0.442), rate of other complications, postoperative white blood cell count, and alanine aminotransferase and aspartate aminotransferase levels were noted between the 2 groups ( P >0.05). For hepatocellular carcinoma, the results showed no differences in either disease-free survival ( P =0.432) or overall survival ( P =0.923) between the 2 groups.</p><p><strong>Conclusions: </strong>LSH is a safe and feasible surgical procedure that is efficient from an oncological point of view. It may be the preferred technique for lesions in the S7 of the liver.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"614-618"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475233","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":"Efficacy of Laparoscopic Left Hemihepatectomy Combined With Choledochoscopic Lithotomy for Complex Intrahepatic Bile Duct Stones and Its Impact on Postoperative Liver Function.","authors":"Zengyin Chen, Juan Du","doi":"10.1097/SLE.0000000000001334","DOIUrl":"10.1097/SLE.0000000000001334","url":null,"abstract":"<p><strong>Background: </strong>This study was designed to investigate the clinical efficacy of laparoscopic left hemihepatectomy combined with choledochoscopic lithotomy for patients with complex intrahepatic bile duct stones.</p><p><strong>Materials and methods: </strong>The clinical data of 97 patients with complex intrahepatic bile duct stones treated in our hospital between February 2019 and April 2022 were retrospectively collected. Patients were allocated into 2 groups based on their surgical approaches. In the control group, 46 patients underwent laparoscopic left hemihepatectomy, while in the combined group, 51 patients underwent laparoscopic left hemihepatectomy combined with choledochoscopic lithotomy. Parameters such as clinical efficacy, surgical indices, stress response markers (CRP, EP, COR), coagulation metrics (FIB, APTT, PT), liver function indicators (GGT, TBIL, ALT), complications, and quality of life were compared between the 2 groups.</p><p><strong>Results: </strong>The combined group exhibited a significantly higher total effective rate compared with the control group (98.04% vs. 82.61%) ( P <0.05). The operation duration of the combined group was longer than that of the control group. However, the duration for postoperative anal exhaustion, postoperative bed mobility, postoperative drainage, and hospital stay was shorter in the combined group than in the control group ( P <0.05). CRP, EP, and COR concentrations were substantially elevated in both groups on the third postoperative day ( P <0.05), but were lower in the combined group. Similarly, levels of FIB, APTT, and PT were markedly increased in both groups on the third postoperative day ( P <0.05), but were lower in the combined group. On the seventh postoperative day, GGT, TBIL, and ALT were notably decreased in both groups, with the combined group exhibiting lower levels ( P <0.05). The incidence of complications in the combined group was lower than that of the control group (5.88% vs. 19.57%) ( P <0.05). At 3 months postoperatively, all GIQLI scores were markedly elevated in both groups, with superior scores observed in the combined group ( P <0.05).</p><p><strong>Conclusion: </strong>The combined laparoscopy and choledochoscopy demonstrate a remarkable efficacy for complex intrahepatic bile duct stones, which significantly facilitate liver function recuperation, reduce stress reactions, reduce complications, enhance the quality of life, and exert a minimal impact on coagulation functions.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"630-637"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508379","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":"A Low Prognostic Nutritional Index Level, an Independent Predictor for Postoperative Intra-abdominal Abscess After Laparoscopic Appendectomy.","authors":"Yijian Yuan, Yanhua Tang, Yubin Liu, Pengcheng Ren","doi":"10.1097/SLE.0000000000001328","DOIUrl":"10.1097/SLE.0000000000001328","url":null,"abstract":"<p><strong>Background: </strong>Intra-abdominal abscess (IAA) is a very common postoperative complication after laparoscopic appendectomy and is associated with poor prognosis.</p><p><strong>Materials and methods: </strong>This study retrospectively analyzed elderly patients who underwent laparoscopic appendectomy from 2015 to 2024, examining demographic, clinical, and laboratory data to identify IAA risk factors. Independent risk factors for IAA were screened and finally identified by multivariate logistic regression analysis.</p><p><strong>Results: </strong>A total of 37 patients developed IAA within postoperative 30 days, with an incidence of 9.6% (37/385). Receiver operating characteristic (ROC) curve analysis indicated white blood cell (cut-off value: 13.35, sensitivity: 54.60%, specificity: 70.27%, P =0.003) and Prognostic Nutritional Index (PNI) (cut-off value: 41.95, sensitivity: 72.41%, specificity: 59.46%, P <0.0001) were 2 predictors for IAA with an area under the curve of 0.649 and 0.727, respectively. Based on the multivariate analysis, perforated appendicitis (odds ratio: 2.48, 95% CI: 1.15-5.32, P =0.021) and a lower PNI score (odds ratio: 3.44, 95% CI: 1.49-7.58, P =0.002) were 2 independent risk factors for IAA in elderly patients after laparoscopic appendectomy.</p><p><strong>Conclusions: </strong>Elderly patients with perforated appendicitis and a PNI score <41.95 have higher risks for IAA after laparoscopic appendectomy.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"603-606"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366599","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":"Application of Indocyanine Green Fluorescence Imaging During Laparoscopic Reoperations of the Biliary Tract Enhances Surgical Precision and Efficiency.","authors":"Ding-Wei Xu, Xin-Cheng Li, Ao Li, Yan Zhang, Manqin Hu, Jie Huang","doi":"10.1097/SLE.0000000000001324","DOIUrl":"10.1097/SLE.0000000000001324","url":null,"abstract":"<p><strong>Background: </strong>A history of abdominal surgery is considered a contraindication for laparoscopic procedures. However, the advancements in laparoscopic instruments and techniques have facilitated the performance of increasingly intricate operations, even in patients with prior abdominal surgeries. ICG fluorescence imaging technology offers advantages in terms of convenient operation and clearer intraoperative bile duct imaging, as confirmed by numerous international clinical studies on its feasibility and safety. The application of ICG fluorescence imaging technology in repeat laparoscopic biliary surgery, however, lacks sufficient reports.</p><p><strong>Methods: </strong>The clinical data of patients who underwent elective reoperation of the biliary tract in our department between January 2020 and June 2022 were retrospectively analyzed. ICG was injected peripherally before the operation, and near-infrared light was used for 3-dimensional imaging of the bile duct during the operation.</p><p><strong>Results: </strong>Altogether, 143 patients were included in this study and divided into the fluorescence and nonfluorescence groups according to the inclusion criteria. Among the 26 patients in the fluorescence group, cholangiography was successfully performed in 24 cases, and the success rate of intraoperative biliary ICG fluorescence imaging was 92.31%. The intraoperative biliary tract identification time was significantly different between the fluorescence and nonfluorescence groups, but no statistical difference was observed in the final operation method, operative time, and intraoperative blood loss between the 2 groups. Although there was no significant difference in the postoperative ventilation rate, incidence of bile leakage, and stone recurrence rate at 6 months postoperatively between the 2 groups ( P >0.05), a significant difference in postoperative hospitalization days was observed ( P =0.032).</p><p><strong>Conclusion: </strong>The application of ICG fluorescence imaging technology in laparoscopic reoperation of the biliary tract is useful for the early identification of the biliary tract during operation, thereby shortening the operative time and reducing the risk of damage to nonoperative areas. This approach also enhances the visualization of the biliary system and avoids secondary injury intraoperatively due to poor identification of the biliary system. This technique is safe for repeat biliary tract surgery and has a good application prospect.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"583-589"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of the Treatment for Gastric Tube Cancer After Esophagectomy for Esophageal Cancer.","authors":"Junya Kitadani, Keiji Hayata, Taro Goda, Akihiro Takeuchi, Shinta Tominaga, Naoki Fukuda, Tomoki Nakai, Shotaro Nagano, Toshiyasu Ojima, Manabu Kawai","doi":"10.1097/SLE.0000000000001310","DOIUrl":"10.1097/SLE.0000000000001310","url":null,"abstract":"<p><strong>Background: </strong>The long-term outcomes of gastric tube cancer (GTC) are unclear. This study therefore aimed to clarify clinicopathologic features and the long-term outcomes of patients with GTC.</p><p><strong>Methods: </strong>The 25 patients who were diagnosed with GTC between April 2003 and December 2022 at our hospital were eligible for inclusion in this retrospective study, and this included 27 lesions. We retrospectively evaluated clinicopathologic factors based on hospital records.</p><p><strong>Results: </strong>In our cohort, 88% of incidences of GTC were located in the middle or lower gastric tube. As the treatment of GTC, we used endoscopic submucosal dissection, gastrectomy, chemoradiotherapy, chemotherapy, and best supportive care for 16 (59%), 6 (22%), 1 (4%), 1 (4%), and 3 (11%) lesions, respectively. Perforation after endoscopic submucosal dissection was observed in 6 of the 16 lesions. Partial gastric tube resection was performed for 3 patients and total gastric tube resection was performed for 3 patients. One patient who underwent total gastric tube resection died due to acute respiratory distress syndrome. In survival analysis, the 3-year overall survival rate was 52% and the 3-year disease-specific survival rate was 74%. Five patients (20%) died of aspiration pneumonia, 2 patients (8%) of another disease, and 1 patient (4%) of another type of cancer. According to multivariate analysis, independent prognostic factors for overall survival were cN status (HR, 18.021; P =0.004) and complication of aspiration pneumonia (HR, 8.373; P =0.004).</p><p><strong>Conclusions: </strong>The occurrence of aspiration pneumonia and cN status were prognostic factors after the treatment for GTC. Assessment of dysphagia and surveillance after treatment for GTC are important to improve the prognosis.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"504-510"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555494","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 Pancreaticoduodenectomy With Open Reconstruction: The Buddha's Middle Path.","authors":"Ameet Kumar, Sumesh Kaistha, Rajesh Gangavatiker","doi":"10.1097/SLE.0000000000001311","DOIUrl":"10.1097/SLE.0000000000001311","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic pancreaticoduodenectomy (LPD) is not universally adopted because of its steep learning curve. Its technical complexity discourages many surgeons. We believe that laparoscopic pancreaticoduodenectomy with open reconstruction (LPOR) has all the benefits of LPD without its drawbacks and combines the ease of open surgery with the benefits of minimal access surgery. We assessed the feasibility and safety of LPOR and compared it with open pancreaticoduodenectomy (OPD), with the objectives being perioperative and short-term clinical/oncologic outcomes.</p><p><strong>Methods: </strong>Retrospective review of prospectively maintained database; study period from January 2013 to December 2019. Till 2015, we did only OPD. In 2016, we started with LPD but soon switched to LPOR. The resection part was done laparoscopically and the reconstruction part was done through a 8-cm mini-laparotomy.</p><p><strong>Results: </strong>We did 19 OPDs and 15 LPORs. Demographic data of the 2 groups were comparable. The duration of surgery was significantly longer in the LPOR group (360 vs. 410 min; P =0.01), whereas the blood loss and hospital stay were longer in the OPD group (520 vs. 360 mL; P =0.03 and 13 vs. 11 d; P =0.08, respectively). Clinically significant complication rates, including delayed gastric emptying and postoperative pancreatic fistulas, were not different in either group. No patients in the LPOR group had wound-related/pulmonary complications. Lymph node yield was similar in both groups (20 vs. 22) and we had 100% R0 resections.</p><p><strong>Conclusions: </strong>LPOR was better than OPD in terms of short-term outcomes and was not inferior to OPD in terms of complications/oncologic outcomes.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"511-517"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627736","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":"Comparative Study on the Effectiveness, Safety, and Economic Costs of Endoscopic Submucosal Dissection for Colorectal Tumors Under Conscious Sedation and General Anesthesia.","authors":"Yanrong Li, Jing Wang, Ye Hong, Qi Wu","doi":"10.1097/SLE.0000000000001308","DOIUrl":"10.1097/SLE.0000000000001308","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic submucosal dissection (ESD) is a minimally invasive surgical procedure used for en bloc removal of colorectal tumors. Although colorectal ESD is ideally conducted under conscious sedation, it is often performed under general anesthesia because of its complexity and lengthy duration. Currently, there is limited research on colorectal ESD performed under conscious sedation. The purpose of this study was to evaluate the effectiveness, safety, and economic cost of colorectal ESD under conscious sedation compared to general anesthesia.</p><p><strong>Materials and methods: </strong>Retrospective analysis of 301 patients who underwent ESD treatment for colorectal tumors at the Endoscopy Center of Peking University Cancer Hospital from January 2018 to November 2020. Patients were divided into the sedation group (group S, n=88) and the general anesthesia group (group A, n=213) based on the anesthetic method. To balance the confounding factors between the 2 groups, 75 matched pairs were obtained after using propensity score matching (PSM). Intraoperative and postoperative parameters were then compared between the matched groups.</p><p><strong>Results: </strong>After PSM, there was no statistically significant difference between group S and group A in terms of the surgical time, en bloc resection rate, and complete resection rate. There was also no statistically significant difference in the occurrence rates of bleeding, perforation, and post-ESD electrocoagulation syndrome (PEECS) between the 2 groups. However, the length of hospital stay was significantly shorter in group S (1.23±0.89d) than in group A (5.92±3.05d) ( P <0.05). The hospitalization costs were also significantly lower in group S (16482.34±13154.32 yuan) compared with group A (34743.74±13779.40 yuan) (P < 0.05 ).</p><p><strong>Conclusions: </strong>Compared to general anesthesia, performing ESD for colorectal tumors under conscious sedation has equivalent effectiveness and safety while shortening the hospital stay and reducing the economic costs.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"491-496"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Daytime and Night-Time Appendectomies: A Systematic Review and Meta-Analysis.","authors":"Lifang Shen, Liangfeng Zhang, Huili Shi","doi":"10.1097/SLE.0000000000001317","DOIUrl":"10.1097/SLE.0000000000001317","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis is a common surgical emergency characterized by appendix inflammation. Surgery remains the gold standard for treatment with laparoscopy gaining in popularity. However, the optimal timing for appendectomy remains unclear. We are not aware of studies evaluating potential differences in clinical outcomes among appendectomies performed during the daytime and at night.</p><p><strong>Methods: </strong>We followed the PRISMA guidelines and searched the ScienceDirect, Medline, and Google Scholar databases for studies published in English before June 2023. We included prospective and retrospective studies reporting appendectomy outcomes. We categorized the appendectomy procedure times as daytime or night-time based on each study's definitions. We extracted baseline characteristics and outcomes and assessed the quality of the studies included using the Newcastle-Ottawa Scale. We calculated pooled risk ratios (RRs) and weighted mean differences (WMDs) using random-effects models; and, we assessed heterogeneity using the I2 statistic.</p><p><strong>Results: </strong>We analyzed data from 12 studies for systematic review ( n =19,183) including daytime ( n =11,839) and night-time ( n =7344) appendectomies. For the meta-analysis, we included 9 studies, that evaluated outcomes such as mortality (pooled RR, 0.44; 95% CI, 0.09-2.01; I2 =43.7%; P =0.11), hospital stay (WMD, -0.02; 95% CI, -0.24 to 0.20; I2 =93.3%; P <0.001), and complications (pooled RR, 0.96; 95% CI, 0.64-1.45; I2 =65.1%; P =0.02). We found similar mortality rates, hospital stay lengths, and complications for the appendectomies, regardless of the time of day of the operation. The baseline characteristics of the patients were also similar, except for the duration of symptoms and the presence of an appendiceal abscess.</p><p><strong>Conclusion: </strong>Our results showed that the timing of an appendectomy (daytime vs. night-time) does not significantly affect its outcomes. Surgeon availability or fatigue, and patient severity may not significantly impact the operation results. Standardized protocols and perioperative care ensure consistent outcomes.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"541-549"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056587","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}