Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

{"title":"Single-port Thoracoscopic Laser Sympathicotomy for Primary Hyperhidrosis: A Safe and Minimally Invasive Approach With Favorable Short-term Outcomes.","authors":"Tat Thanh Do, Quoc Hung Doan, Huu Nguyen Cong, Thi Minh Chinh Nguyen, Vu Tu Quyen Doan, Nguyen Lam Vuong","doi":"10.1097/SLE.0000000000001340","DOIUrl":"10.1097/SLE.0000000000001340","url":null,"abstract":"<p><strong>Objective: </strong>Thoracoscopic sympathicotomy is a well-established treatment for severe palmar hyperhidrosis. This study evaluates the safety and efficacy of a novel one-stage, bilateral, single-port laser sympathicotomy with minimal dissection.</p><p><strong>Methods: </strong>We retrospectively reviewed 73 patients with severe palmar hyperhidrosis who underwent this novel surgical technique between June 2023 and October 2023. Outcomes included complications, recurrent hyperhidrosis, and compensatory hyperhidrosis (CH). Hyperhidrosis severity was assessed using the hyperhidrosis disease severity score (HDSS).</p><p><strong>Results: </strong>The mean patient age was 21.3 ± 7.7 years, with a female predominance (52.1%). Sympathicotomy was performed at the T3 level only in 46 patients (63%), with the remaining undergoing sympathicotomy at both T3 and T4 levels. Median cauterization and operating times were 78 seconds and 8.7 minutes, respectively. No complications occurred. Two patients experienced recurrent hyperhidrosis during a median follow-up of 9 months, both were mild (HDSS grade 1). CH developed in 41 patients (56.2%), with all occurring within the first month postoperatively. The most common sites for CH were the back (51.2%), chest (43.9%), thigh (41.5%), abdomen (36.6%), and lower leg (36.6%). The majority of patients with CH (95.1%) reported mild (HDSS grade 1) or moderate (HDSS grade 2) hyperhidrosis. A higher body mass index was a significant risk factor for CH (odds ratio: 1.36, 95% CI: 1.12-1.71 for every 1 kg/m 2 increase).</p><p><strong>Conclusions: </strong>This minimally invasive, single-port thoracoscopic laser sympathicotomy appears to be safe and effective for patients with palmar primary hyperhidrosis. Future studies should investigate long-term outcomes and refine the technique to minimize invasiveness even further.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628678","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":"Postinsertion Management of Cholecystostomy Tubes for Acute Cholecystitis: A Systematic Review.","authors":"Andrea Spota, Ali Shahabi, Emma Mizdrak, Marina Englesakis, Fabiha Mahbub, Eran Shlomovitz, Eisar Al-Sukhni","doi":"10.1097/SLE.0000000000001336","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001336","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous gallbladder drainage (PGD) is indicated to treat high-risk patients with acute cholecystitis. Trends suggest increasing use of PGD over time as the population ages and lives longer with multiple comorbidities. There is no consensus on the management of cholecystostomies tube once inserted. This review aims to synthesize and describe the most common protocols in terms of the need and timing of follow-up imaging, management of a destination tube, timing of tube removal, and optimal interval time from tube positioning to delayed cholecystectomy.</p><p><strong>Methods: </strong>The study protocol has been registered on the International Prospective Register of Systematic Reviews-PROSPERO. Studies on adult patients diagnosed with acute cholecystitis who underwent a PGD from 2000 to November 2023 were included. The databases searched were MEDLINE, Embase, and Cochrane. The quality assessment tools provided by the NHLBI (National Heart, Lung, and Blood Institute) were applied and descriptive statistics were performed.</p><p><strong>Results: </strong>We included 22,349 patients from 94 studies with overall fair quality (6 prospective and 88 retrospective). In 92.7% of papers, the authors checked by imaging all patients with a PGD (41 studies included). Depending on protocol time, 30% of studies performed imaging within the first 2 weeks and 35% before tube removal (40 studies included). In the case of a destination tube, 56% of studies reported removing the tube (25 studies included). In the case of tube removal, the mean time after insertion was more than 4 weeks in 24 of the 33 included studies (73%). Interval cholecystectomies are more frequently performed after 5 weeks from PGD (32/38 included studies, 84%). Limitations included high clinical heterogeneity and prevalent retrospective studies.</p><p><strong>Conclusions: </strong>A standard management for percutaneous cholecystostomy after insertion is difficult to define based on existing evidence, and currently we can only rely on the most common existing protocols.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":"35 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080989","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 Impact of Cholecystectomy on the Metabolic Profile of Patients Previously Submitted to Bariatric Surgery.","authors":"Álvaro A B Ferraz, Cassio F M Vianna, Deborah F Henriques, Gustavo C F Gorgulho, Fernando Santa-Cruz, Luciana T Siqueira, Flávio Kreimer","doi":"10.1097/SLE.0000000000001348","DOIUrl":"10.1097/SLE.0000000000001348","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the influence of late cholecystectomy following bariatric surgery on the postoperative evolution of weight loss and biochemical, metabolic, and micronutrient parameters.</p><p><strong>Methods: </strong>A retrospective study that assessed 86 patients who underwent cholecystectomy after at least 18 months of bariatric surgery. The analyzed variables included demographic data, comorbidities, weight loss, and biochemical, metabolic, and micronutrient parameters.</p><p><strong>Results: </strong>Among the analyzed patients, 20 underwent gastric bypass (GB) and 66 underwent sleeve gastrectomy (SG). The GB group comprised 55% of women, with a mean age of 54.4 years and a mean preoperative body mass index (BMI) of 29.2 kg/m 2 . The mean time elapsed between GB and cholecystectomy was 118.3±43.9 months. The sample of SG comprised 83.3% of women, with a mean age of 41.1 years and a mean preoperative BMI of 28.7 kg/m 2 . The mean time elapsed between SG and cholecystectomy was 26.1±17.5 months. Both SG and GB groups showed a reduction in the mean BMI, but it was not statistically significant after cholecystectomy. In the metabolic, biochemical, and micronutrient evaluation, there was no statistically significant difference, except in the GB group, where an increase in vitamin D was observed after cholecystectomy with statistical significance.</p><p><strong>Conclusion: </strong>Cholecystectomy does not negatively impact the clinical and anthropometric evolution of patients previously submitted to bariatric surgery.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772531","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":"Rectal Eversion as an Anus-sparing Technique in Laparoscopic Low Anterior Resection With Double Stapling Anastomosis: Long-term Functional Results.","authors":"Servet Karagul, Serdar Senol, Oktay Karakose, Huseyin Eken, Cuneyt Kayaalp","doi":"10.1097/SLE.0000000000001338","DOIUrl":"10.1097/SLE.0000000000001338","url":null,"abstract":"<p><strong>Background: </strong>Rectal eversion (RE) is a natural orifice specimen extraction (NOSE) method that allows anus-sparing resection in very low rectal tumors. This study aims to share the long-term results of RE in laparoscopic rectal resection performed with double stapling anastomosis.</p><p><strong>Materials and methods: </strong>A single-center retrospective cohort study was conducted for patients who underwent laparoscopic low anterior resection with RE. Age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, type of surgery, distance of the tumor to the dentate line, specimen extraction site, cancer stage, preoperative chemoradiotherapy, postoperative complications, and postoperative clinical follow-up findings were recorded. Incontinence was assessed using the Wexner score (WS). Low anterior resection syndrome (LARS) is determined by the LARS score. A 7-point Likert scale was used to evaluate the satisfaction of the patients.</p><p><strong>Results: </strong>A total of 17 patients underwent resection by RE for rectal tumors. Of the 11 patients included in the study, 4 were female and 7 were male. The mean age was 66.09±15.04 years. The mean follow-up was 64.18±16.83 months. The mean tumor diameter was 3.1 cm (range: 0.9 to 7.2 cm). The mean distance of the tumor from the dentate line was 2.7 cm (range: 1.2 to 5.6 cm). No anastomotic leak was observed in any patient. One patient had an anastomotic stenosis and was treated with balloon dilatation. The median LARS score was 16 (range 0 to 32) and 64% of the patients had no LARS. Two patients had minor LARS and 2 patients had major LARS. The median Wexner score was 3.5 (range 0 to 14). The median Likert scale was 7 (range 5 to 7). It was found that 55% of the patients were extremely satisfied, 18% were satisfied, and 27% were slightly satisfied with their surgery. There were no dissatisfied patients.</p><p><strong>Conclusion: </strong>RE is a safe NOSE technique in laparoscopic double stapling anastomosis for rectal resection. There is a high level of long-term patient satisfaction with anus-sparing procedures via RE, even in the presence of various symptoms.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628676","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 Impact of Acupuncture on Pain Intensity, Nausea, and Vomiting for Laparoscopic Cholecystectomy: A Meta-analysis Study.","authors":"Xi Tang, Shijie Qu","doi":"10.1097/SLE.0000000000001349","DOIUrl":"10.1097/SLE.0000000000001349","url":null,"abstract":"<p><strong>Background: </strong>Acupuncture may have some potential in pain relief after laparoscopic cholecystectomy, and this meta-analysis aims to explore the impact of acupuncture on pain intensity, nausea and vomiting for patients undergoing laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>PubMed, EMbase, Web of science, EBSCO, Cochrane library databases, CNKI, VIP, and Wangfang were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of acupuncture on pain control for laparoscopic cholecystectomy.</p><p><strong>Results: </strong>Five RCTs and 366 patients were included in the meta-analysis. Overall, compared with control intervention for laparoscopic cholecystectomy, acupuncture was associated with significantly reduced pain scores at 6 hours [mean difference (MD)=-0.86; 95% CI=-1.37 to -0.34; P =0.001, 2 RCTs) and pain scores at 8 to 10 hours (MD=-0.71; 95% CI=-1.13 to -0.28; P =0.001, 2 RCTs), decreased incidence of nausea (odds ratio=0.10; 95% CI=0.03-0.34; P =0.0003, 3 RCTs), and vomiting (odds ratio=0.11; 95% CI=0.01-0.85; P =0.03, 3 RCTs), but demonstrated no obvious impact on pain scores at 12 to 24 hours (MD=-0.38; 95% CI=-1.02 to 0.27; P =0.25, 2 RCTs).</p><p><strong>Conclusions: </strong>Acupuncture may be effective to reduce pain intensity, nausea, and vomiting for laparoscopic cholecystectomy.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772528","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":"Rouvière's Sulcus as a Landmark for a Safe Laparoscopic Cholecystectomy: An Interim Analysis of a Multicenter Cross-sectional Study on the Prevalence and Morphologic Type of Rouvière's Sulcus in the Italian Population.","authors":"Roberto Cirocchi, Luca Properzi, Matteo Matteucci, Marco Artico, Nereo Vettoretto, Jacopo Desiderio, Antonio Di Cintio, Domenico Di Nardo, Federico Farinacci, Alessandro Gemini, Lorenzo Guerci, Stefano Mazzetti, Francesco Ricci, Stefano Trastulli, Stefano Avenia, Carlo Boselli, Bruno Cirillo, Gioia Brachini, Piergiorgio Fedeli, Giulia Montori, Pietro Ursi, Ruggero Iandoli, Carlo Bergamini, Alessio Giordano, Alberto Santoro, Andrea Mingoli, Pavlos Antipas, Giovanni Domenico Tebala","doi":"10.1097/SLE.0000000000001351","DOIUrl":"10.1097/SLE.0000000000001351","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic cholecystectomy is the gold standard in the treatment of symptomatic gallstones. The large number of gallbladders removed every year is not fully consistent with the excessively high incidence of iatrogenic bile duct injury (IBDI). Several strategies have been suggested to reduce this risk. Among them, the use of extra biliary anatomic structures, such as the Rouvière's sulcus, as a landmark to guide the surgeon during dissection has been proposed as a means to prevent IBDI. The main aim of the present paper is the evaluation of the prevalence of Rouvière's sulcus (RS) and its anatomic variants in a given population.</p><p><strong>Materials and methods: </strong>This observational, cross-sectional, and multicenter study has been conducted at the Department of Digestive and Emergency Surgery of the \"Azienda Ospedaliera Santa Maria,\" Terni (Italy), at the Department of Surgical Sciences of the \"Azienda Ospedaliera Perugia,\" Perugia (Italy) and at the Department of Emergency and Trauma Surgery of the \"Policlinico Umberto I,\" Rome (Italy). Intraoperative images of 111 patients undergoing laparoscopic cholecystectomy were analyzed to identify the presence and type of RS, according to the Singh-Prasad classification and the Dahmane classification.</p><p><strong>Results: </strong>RS was present in 93 (83.8%) patients. Singh-Prasad type 1A is present in 48.4% of patients, type 1B in 25.8%, type 2 in 12.9% and type 3 in 12.9%. Dahmane's open type is present in 48.4% of patients and fused type in 51.6%.</p><p><strong>Conclusion: </strong>Due to its high prevalence, RS can be used as an anatomic landmark and probably reduces the incidence of IBDI during laparoscopic cholecystectomy.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795217","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":"Clinical Efficacy of Endoscopic Retrograde Cholangiopancreatography Combined With Traditional Chinese Medicine Comprehensive Nursing in the Treatment of Biliary Tract Complications After Liver Transplantation.","authors":"Yingjia Li","doi":"10.1097/SLE.0000000000001337","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001337","url":null,"abstract":"<p><strong>Objective: </strong>This study explored the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) combined with traditional Chinese medicine (TCM) comprehensive nursing in treating biliary tract complications (BTCs) after liver transplantation (LT).</p><p><strong>Materials and methods: </strong>A total of 124 patients with BTCs after LT were screened and randomly divided into a control group and an experimental group. Both groups of patients underwent ERCP treatment and patients in the control group received conventional nursing, and those in the experimental group received TCM comprehensive nursing on top of the control group. The clinical efficacy after 1 month of intervention was recorded. Before intervention and 1 month after intervention, fasting venous blood was collected to detect the levels of hepatic function indicators alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The negative emotions of the patients were evaluated by using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), and the quality-of-life scores were determined by using the Quality-of-Life Scale. Postintervention complications, such as pancreatitis, hyperamylasemia, and reflux cholangitis, were recorded.</p><p><strong>Results: </strong>The total effective rate in the experimental group (90.32%) was higher than that in the control group (72.58%). ALT, AST, SAS, and SDS scores of the 2 groups after treatment were lower than before treatment, and the scores of quality of life were higher. Greater improvements were observed in the experimental group. The complication rate of the experimental group (3.23%) was lower than that of the control group (22.58%) (P<0.05).</p><p><strong>Conclusion: </strong>ERCP combined with TCM comprehensive nursing for patients with BTCs after LT can effectively reduce anxiety and depression, improve the quality of life, and reduce the incidence of complications.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":"35 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080985","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":"Novel Robotic Valvuloplastic Esophagogastrostomy Technique After Proximal Gastrectomy: A Safety and Feasibility Study.","authors":"Neda Amini, Takahiro Kinoshita, Manuel Arrieta, Mitsumasa Yoshida, Hiromi Nagata, Takumi Habu, Masaru Komatsu, Masahiro Yura","doi":"10.1097/SLE.0000000000001322","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001322","url":null,"abstract":"<p><strong>Background: </strong>Esophagogastrostomy is one of the reconstruction techniques after proximal gastrectomy, but reflux and esophagitis are significant concerns. We introduced a new robotic valvuloplasty technique (single-flap), taking advantage of robotic surgery to address these issues and simplify the technique, especially for tumors with esophageal invasion.</p><p><strong>Methods: </strong>Between March 2022 and March 2024, patients who underwent robotic proximal gastrectomy with the single-flap technique were included. Based on the difficulty of the surgery, patients were divided into 2 groups: one with esophageal invasion requiring anastomosis in the mediastinum and the second group with tumors in the upper third of the stomach requiring anastomosis in the abdomen.</p><p><strong>Results: </strong>A total of 22 patients were included: 13 in the esophageal invasion group and 9 in the upper stomach group. The median size of esophageal invasion was 2 cm (1 to 3 cm). The median operative time was 320 minutes (esophageal invasion 326 vs. upper stomach 280 min, P=0.51), with a median blood loss of 35 g (31 vs. 38 g, P=0.19). No postoperative mortality, anastomotic leaks, reflux symptoms, or pancreatic fistulas were observed. Eighteen patients underwent endoscopic evaluation, and no sign of esophagitis was detected. Five patients (22.7%) developed grade III strictures requiring endoscopic balloon dilation (esophageal invasion 32.1% vs. upper stomach 22.2%; P=0.96).</p><p><strong>Conclusions: </strong>Robotic proximal gastrectomy with single-flap valvuloplastic esophagogastrostomy is a safe and feasible option for gastroesophageal junction tumors with up to 3 cm of esophageal invasion.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080982","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":"Impact of a Quantitative Early Activity Program on Gastrointestinal Function Following Laparoscopic Pancreaticoduodenectomy: A Single-Center Retrospective Analysis.","authors":"Ling Zhang, Fan Zhang, Chen-Jie Xiao, Yue-Fen Shu, Zheng Li, Jun Wang, Wen-Jie Tang","doi":"10.1097/SLE.0000000000001357","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001357","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to assess the impact of a quantitative early activity program, integrated into the Enhanced Recovery After Surgery (ERAS) protocol on gastrointestinal function in patients undergoing laparoscopic pancreatoduodenectomy (LPD).</p><p><strong>Methods: </strong>Perioperative data from 203 patients who underwent LPD at the Department of Comprehensive Treatment of Pancreatic Cancer, Fudan University Shanghai Cancer Center, between January 2021 and December 2022 were analyzed retrospectively. The patients were categorized into 2 groups based on their nursing plans. Group A received the standard perioperative ERAS nursing plan, while group B followed the ERAS plan supplemented with a quantitative early activity program. We assessed postoperative outcomes including bowel sound recovery time, time to first anal exhaust, time to first mobilization, activity compliance 1-week postsurgery, and incidence of postoperative breakthrough pain.</p><p><strong>Result: </strong>We compared several postoperative metrics between group A and group B. Specifically, the time to bowel sound recovery was 62.39±17.89 hours in group A versus 56.45±22.85 hours in group B. The time to first anal exhaust was 78.88±71.99 hours in group A compared with 63.62±24.73 hours in group B. The time to first mobilization was 56.98±18.66 hours in group A versus 49.85±20.48 hours in group B. In addition, activity compliance 1-week postsurgery and the incidence of postoperative breakthrough pain (1.55±2.01 times in group A vs. 0.94±1.16 times in group B) were also compared. All these differences were statistically significant (P<0.05). Conversely, the incidence of postoperative complications and the length of hospital stay (11.20±5.69 d in group A vs. 12.47±6.67 d in group B) did not reveal any significant differences (P>0.05).</p><p><strong>Conclusion: </strong>The quantitative early activity program for LPD, based on the ERAS protocol, enhances the adherence to postoperative activity and decreases the incidence of breakthrough pain, thereby facilitating gastrointestinal function recovery in patients. This approach merits clinical adoption.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080980","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":"Endoscopic Papillary Balloon Dilation Versus Small Endoscopic Sphincterotomy for Endoscopic Retrograde Cholangiopancreatography-Related Adverse Events in Patients With Non-Dilated Distal Bile Duct.","authors":"Lili Gao, Huafang Yan, Limei Bu, Hao Zhang","doi":"10.1097/SLE.0000000000001200","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001200","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopic papillary balloon dilation (EPBD), small endoscopic sphincterotomy (EST), and small EST plus EPBD are commonly used as rescue techniques to remove bile duct stones. However, we often encountered challenging cases with non-dilated distal bile ducts, especially in those undergoing EPBD. We aimed to explore the reasons by assessing whether patients without the dilated bile duct had a higher risk of early complications and whether it was impacted by the rescue techniques.</p><p><strong>Methods: </strong>We performed a retrospective cohort study by frequency matching design in patients diagnosed with stones in non-dilated distal bile duct who received rescue techniques from July 2016 to June 2022. Besides, patients with stones and without dilatation of the distal bile duct (DDBD) were divided into 3 subgroups according to the rescue technique received. Outcomes were compared between the subgroups.</p><p><strong>Results: </strong>The non-DDBD group was more likely to develop post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and hyperamylasemia (HP) than the DDBD group (P < 0.05). Some cases had mild or moderate pancreatitis, but no one in either group developed severe pancreatitis. For subgroup analysis, each technique resulted in complete stone removal; the EPBD group had a higher HP rate than the other subgroups and reached statistical significance: the EPBD group versus the small EST group (P = 0.013) and the EPBD group versus the EPBD plus small EST group (P = 0.008). Although there was no statistical significance, PEP incidence in the EPBD group was 13.7% higher than in other subgroups (P > 0.05/3).</p><p><strong>Conclusion: </strong>Non-DDBD patients have a higher risk for endoscopic retrograde cholangiopancreatography-related pancreatic inflammation. EPBD should be used cautiously due to the significant association with increased rates of PEP and HP. Conversely, small EST and combination therapy are suitable for non-dilated bile duct stones because of their high safety profile and efficacy.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080978","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}