Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

{"title":"Impact of Ursodiol on Number of Cholecystectomies Performed After Bariatric Surgery.","authors":"Romulo Lind, Estela Abich, Rodrigo Neves, Icaro Barreto, Kareem Jawad, Muhammad Ghanem, Muhammad A Jawad, Andre F Teixeira, Graziella Galvao Goncalves","doi":"10.1097/SLE.0000000000001354","DOIUrl":"10.1097/SLE.0000000000001354","url":null,"abstract":"<p><strong>Background: </strong>The risk of gallstone formation is greater in obese patients; paradoxically, the rapid weight loss after bariatric surgery (BS) is also a great contributor to cholelithiasis and biliary disease. While concomitant cholecystectomy has been used to mitigate this issue, the demand for a less invasive prophylaxis was met by ursodeoxycholic acid (UDCA). This study aims to evaluate the impact of UDCA on the incidence of cholecystectomies after BS.</p><p><strong>Methods: </strong>This retrospective chart review included all primary and revisional bariatric procedures. Patients were divided into 2 groups based on the postoperative use of daily 600 mg UDCA for 6 months (group 2) or no UDCA use (group 1) to assess its impact on the incidence of cholecystectomy. A subanalysis compared baseline demographics, weight loss performance, and the number of cholecystectomies between groups.</p><p><strong>Results: </strong>In a cohort of 8433 patients, 5061 were in group 1, and 3372 were in group 2 who received UDCA. The total number of cholecystectomies after BS was 164 (1.9% of the cohort): 146 in group 1 (2.9%) and 18 in group 2 (0.5%) ( P <0.00). A subanalysis revealed no significant differences in preoperative weight, body mass index (BMI), and postoperative total body weight loss (TBWL%) between the groups. Nonetheless, incidences of cholecystectomy after biliopancreatic diversion with duodenal switch (BPD-DS), Roux-en-Y Gastric Bypass (RYGB), and sleeve gastrectomy (SG) were greater in group 1, 8% versus 1.4%, 4.4% versus 0.1%, and 1.7% versus 0.4%, respectively (all P <0.05).</p><p><strong>Conclusion: </strong>UDCA is associated with lower incidence rates of cholecystectomy after BS.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042716","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 Effects of Erector Spinae Plane Block Versus Incision Site Local Anesthetic Infiltration on Stress Hormone Response in Patients Undergoing Laparoscopic Cholecystectomy: Randomized Controlled Study.","authors":"Murat Sahin, Cinar A Surhan, Altinay Mustafa, Cetiner Ilay, Uyanikoglu Ozge, Omeroglu Sinan","doi":"10.1097/SLE.0000000000001373","DOIUrl":"10.1097/SLE.0000000000001373","url":null,"abstract":"<p><strong>Background: </strong>After laparoscopic cholecystectomy surgery, an increase in stress hormones and moderate-to-severe pain occur in the postoperative period. The aim is to compare the effects of unilateral erector spinae plane block (ESPB) and port site local anesthetic (LA) infiltration methods on stress hormone response and postoperative pain in laparoscopic cholecystectomy operations.</p><p><strong>Methods: </strong>This study was a prospective, randomized controlled, single-blind trial that divided laparoscopic cholecystectomy patients into 3 groups. In group I, local anesthetic infiltration was administered at 4 trocar sites; group E underwent unilateral ESPB guided by ultrasound; and group C was the control group with no intervention. Stress hormones were measured preoperatively and postoperatively, and postoperative VAS scores were recorded. The primary outcome was to compare the effects of LA infiltration and ESPB on stress hormone response, while the secondary outcome was the efficacy of postoperative analgesia.</p><p><strong>Results: </strong>A total of 90 patients were included in the study. The duration of analgesia was significantly longer in group I compared with group C ( P <0.05). Postoperative VAS scores were significantly lower in group E and group I than in group C ( P <0.05). Group E significantly suppressed prolactin levels compared with the other 2 groups ( P <0.05). In addition, group E significantly reduced glucose levels compared with group C ( P <0.05).</p><p><strong>Conclusion: </strong>Unilateral ESPB and infiltration have similar effects on pain and stress hormones after laparoscopic cholecystectomy. Infiltration may be preferred due to its easier application.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047267","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":"Mechanisms of Gastroesophageal Reflux Post-Roux-en-Y Gastric Bypass: Universal Alteration of the Antireflux Barrier is the Culprit.","authors":"Barham K Abu Dayyeh, Karim Al Annan, Razan Aburumman, Tala Abedalqader, Rudy Mrad, Khushboo Gala, Vitor Brunaldi, Omar M Ghanem","doi":"10.1097/SLE.0000000000001366","DOIUrl":"10.1097/SLE.0000000000001366","url":null,"abstract":"<p><strong>Introduction: </strong>Gastroesophageal reflux disease (GERD) symptoms and the use of proton pump inhibitors (PPIs) remain prevalent after Roux-en-Y Gastric Bypass (RYGB), despite it being known to alleviate reflux. The physiological changes behind long-term GERD and hiatal hernia (HH) prevalence post-RYGB are not commonly investigated.</p><p><strong>Methods: </strong>In this consecutive cohort study, we examined patients who underwent RYGB and subsequent upper endoscopy, conducted by an expert bariatric endoscopist. The primary focus was on pouch endoscopic retrosflexion to evaluate the antireflux barrier (ARB). We gathered data encompassing patient demographics, anthropometrics, comorbidities, and findings from esophagogastroduodenoscopy (EGD) at the time of surgery and during follow-up EGD.</p><p><strong>Results: </strong>Our study included a total of 42 patients, predominantly female (97.5%) and White (100%), with an average age of 53.6±10.6 years and a body mass index (BMI) of 32.9±9.4 kg/m 2 . In our findings, all EGDs revealed the presence of a HH of varying sizes. The average HH size was 2.07±0.87 cm. The esophagogastric junction (EGJ) flap was also effaced in all patients with the majority (90.4%, 38 patients) classified as Hill grade IV and a smaller proportion (9.6%, 4 patients) as Hill grade III. Notably, PPI usage increased from the time of surgery to the time of EGD (69.0% vs. 42.9%, P =0.06).</p><p><strong>Conclusion: </strong>This research highlights the high incidence of HH and EGJ flap effacement in patients after RYGB, potentially elucidating the persistence of reflux symptoms, including weakly acidic or alkaline reflux, post-RYGB.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812445","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":"Surgical Technique of Robotic Distal Gastrectomy for Gastric Cancer Using the Hinotori Surgical System.","authors":"Masaaki Nishi, Chie Takasu, Yuma Wada, Takuya Tokunaga, Hideya Kashihara, Daichi Ishikawa, Toshiaki Yoshimoto, Chiharu Nakasu, Mistuo Shimada","doi":"10.1097/SLE.0000000000001369","DOIUrl":"10.1097/SLE.0000000000001369","url":null,"abstract":"<p><strong>Aim: </strong>The da Vinci Surgical System (Intuitive Surgical) currently dominates robotic gastrectomy for gastric cancer. The hinotori Surgical Robot System (Medicaroid Corporation) is a newly developed, Japan-made surgical assist robot. This study aimed to introduce the initial experience of robotic gastrectomy using the hinotori and discuss key techniques and challenges.</p><p><strong>Methods: </strong>This single-center retrospective study involved 10 eligible patients who underwent curative robotic distal gastrectomy using the hinotori for primary Stage I to III gastric cancer. Short-term surgical outcomes were evaluated. Lymph node dissection was mainly performed using the conventional double bipolar technique, left-handed double bipolar technique, or laparoscopic coagulation shears from the assist port.</p><p><strong>Results: </strong>No patients developed intraoperative complications, and all procedures were successfully completed without conversion to open or laparoscopic surgery. All patients achieved R0 resection. The median operation time was 275 minutes (range, 252 to 336 min), and the estimated blood loss was 5 mL (range, 3 to 20 mL). The drain amylase content on postoperative day 1 was 220.5 IU/L (range, 66 to 1207 IU/L). The median number of retrieved lymph nodes was 29.5 (range, 11 to 58). No patients developed postoperative Clavien-Dindo grade ≥IIIa complications, and there was no mortality.</p><p><strong>Conclusion: </strong>Robotic gastrectomy using the hinotori shows potential benefits for gastric cancer. Further studies are needed to validate these advantages.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803532","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 and Safety of Robotic Bilateral Axillo-Breast Approach Versus Robotic Gasless Axillary Approach for Thyroidectomy: A Systematic Review and Meta-Analysis.","authors":"Abdulkreem A Al Juhani, Faisal Alzahrani, Aya K Esmail, Raghad F AlRasheed, Abdullah Esmail, Hasan M Alnakhli, Lujain B Alotaibi, Bayan M Alturki, Mohammed A Borah, Ghala S Alahmari","doi":"10.1097/SLE.0000000000001370","DOIUrl":"10.1097/SLE.0000000000001370","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the comparative efficacy and safety of robotic thyroidectomy techniques, including the robotic bilateral axillo-breast approach (BABA) and the robotic gasless axillary approach (GAA).</p><p><strong>Data sources: </strong>A comprehensive literature search was conducted across 5 major electronic databases (PubMed, Embase, Cochrane Library, Web of Science, and Scopus) to identify relevant studies published until May 2024.</p><p><strong>Review methods: </strong>Analysis was conducted using RevMan 5.4 software with pooled mean and rate ratios calculated with 95% CIs.</p><p><strong>Results: </strong>A total of 73 studies, comprising 70 eligible for meta-analysis, were included. Compared with robotic GAA, robotic BABA was associated with significantly longer operative time (pooled mean: 64.65 min, 95% CI: 51.77-77.53, P <0.00001), increased hospital stay (pooled mean: 1.24 d, 95% CI: 0.92-1.56, P <0.00001), and higher intraoperative bleeding (pooled mean: 44.90 mL, 95% CI: 26.99-62.81, P <0.00001). While no significant differences were observed in the rates of hypoparathyroidism, recurrent laryngeal nerve palsy, chyle leakage, seroma, hematoma, or infection, the incidence of Horner syndrome was significantly higher in the BABA group (pooled risk ratio: 0.01, 95% CI: 0.00-0.05, P =0.003).</p><p><strong>Conclusions: </strong>Robotic BABA was associated with longer operative times, increased hospital stays, and higher intraoperative bleeding compared with Robotic GAA, although both techniques demonstrated comparable safety profiles for most outcomes. The higher incidence of Horner syndrome with BABA should be considered when selecting the optimal surgical approach for thyroidectomy.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019677","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":"Down-to-Top Enhanced View-Totally Extraperitoneal Repair for Upper Midline Ventral Hernia Repair: Initial Experience and Surgical Technique.","authors":"Jae Kyun Park, Jane Chungyoon Kim, Min-Gyu Kim, Seungho Lee, Jeesun Kim, Yo-Seok Cho, Do Joong Park, Hyuk-Joon Lee, Han-Kwang Yang, Seong-Ho Kong","doi":"10.1097/SLE.0000000000001371","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001371","url":null,"abstract":"<p><strong>Purpose: </strong>The extended totally extraperitoneal (eTEP) approach is a novel repair method for ventral hernias. This study evaluated the feasibility and initial outcomes of a down-to-top eTEP repair technique for upper midline ventral hernias, addressing the challenges of subxiphoid midline crossing.</p><p><strong>Materials and methods: </strong>The clinical data of 14 patients who underwent down-to-top eTEP surgery for upper midline ventral hernias at Seoul National University Hospital between January 2018 and December 2022 were retrospectively studied. Patients with M1 or M2 components according to the European Hernia Society classification were included.</p><p><strong>Results: </strong>The mean age was 55.9 ± 13.6 years, and mean BMI was 25.9 ± 3.5 kg/m2. The mean defect area was 41.1 ± 22.5 cm2. Five patients underwent transversus abdominis release (TAR). Mean operative time was 178.3 ± 50.3 minutes in the non-TAR group and 288 ± 89.7 minutes in the TAR group. Mean hospital stay was comparable between non-TAR (5.2 ± 2.5 d) and TAR (4.8 ± 1.3 d) groups. Mean postoperative pain scores (VAS) were 3.8 on day one and 2.6 on day 3. The hernia sac was preserved in 5 patients (33.3%). No major postoperative complications occurred. No hernia recurrence was observed during the mean follow-up of 20.4 months.</p><p><strong>Conclusion: </strong>The down-to-top eTEP approach for upper midline ventral hernia repair appears feasible and safe. This technique can be performed with TAR when necessary and is effective for repairing defects in all cases. Hernia sac preservation may reduce the need for TAR. This approach may be particularly beneficial when subxiphoid midline crossing is challenging.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":"35 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209560","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":"Minimizing Omental Bleeding Risk Following Sleeve Gastrectomy: Assessing the Double-line Sealing Technique.","authors":"Muhammed Said Dalkiliç, Mehmet Gençtürk, Merih Yilmaz, Hasan Erdem, Abdullah Şişik","doi":"10.1097/SLE.0000000000001323","DOIUrl":"10.1097/SLE.0000000000001323","url":null,"abstract":"<p><strong>Objective: </strong>Laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed bariatric procedure due to its technical simplicity and effectiveness. While stapler line reinforcement has significantly reduced hemorrhagic complications, postoperative bleeding remains a concern, particularly from omentum or unidentified sources. The LigaSure device, known for sealing vessels successfully up to 7 mm in diameter, may face challenges in obese patients due to excessive omental fat. This study introduces a double-sealing technique as a simple solution aimed at reducing postoperative bleeding related to patient-specific factors.</p><p><strong>Methods: </strong>This study conducts a retrospective analysis to evaluate the double-line omental sealing technique in LSG, an intervention aimed at reducing the incidence of postoperative bleeding. We compared outcomes from 222 patients using the double-line sealing (DLS) technique and 297 patients with standard dissection. DLS technique involves creating 2 adjacent rows of seals on the omentum during dissection, aiming to minimize bleeding risks. Patient demographics, including age, sex, body mass index, and comorbidities, were examined, alongside operative time, length of hospital stay, and instances of reoperation. Special attention was given to identifying cases of severe postoperative bleeding, primarily determined by the need for blood transfusion.</p><p><strong>Results: </strong>No demographic differences emerged between the groups. The study group, which utilized DLS, demonstrated a significantly lower incidence of intraperitoneal severe bleeding (0.45%) compared with the control group (3%). Reoperations were significantly reduced, with only 2 cases (0.67%) in the control group and none in the DLS group. It also correlates with reduced length of hospital stay but increased operative time.</p><p><strong>Conclusions: </strong>DLS in LSG shows promise in reducing severe postoperative bleeding. Despite these positive initial findings, further studies with larger sample sizes are recommended to fully ascertain the efficacy and safety of this technique.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795215","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":"Comparison of Weight Loss and Improvement in Metabolic Comorbidities Between Endoscopic Gastroplasty and Lifestyle Modifications: A Meta-analysis.","authors":"Kai Siang Chan, Sapphire Ho, Kathleen Pang, Aaryan Nath Koura, Aung Myint Oo, Saleem Ahmed, Danson Xue Wei Yeo, Charleen Yeo","doi":"10.1097/SLE.0000000000001361","DOIUrl":"10.1097/SLE.0000000000001361","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic gastroplasty (EG) is a less invasive method for managing obesity compared with bariatric surgery. However, evidence on the use of EG is still scarce. This study aims to review existing evidence comparing EG with lifestyle modifications (LM) in terms of weight loss and improvement in metabolic syndrome.</p><p><strong>Materials and methods: </strong>A systematic search was performed on PubMed, Embase, and the Cochrane Library from inception to August 2023. Exclusion criteria were patients who received concomitant pharmacological therapy for weight loss, the use of other endoscopic interventions apart from EG, and patients with prior bariatric surgery. Based on the heterogeneity of included studies, meta-analysis was performed using either a fixed-effect model or a random-effect model.</p><p><strong>Results: </strong>There were 5 studies (4 RCTs and 1 retrospective study) with 1007 patients included in the pooled analysis. Only a minority were males (n=199, 19.8%), and only 1 study included a Sham procedure in the LM group. Six-month percentage total body weight loss (%TBWL) (n=3 studies, MD: 6.34, 95% CI: 2.89, 9.78, P <0.01) and 12-month %TBWL (n=4 studies, MD: 6.43, 95% CI: 2.62, 10.25, P <0.01) were significantly higher in EG compared with LM. Patients in the EG group also had significant improvement in control of diabetes mellitus (n=2 studies, OR: 29.10, 95% CI: 5.84, 145.08) and hypertension (n=2 studies, OR: 2.35, 95% CI: 1.18, 4.70) compared with LM. Incidence of serious adverse events ranged from 2% to 5%.</p><p><strong>Conclusion: </strong>EG is effective for weight loss and improvement in metabolic comorbidities compared with LM alone but is suboptimal based on the Food and Drug Administration thresholds.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598056","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":"Comparison of Various Diet Regimens Involving Sennoside for Bowel Cleansing Prior to Colonoscopy: A Randomized Controlled Trial.","authors":"Hilmi Bozkurt, Enver Reyhan, Cumhur Özcan, Tahsin Çolak, Mustafa Onur Beştaş, Didem Derici Yıldırım","doi":"10.1097/SLE.0000000000001368","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001368","url":null,"abstract":"<p><strong>Background: </strong>Consuming only low-fiber food on the day before the procedure is recommended as standard practice for bowel cleansing in patients using polyethylene glycol (PEG). However, there have been few studies to date investigating the optimal dietary regimen for patients using the more cost-effective Sennoside A+B calcium before colonoscopy. The present study compares the quality of bowel preparation of patients following a clear diet and those following a low-fiber diet on the day before colonoscopy among patients using Sennoside A+B calcium.</p><p><strong>Methods: </strong>This prospective, randomized, and investigator-blinded study was conducted between November 2023 and February 2024. Included in the study were 150 patients aged 18 years and over with a mean age of 55.6±14 years, with 75 patients assigned to the clear diet group and 75 patients to the low-fiber diet group. The assessment of colonoscopy cleanliness before colonoscopy was conducted using the Boston Bowel Preparation Scale (BBPS).</p><p><strong>Results: </strong>None of the patients experienced intolerance. The mean overall total cleanliness score, measured using the BBPS, was 7.24±2.1, with 7.48 ± 2.1 in the low-fiber diet group and 7.0 ±2.1 in the clear liquid diet group. No significant difference in cleanliness was found between the 2 groups (P=0.096).</p><p><strong>Conclusion: </strong>Patients using cost-effective Senna for bowel cleansing before colonoscopy can safely consume low-fiber foods on the day before the procedure. In the present study, a clear diet offered no benefit over a more comfortable and better-tolerated diet in terms of colon cleanliness.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182067","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 Reverse Cholangiopancreatography (LRCP): Our Algorithm For Laparoscopic Common Bile Duct Exploration (LCBDE).","authors":"Robin R Cotter, Tawni M Johnston, Casey R Lamb, Eleah D Porter, Jenaya L Goldwag, James C Cooros, D Joshua Mancini, Kari M Rosenkranz, B Fernando Santos","doi":"10.1097/SLE.0000000000001377","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001377","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic common bile duct exploration (LCBDE) is safe and efficacious. \"Classic\" LCBDE technique utilizes isolated choledochoscope-guided retrograde basketing; however, it is less effective than transcholedochal exploration. We report on the evolution of our LCBDE technique away from \"classic\" transcystic approach towards prioritizing antegrade clearance using a novel algorithm utilizing a variety of tools, which we term laparoscopic reverse cholangiopancreatography (LRCP).</p><p><strong>Methods: </strong>We report an algorithm-driven LRCP technique for LCBDE that tailors intervention to the patient's anatomy and stone burden (size, location, number) seen on cholangiogram (IOC). For cystic ducts ≥4 mm, we use a choledochoscope-assisted technique versus a fluoroscopy-guided technique if <4 mm. For small stones, we use wire basketing (with the \"classic\" technique) or the \"snow-plow\" maneuver. For medium (≤10 mm) or multiple stones, we utilize sphincteroplasty plus \"snow-plow\" if needed. For large (>10 mm), we use laser or electrohydraulic lithotripsy. Fallback methods are ERCP or transcholedochal exploration.</p><p><strong>Results: </strong>We retrospectively reviewed our 80 LCBDE cases at a single Veterans Affairs hospital: 50 cases in the \"classic\" phase and 30 subsequent cases using LRCP. Transcystic clearance was significantly higher for LRCP at 97% vs. 56% during the \"classic\" phase (χ2=15.14, P<0.001). There was zero utilization of choledochotomy during LRCP.</p><p><strong>Conclusions: </strong>Algorithm-driven LRCP dramatically improved transcystic clearance success and reduced reliance on choledochotomy. Our algorithm serves as a decision aid, allowing surgeons to utilize a variety of available tools for LCBDE.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094943","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}