Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Retroperitoneoscopic Vascular Hitch Procedure for Pelvi-Ureteric Junction Obstruction in Children-The Southampton Experience.","authors":"Rosie Cresner, Jessica Ng, Stephen Griffin, Sengamalai Manoharan, Ewan Brownlee","doi":"10.1177/10926429251385352","DOIUrl":"https://doi.org/10.1177/10926429251385352","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> There has been a longstanding debate regarding whether lower pole renal crossing vessels on the pelvi-ureteric junction preclude the need for a dismembered pyeloplasty. A retroperitoneoscopic technique for a transposition of these vessels has not yet been described in the literature. We report our early experience of the retroperitoneoscopic vascular hitch procedure for transposition of lower pole renal crossing vessels, including technique and outcomes. <b><i>Methods:</i></b> Single-center retrospective review of all children who had a retroperitoneoscopic vascular hitch procedure for pelvi-ureteric junction obstruction from March 2022 to April 2024. Data on symptom resolution, change in sonographic anterior-posterior diameter (APD), MAG-3 (mercaptoacetyltriglycine) renogram curves, postoperative length of stay, complications, and further surgical interventions were collected. Results are reported as median and interquartile range. <b><i>Results:</i></b> Ten patients (70% male, median age 11.7 years, range 8-13 years) with preoperative APD of 34 mm (23-40) over the 2-year period were included. One patient received an on-table diuretic stress test. Seven out of 10 patients had day-case surgery, and 3 patients had an overnight stay. The follow-up period was 343 days (122-456). Postoperative APD was 13 mm (6-23), and the change in APD was -18 mm (-25 to -10). No loss of function or uptake areas on MAG-3 scans were observed. Two patients received antibiotics for a presumed urinary tract infection in the postoperative period. Symptom resolution was achieved in 90% of patients, and 1 patient underwent robotic-assisted dismembered pyeloplasty 10 months later. <b><i>Conclusion:</i></b> Retroperitoneoscopic vascular hitch for lower pole renal crossing vessels is an acceptable alternative to dismembered pyeloplasty in selected pediatric cases.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226066","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":"Endoloop Versus LigaSure for Appendiceal Stump Closure in Pediatric Laparoscopic Appendectomy: A Multicenter Prospective Trial.","authors":"Şenay Kurtuluş, Alev Süzen, Neslihan Kaya Terzi, Serkan Yaşar Çelik","doi":"10.1177/10926429251382515","DOIUrl":"https://doi.org/10.1177/10926429251382515","url":null,"abstract":"<p><p><b><i>Background:</i></b> Appendiceal stump closure is critical in laparoscopic appendectomy (LA) to prevent complications such as stump leakage and intra-abdominal abscess formation. This study aims to evaluate the safety and effectiveness of LigaSure™ versus Endoloop for appendiceal stump closure in pediatric LA. <b><i>Methods:</i></b> This prospective multicenter comparative study included 199 pediatric patients who underwent LA between May 2021 and October 2023 at two pediatric surgery clinics. Patients were allocated to the LigaSure group (<i>n</i> = 74) or Endoloop group (<i>n</i> = 125) based on the surgeon's intraoperative preference. Data collected included demographic characteristics, laboratory and radiological findings, intraoperative details, postoperative complications, and histopathological measurements of appendiceal and lumen diameters. Statistical analyses were performed using the independent samples <i>t</i>-test and chi-square test, with significance at <i>P</i> < .05. <b><i>Results:</i></b> No significant differences were observed between groups regarding age (<i>P</i> = .670), gender (<i>P</i> = .439), leukocyte count (<i>P</i> = .072), or C-reactive protein levels (<i>P</i> = .368). Complicated appendicitis was more prevalent in the LigaSure group (12.2%) compared to the Endoloop group (5.6%). No intra-abdominal abscesses or stump leakage were reported in either group. Histopathological analysis revealed no significant difference in mean appendiceal diameter (LigaSure: 8.9 ± 0.2 mm; Endoloop: 8.9 ± 0.1 mm; <i>P</i> = .743) or lumen diameter (<i>P</i> = .096). The largest lumen diameter measured in appendix specimens was 5113 μm, while the smallest was 255.6 μm (<i>P</i> = .096). No cases of intra-abdominal abscess or stump leakage were reported. The mean hospital stay was comparable (LigaSure: 2 ± 0.2 days; Endoloop: 2 ± 0.1 days; <i>P</i> = .068). <b><i>Conclusion:</i></b> LigaSure™ is a safe and effective alternative to Endoloop for appendiceal stump closure in pediatric LA. The device's ability to provide a secure seal makes it a reliable option, even in cases of complicated appendicitis.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226144","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":"First Description of Redo Gastric Per-Oral Endoscopic Myotomy for Refractory Gastroparesis: Technical Conduct and Outcomes.","authors":"Mélissa V Wills, Valentin Mocanu, Sol Lee, Salvador Navarrete, John Rodriguez, Andrew Strong, Jerry Dang, Matthew Allemang, Matthew Kroh","doi":"10.1177/10926429251384091","DOIUrl":"https://doi.org/10.1177/10926429251384091","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Gastroparesis is a progressive disease that may require endoscopic or surgical intervention, such as gastric per oral endoscopic myotomy (G-POEM), when conservative measures are ineffective or not tolerated. Limited data exist on redo G-POEM safety and effectiveness. We describe outcomes of patients undergoing repeat G-POEM for refractory gastroparesis. <b><i>Methods:</i></b> A retrospective review of patients who underwent redo G-POEM at our center from 2008 to 2024. Data included demographics, gastroparesis etiology, previous treatments, Gastroparesis Cardinal Symptom Index (GCSI), gastric emptying studies (GES), and clinical outcomes. <b><i>Results:</i></b> Three patients (mean age at first G-POEM 52.3 ± 19 years) were identified. All procedures were technically successful, and all 3 patients survived to discharge without major complications. Patient A (sarcoidosis-induced gastroparesis) had transient symptomatic improvement after the first G-POEM, but symptoms deteriorated the following year. GES showed initial improvement (26% to 14% 4-hour retention) but returned to baseline (26%) after the second G-POEM. She ultimately required jejunostomy tube placement. Patient B (idiopathic gastroparesis) with a history of renal transplant showed no objective improvement in GES after either procedure (40% to 41% 4-hour retention) and remained noncompliant with dietary recommendations. He died at age 35 from cardiac arrhythmia 2 years after the second G-POEM. Patient C (postsurgical gastroparesis) had improvement in GES after the first G-POEM (88% to 53% 4-hour retention) but then deteriorated to 73% despite symptomatic improvement. After symptom recurrence, redo G-POEM provided an excellent symptomatic response, but she remained total parenteral nutrition-dependent until death 4 years later. <b><i>Conclusion:</i></b> While redo G-POEM is technically feasible and safe, our case series demonstrates poor long-term clinical outcomes across different gastroparesis etiologies. All 3 patients experienced treatment failure, with 2 requiring permanent nutritional support and 1 showing a lack of symptomatic response. These findings may suggest limited utility of redo G-POEM and highlight the need for careful patient selection.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202041","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 Effect of Liver Size on Early Postoperative Complications in Patients Undergoing Laparoscopic Sleeve Gastrectomy.","authors":"Uğur Özsoy, Murat Yildirim, Bulent Koca, Alı Ihsan Saglam, Ali Genç, Namik Ozkan","doi":"10.1177/10926429251383002","DOIUrl":"https://doi.org/10.1177/10926429251383002","url":null,"abstract":"<p><p><b><i>Aim:</i></b> The aim of the study was to show whether the complications of hepatomegaly increase in patients undergoing LSG. <b><i>Material Method:</i></b> This study was designed as a retrospective study. LSG surgeries performed between 2014 and 2024 were examined. Complications were determined by examining blood test results, radiological images, and epicrisis information. Complications were classified according to the Clavian-Dindo classification. The patients were divided into two groups according to the presence of hepatomegaly. Groups were compared according to complications. <b><i>Results:</i></b> The study was conducted with a total of 972 patients. Of the patients, 303 (31.1%) were male and 669 (68.8%) were female. The mean age was 37.7 years (range: 18-65). Of all patients, 623 (64%) had hepatomegaly, and 349 (36%) had normal liver size. In the hepatomegaly group, 26 patients had major complications, while 3 patients in the non-hepatomegaly group had them. It was found that major complications were significantly higher in the hepatomegaly group compared to the non-hepatomegaly group (<i>P</i> < .05). Minor complications were observed in 129 patients in the hepatomegaly group and 66 patients in the non-hepatomegaly group. The difference between the two groups for the minor complications was not significant (<i>P</i> > .05).In addition, the average surgery duration and hospital stay were statistically significantly higher in the hepatomegaly group (<i>P</i> < .05). <b><i>Conclusions:</i></b> Hepatomegaly significantly increases the major complications after LSG.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187421","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 Short-Term Outcomes of Robot-Assisted Distal Gastrectomy Using the KangDuo Surgical Robot-01 System and Laparoscopic Gastrectomy.","authors":"Qiancheng Wang, Shiyang Jin, Zeshen Wang, Pengcheng Sun, Yuming Ju, Guanyu Zhu, Kuan Wang","doi":"10.1177/10926429251383719","DOIUrl":"https://doi.org/10.1177/10926429251383719","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This study aimed to assess the effectiveness, safety, and feasibility of a novel robotic surgical system-the KangDuo Surgical Robot-01 (KD-SR-01)-for treating clinical stage I-III distal gastric cancer (GC) by comparing it to conventional laparoscopic gastrectomy (LG). <b><i>Methods:</i></b> From September to December 2023, 15 patients with distal GC underwent gastrectomies using the KD-SR-01 (KD group). An additional 15 cases of LG performed by the same surgeon during the same period were selected as the control group (LG group). Preoperative, intraoperative, and postoperative data were analyzed and compared between the two groups. <b><i>Results:</i></b> Both groups achieved the same surgical success rate, with no conversions to open surgery. The KD group exhibited significantly less blood loss (30 [20-60] mL versus 50 [30-200] mL, <i>P</i> < .001) and reported a lighter workload (27.5 ± 3.0 versus 30.1 ± 2.6, <i>P</i> = .011) compared to the LG group. Although the operation time in the KD group was significantly longer (213.3 ± 30.1 minutes versus 166.0 ± 32.8 minutes, <i>P</i> < .001), it was not significantly different from the LG group when excluding the device docking time of KD-SR-01 (179.7 ± 24.5 minutes versus 166.0 ± 32.8 minutes, <i>P</i> = .207). There were no significant differences in postoperative hospital stay (7.7 ± 1.5 days versus 7.3 ± .8 days, <i>P</i> = .357) and complication rates (26.7% versus 40.0%, <i>P</i> = .700) between the two groups. <b><i>Conclusion:</i></b> The KD-SR-01 is safe and effective for treating distal GC and may be a viable alternative to conventional LG.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187381","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":"Gastric Band after 15 Years: Migration Rates and Management.","authors":"Niculae Iordache, Saleh Abujamra, Anamaria Nedelcu, Octav Ginghina, Razvan Andrei Stoica, Ramon Vilallonga, Marius Nedelcu","doi":"10.1177/10926429251384810","DOIUrl":"https://doi.org/10.1177/10926429251384810","url":null,"abstract":"<p><p><b><i>Background:</i></b> Laparoscopic adjustable gastric banding (LAGB) was once a widely adopted bariatric procedure due to its reversibility and minimally invasive nature. However, concerns about long-term complications, particularly intragastric migration and slippage, have led to a decline in its use. <b><i>Methods:</i></b> We conducted a retrospective review of 411 patients who underwent LAGB between 2002 and 2010 at a tertiary care center. Data on demographics, complication rates, time to onset, and management strategies were analyzed. Follow-up data were available for 178 patients over a 15-year period. <b><i>Results:</i></b> Band migration was diagnosed in 33 patients (18.5%), with a median detection time of 74 months post-implantation. Most cases (54.5%) were diagnosed between 6 and 10 years postoperatively. Common clinical presentations included weight regain (45.4%) and port-site infection with fever (33.3%), while 21.2% were asymptomatic. Surgical removal was performed in all migration cases, with a laparoscopic approach successfully used in 84.8%. Conversion to open surgery was necessary in 2 patients, and primary laparotomy was used in 3 early cases. Band slippage occurred in 10.7% of patients, with 63.2% requiring surgical intervention. Postoperative complications were minimal and managed conservatively. <b><i>Conclusions:</i></b> Our findings confirm that LAGB is associated with a significant long-term risk of complications, particularly band migration, which may occur more than a decade postoperatively. Long-term follow-up is essential, and routine upper GI imaging should be considered in all patients with LAGB, especially in those presenting with port-site infections. These results highlight the importance of individualized management and long-term vigilance in patients undergoing LAGB.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187356","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 Celiac Artery Stenosis on Pancreatic Fistula Incidence after Pancreatoduodenectomy.","authors":"Mert Guler, Omer Akay, Husnu Sevik, Ibrahim Taskin Rakici, Ceyda Turan Bektas, Rabia Kucukarslan, Mert Mahsuni Sevinc, Ufuk Oguz Idiz","doi":"10.1177/10926429251382789","DOIUrl":"https://doi.org/10.1177/10926429251382789","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Celiac artery stenosis (CAS) may exacerbate postoperative complications by impairing arterial perfusion in upper abdominal organs. This study evaluated the prevalence of CAS in patients undergoing pancreaticoduodenectomy and its association with clinically significant postoperative pancreatic fistula (POPF). <b><i>Methods:</i></b> A retrospective analysis of 151 patients who underwent pancreaticoduodenectomy between 2017 and 2022 was conducted. CAS was assessed via preoperative computed tomography with a stenosis threshold of ≥50%. Multivariate logistic regression identified risk factors for POPF. <b><i>Results:</i></b> CAS ≥50% was observed in 17.2% of patients, and Grade B/C POPF occurred in 17.9%. In patients with a CAS ≥50%, the risk of POPF was significantly increased (Odds Ratio: 16.458, 95% Confidence Interval: 4.575-59.203, <i>P</i> < .001). A pancreatic duct diameter of less than 3 mm and a soft pancreatic texture were found to be associated with POPF in the univariate analysis (<i>P</i> = .029, <i>P</i> = .032, respectively). Additionally, the prevalence of smoking and the median age were higher in patients with a CAS ≥50 (respectively, <i>P</i> = .011 and <i>P</i> = .052). <b><i>Conclusions:</i></b> CAS is an independent risk factor for clinically significant POPF. Preoperative CAS identification and management are vital to minimizing postoperative complications. Further studies are needed to confirm these findings.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139240","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 Application of Robotic-Assisted Surgery in Renal Disorders of Infants and Toddlers: A Retrospective Cohort Analysis.","authors":"Chao Yang, Chi Zhang, Jialin Liu, Changkun Mao","doi":"10.1177/10926429251377438","DOIUrl":"https://doi.org/10.1177/10926429251377438","url":null,"abstract":"<p><p><b><i>Objective:</i></b> While robotic-assisted surgery (RAS) has shown benefits in urology, its use in infants and toddlers remains relatively restricted. This study aims to evaluate the safety and feasibility of robotic surgery for renal disorders in this age group. <b><i>Methods:</i></b> A retrospective analysis was performed on the clinical data of 122 patients under the age of 3 who underwent robotic and laparoscopic surgeries (LSs) for renal disorders at our institution between December 2021 and September 2023. The analysis included demographic information, surgical techniques, and postoperative complications. <b><i>Results:</i></b> The study included 122 patients aged between 2.2 and 35.8 months. Of these, 66 patients underwent RAS (RAS group), whereas 56 patients underwent laparoscopic surgery (LS group). In cases of ureteropelvic junction obstruction (UPJO), RAS group showed shorter operative times and less blood loss than LS (<i>P</i> < .001). For the patients with renal dysplasia who underwent nephrectomy and ureterectomy, no significant differences were observed between the RAS and LS groups in terms of operative time, intraoperative blood loss, or hospital stay (<i>P</i> > .05). In patients with duplicated kidneys, RAS also demonstrated advantages in operative time (<i>P</i> = .001), blood loss (<i>P</i> = .019), and hospital stays (<i>P</i> < .001). However, RAS group incurred higher hospital costs (<i>P</i> < .001), with no significant difference in complication rates (<i>P</i> > .05). <b><i>Conclusion:</i></b> Although RAS incurs higher costs compared with LS, it remains both safe and feasible for the treatment of renal disorders in infants and toddlers. Notably, RAS shows significant advantages in managing UPJO and complete duplicated kidneys.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139243","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":"Implementation of Robotic Telesurgery in Brazil: The First Experimental Remote Surgery Performed Between Two Brazilian Cities.","authors":"Marcelo de Paula Loureiro, Paolo Salvalaggio, Mariano Palermo, Thais Andrade Costa Casagrande, Kendi Chikude, Reitan Ribeiro, Luiz Augusto Militao da Silva, Wagner de Paula Loureiro, Guido Lemos de Souza Filho, Denio Mariz Timoteo de Sousa, Gualter Lisboa Ramalho, Leandro Totti Cavazzola","doi":"10.1177/10926429251377012","DOIUrl":"https://doi.org/10.1177/10926429251377012","url":null,"abstract":"<p><p><b><i>Background:</i></b> Telesurgery represents a revolutionary milestone in medicine, allowing surgeons to perform complex procedures at a distance through advanced robotic systems. Although the first telesurgery in Brazil was performed in 2000 with a single-arm robotic platform between São Paulo and Baltimore (USA), no telesurgery had ever been conducted between two distinct Brazilian cities with a state-of-the-art robotic system. The aim is to report the first telesurgery performed between two Brazilian cities, connecting Scolla-Surgical Training Center in Campo Largo and CEONC Hospital in Cascavel, both in the state of Paraná, approximately 600 km apart, using high-performance fiber optic technology with 5G redundancy to perform robotic cholecystectomy in a swine model. <b><i>Methods:</i></b> A prospective experimental study was conducted using a 40 kg swine (<i>Sus scrofa</i>) as an animal model. Connectivity was established through high-speed fiber optic cable, allowing minimal latency and real-time data transmission. A robotic cholecystectomy was performed remotely, with continuous monitoring of delay parameters and connection quality. <b><i>Results:</i></b> Telesurgery was performed without complications, demonstrating the technical feasibility and safety of the procedure between two Brazilian cities. Transmission delays remained within acceptable limits for robotic surgery, and no technical or surgical complications were observed during the procedure. Image quality and responsiveness of robotic commands remained stable throughout the surgery. <b><i>Conclusion:</i></b> This study establishes a historic milestone in Brazilian medicine, demonstrating that telesurgery between Brazilian cities is technically feasible and safe. The results open promising perspectives for expanding access to specialized surgical care in remote regions of Brazil, potentially revolutionizing the distribution of medical expertise in the country and Latin America.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139270","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 Treatment of Acute Symptomatic Postesophagectomy Diaphragmatic Hernia.","authors":"Pamela Milito, Stefano Siboni, Andrea Lovece, Eleonora Vico, Roberta De Maron, Valentina Milani, Marco Sozzi, Daniele Bernardi, Emanuele Asti","doi":"10.1177/10926429251381432","DOIUrl":"https://doi.org/10.1177/10926429251381432","url":null,"abstract":"<p><p><b><i>Background:</i></b> Postesophagectomy diaphragmatic hernia (PEDH) is a rare yet potentially life-threatening complication following esophagectomy, particularly when acute symptoms such as ischemia or organ perforation arise. Prompt diagnosis and emergency surgical intervention are crucial. This study reports the experience of a tertiary care center in managing acute symptomatic PEDH. <b><i>Methods:</i></b> We performed a retrospective analysis of patients who underwent esophagectomy for cancer at our institution between 2013 and 2023. Early PEDH was defined as hernia onset within 30 days postoperatively. Patients presenting with respiratory symptoms, volvulus, ischemia, or perforation underwent emergency surgery. Primary outcomes included the method of diaphragmatic repair, use of mesh, and surgical success. <b><i>Results:</i></b> Out of 358 patients, 11 (3.1%) developed PEDH requiring emergency surgery. Five cases were early PEDH and 3 developed an anastomotic leak. Organ or omental resection was performed in 4 patients. Laparoscopic repair was successful in 8 cases, while 2 patients required laparotomy and thoracotomy. Cruroplasty was performed in 8 patients, in 2 a mesh was added and in 6 the falciform ligament was used to buttress the closure. Mortality was nil. Recurrence rate was 18%. No preoperative risk factors for PEDH were identified. <b><i>Conclusions:</i></b> Diaphragmatic hernia is a rare but serious complication after esophagectomy, often associated with high morbidity and mortality. Early recognition is critical and life-saving. In high-volume centers, laparoscopic repair is the preferred approach and the decision to perform cruroplasty with or without mesh reinforcement should be individualized based on patient characteristics.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139259","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}