Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Risk Factors for Postcholecystectomy Diarrhea: A Systematic Review and Meta-Analysis.","authors":"Yi Zhang, Shufan Chen, Lili Ma, Yongmei You","doi":"10.1177/10926429261497077","DOIUrl":"https://doi.org/10.1177/10926429261497077","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate potential risk-associated factors for postcholecystectomy diarrhea (PCD) and provide evidence to support clinical risk identification.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, Scopus, CNKI, Wanfang, and VIP from inception to March 2026. Observational studies reporting PCD risk factors in adults were included. Two researchers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality checklist. Meta-analyses were conducted for comparable variables, and evidence quality was assessed using GRADE.</p><p><strong>Results: </strong>A total of 17 studies including 9148 postcholecystectomy patients, of whom 1493 developed PCD, were analyzed. Alcohol consumption (odds ratio [OR] = 2.10, 95% confidence interval [CI]: 1.24-3.57; moderate GRADE evidence) and nonlow-fat diet (OR = 1.95, 95% CI: 1.15-3.29; moderate GRADE evidence) were associated with increased PCD risk. Postoperative food intolerance was associated with PCD, although its role as an antecedent risk factor remains uncertain because the temporal relationship with diarrhea could not be established. Age analyses showed inconsistent results: younger patients (<50 versus ≥50 years) had higher PCD risk (OR = 3.49, 95% CI: 1.56-7.80; moderate GRADE evidence), whereas continuous age analyses were nonsignificant, suggesting a potential nonlinear association. Evidence for sex, body mass index (BMI), smoking, diabetes, gallbladder function, and psychological factors was limited or inconsistent. Considerable heterogeneity and differences in outcome definitions among studies were noted.</p><p><strong>Conclusion: </strong>Alcohol consumption and a nonlow-fat diet may represent clinically relevant factors associated with PCD, while postoperative food intolerance requires cautious interpretation because its temporal relationship with diarrhea remains uncertain. Age may have a nonlinear association with PCD, whereas evidence for other factors remains limited or inconsistent. These findings may assist in recognizing patients at increased risk of PCD and inform preoperative counseling and postoperative management. High-quality, multicenter studies with standardized exposure and outcome definitions are warranted to further clarify PCD risk factors.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261497077"},"PeriodicalIF":1.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169150","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 Course of Temporary Internal Biliary Stents after Laparoscopic Common Bile Duct Exploration: A Systematic Review and Meta-Analysis.","authors":"Cheng Zhang, Shenglong Zhang, Ke Sun","doi":"10.1177/10926429261497072","DOIUrl":"https://doi.org/10.1177/10926429261497072","url":null,"abstract":"<p><strong>Introduction: </strong>Temporary internal biliary stents placed after laparoscopic common bile duct exploration (LCBDE) are designed to decompress the duct and pass without elective endoscopic removal, but their subsequent clinical course has not been systematically evaluated.</p><p><strong>Materials and methods: </strong>Eight English- and Chinese-language databases were searched through July 29, 2026. Eligible studies evaluated temporary internal stents intended for spontaneous passage after LCBDE. Two reviewers independently selected studies, extracted public aggregate data, resolved overlapping cohorts, and assessed risk of bias. Single-arm outcomes were pooled using random-effects binomial-normal generalized linear mixed models. A prespecified sensitivity analysis excluded studies authored by the review team.</p><p><strong>Results: </strong>Fifteen studies included 1004 stent recipients, although outcome-specific quantitative syntheses were limited to studies with compatible reporting. Overall confirmed passage was 96.8% (350/371; 95% confidence interval [CI], 87.6%-99.2%; <i>I² =</i> 64.2%) and remained 98.1% (249/259; 95% CI, 87.7%-99.7%) after excluding review-team studies. Passage by approximately 30 days was 98.0% (147/151; 95% CI, 85.5%-99.8%); directly reported 30-day data yielded 99.2% (127/128; 95% CI, 94.7%-99.9%). Endoscopic removal or retrieval occurred in 2.6% (12/353; 95% CI, 0.7%-9.3%). Heterogeneous devices and time origins precluded pooling passage time.</p><p><strong>Conclusion: </strong>Temporary internal stents usually pass spontaneously after LCBDE, although performance varies across devices and settings. When passage has not been documented, approximately 1 month is the best-supported verification checkpoint. Persistent, migrated, or symptomatic stents warrant targeted evaluation and early endoscopic consultation. This pathway is evidence-informed rather than a formal guideline recommendation. Given the predominantly East Asian evidence base, validation in other populations is required.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261497072"},"PeriodicalIF":1.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171133","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":"Minimally Invasive Inguinal Hernia Repair in Elderly Patients Over 70 Years: Postoperative Outcomes and Complications.","authors":"Christiano M P Claus, João R B Ruggeri, Victor H S Nezo, João Carlos C C Filho, Bruno L S Marçal, Danielle K Ono, Julio C U Coelho","doi":"10.1177/10926429261497067","DOIUrl":"https://doi.org/10.1177/10926429261497067","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery (MIS) for inguinal hernia repair offers postoperative advantages over conventional techniques and is considered the gold standard. As the population ages, concerns regarding comorbidities and anesthetic risks may limit the use of MIS in patients over 70 years.</p><p><strong>Objective: </strong>To compare postoperative outcomes after elective MIS inguinal hernia repair between patients aged ≥70 and <70 years.</p><p><strong>Methods: </strong>Retrospective analysis of a prospectively maintained database including 200 patients, of whom 57 were elderly (≥70 years). Three of the initial 203 patients were excluded because they underwent open repair: two (<1%) due to anesthetic contraindications associated with age and comorbidities, and one because of a previous radical prostatectomy and pelvic radiotherapy. Outcomes included surgical technique, operative time, hospital stay, postoperative pain assessed using the Numeric Pain Rating Scale (NPRS), and complications (seroma, ecchymosis, and surgical site infection). Assessments were performed immediately after surgery, at 7, 30, and 90 days, and at 6 and 12 months.</p><p><strong>Results: </strong>Elderly patients had a longer mean operative time (83.4 ± 56.0 versus 65.7 ± 36.1 minutes; <i>P</i> = .049). However, after excluding associated procedures (<i>n</i> = 183), the difference was no longer significant (71.8 ± 43.6 versus 66.3 ± 35.7 minutes; <i>P</i> = .39). Postoperative complication rates were similar between groups. Elderly patients reported lower NPRS scores both immediately after surgery (0.99 versus 1.4; <i>P</i> = .008) and at 30 days (0.17 versus 0.38; <i>P</i> = .007). Hospital stay was comparable between groups.</p><p><strong>Conclusion: </strong>MIS inguinal hernia repair, including laparoscopic and robotic approaches, appears safe and effective in elderly patients, even in the presence of significant comorbidities. Complication rates and hospital stay were comparable between age groups, while elderly patients reported lower postoperative pain scores. Age alone should not be considered a contraindication to minimally invasive inguinal hernia repair.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261497067"},"PeriodicalIF":1.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171287","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":"Robotic Bariatric Surgery in Patients with BMI > 50 kg/m² (Obesity V): A Systematic Review and Meta-Analysis.","authors":"Laura Vidotto, Raquel Nogueira, Julia Kasmirski, Carlos Balthazar da Silveira, Antonio Lam, Diego Camacho, Diego L Lima","doi":"10.1177/10926429261496025","DOIUrl":"https://doi.org/10.1177/10926429261496025","url":null,"abstract":"<p><strong>Purpose: </strong>Bariatric surgery poses a challenge in patients with BMI > 50 kg/m². The current literature lacks sufficient data comparing robot-assisted and laparoscopy in this population. This systematic review aims to evaluate the effectiveness and safety of robotic bariatric surgery in patients with a BMI > 50 kg/m².</p><p><strong>Methods: </strong>PubMed, Cochrane Central and EMBASE were searched for studies comparing robotically-assisted and laparoscopic bariatric surgery in patients with BMI > 50 kg/m² from inception until May 2024. We included all robotic bariatric techniques as the intervention group. Studies lacking control groups or having overlapping populations were excluded. Our outcomes were mean operative time, postoperative and intraoperative complications, reoperation, conversion to open, surgical site infection, anastomotic leak, length of hospital stay (LOS), and mortality.</p><p><strong>Results: </strong>From 163 initial results, 9 studies comparing laparoscopy and robotic approaches were included in our final analysis. Our sample comprised 149.047 patients, of whom 10,761 (7.2%) were submitted to robotic surgery. The mean BMI of the population ranged from 53.4 to 65.9 kg/m². The robot platform use significantly increased the operative time (MD = 31.9 minutes; 95% CI: 2.8; 61; <i>P</i> = .032). However, there were no statistically significant differences observed in: postoperative or intraoperative complications (RR = 1.3; 95% CI: 0.4; 4.1; <i>P</i> = .6) and RR = 0.4; 95% CI: 0.04; 4.46; <i>P</i> = .4); reoperation rates (RR = 0.9; 95% CI: 0.4; 1.9; <i>P</i> = .8); conversion to open (RR = 0.8; 95% CI: 0.2; 3.6; <i>P</i> = .8); surgical site infection (RR = 1.1; 95% CI: 0.8; 1.6; <i>P</i> = .5); anastomotic leak (RR = 0.9; 95% CI: 0.09; 9.1; <i>P</i> = .9); length of hospital stay (MD = -0.07; 95% CI: -0.6; 0.4; <i>P</i> = .7) and mortality (RR = 0.7; 95% CI: 0.3; 1.7; <i>P</i> = .4).</p><p><strong>Conclusion: </strong>Our analysis supports the feasibility and safety of robotic platforms for bariatric procedures in patients with BMI > 50 kg/m². Future prospective studies should prioritize investigating long-term outcomes and cost-effectiveness to enhance clinical decision-making for this patient demographic.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261496025"},"PeriodicalIF":1.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal Change in Minimally Invasive Surgery: National Trends in Laparoscopic Duodenal Atresia Repair, 2016-2024.","authors":"Johanna M Borst, John Rode, Meredith E Osmulski, Willemijn LA Schäfer, Jane L Holl, Yao Tian, Mehul V Raval","doi":"10.1177/10926429261497081","DOIUrl":"https://doi.org/10.1177/10926429261497081","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic duodenal atresia repair in neonates, introduced over two decades ago, is associated with select short-term benefits versus open repair, but recent U.S. population-level data are lacking. We evaluated national trends and compared operative time and outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program Pediatric database from 2016 to 2024 of neonates (≤28 days) undergoing duodenal atresia repair was conducted to assess the annual proportion of laparoscopic versus open repairs (primary outcome) and length of stay (LOS), shortened LOS (≤13 days), composite 30-day morbidity (death, reoperation, prolonged ventilation, transfusion, and surgical site infection), and operative time (secondary outcomes). Temporal trends were assessed using logistic regression. Outcomes were compared using multivariable regression adjusting for patient characteristics.</p><p><strong>Results: </strong>Among 1407 neonates, 241 (17.1%) underwent laparoscopic or converted repair and 1,166 (82.9%) open repair. Laparoscopic utilization increased from 13.6% in 2016 to 18.3% in 2024 (adjusted odds ratio [aOR]: 1.10 per year, 95% CI: 1.03-1.17). Patients undergoing laparoscopic repair had higher birth weight (median 2.63 versus 2.47 kg, <i>P</i> < .001). In adjusted analyses, laparoscopic repair was associated with shorter LOS (geometric mean ratio 0.93, 95% CI: 0.88-0.99), higher odds of shortened LOS (aOR: 1.90, 95% CI: 1.10-3.28), lower composite morbidity (aOR: 0.61, 95% CI: 0.38-0.99), and longer operative time (+41.7 minutes, 95% CI: 31.7-51.8).</p><p><strong>Conclusions: </strong>Laparoscopic repair was associated with shorter LOS and lower morbidity, yet adoption remains low. Longer operative time and preferential use in larger neonates suggest potential technical barriers to adoption, which are potentially modifiable.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261497081"},"PeriodicalIF":1.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129130","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":"Incisional Hernia after Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis of Incidence and Risk Factors.","authors":"Maria Fernanda Andrade da Silva, Maria Clara Morais, Gabriele Lech, Matheus Faleiro, João Kasakewitch, Victor Perim, Raquel Nogueira, Diego L Lima","doi":"10.1177/10926429261421860","DOIUrl":"10.1177/10926429261421860","url":null,"abstract":"<p><strong>Background: </strong>Pancreaticoduodenectomy (PD) is a high-risk surgical procedure associated with significant postoperative morbidity. While complications such as pancreatic fistula and delayed gastric emptying are well-studied, the incidence and risk factors of incisional hernia (IH) following PD remain poorly characterized. This systematic review and meta-analysis aimed to evaluate the incidence of IH and identify associated risk factors in patients undergoing PD.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Embase, CENTRAL, and Web of Science databases from inception to December 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting IH incidence after PD were included. The primary outcome was the pooled incidence of IH. Secondary outcomes included risk factors associated with IH. A random-effects model was used for meta-analyses, and heterogeneity was assessed using <i>I</i>² statistics. Risk of bias was evaluated using the ROBINS-I tool.</p><p><strong>Results: </strong>A total of 6 studies comprising 1929 patients met inclusion criteria. The pooled incidence of IH following open PD was 6% (95% CI: 2%-15%), with substantial heterogeneity (<i>I</i>² = 94%). Risk factors significantly associated with IH included BMI ≥ 30 kg/m² (OR range: 1.67-2.6), preoperative hypoalbuminemia (OR 3.4; 95% CI: 1.2-9.4), chronic obstructive pulmonary disease (HR 24.4; 95% CI: 1.6-391.9), elevated preoperative CRP (HR 11.4; 95% CI: 1.2-103.1), postoperative fascial dehiscence (HR 14.1; 95% CI: 1.10-180.4), and wound infection (OR 2.9; 95% CI: 1.8-4.6). Sensitivity analyses confirmed the robustness of incidence estimates.</p><p><strong>Conclusion: </strong>IH is a relatively underrecognized yet significant complication following PD, with a pooled incidence of 6%. Several modifiable and non-modifiable risk factors contribute to its development. These findings underscore the need for targeted preventive strategies in high-risk patients and further research to inform surgical decision-making and postoperative care.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"737-743"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144559","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 Simplified Surgical Technique for Thoracoscopic Repair of Congenital Diaphragmatic Hernia.","authors":"Jiepin Wang, Yuting Zhang, Haozhong Xu, Junxiang Wang, Xiuliang Wang, Chi Zhang, Zhen Zheng, Dong Xiao","doi":"10.1177/10926429261449965","DOIUrl":"10.1177/10926429261449965","url":null,"abstract":"<p><strong>Introduction: </strong>The current surgical approaches for treating congenital diaphragmatic hernia (CDH) are challenging. Thoracoscopic transcutaneous closure of CDH is described, of which a retrospective study was conducted to investigate the safety and effectiveness.</p><p><strong>Materials and methods: </strong>In thoracoscopic transcutaneous closure, a thoracoscope and operating forceps are placed through two intercostal ports to expose the defect, followed by stepwise thoracic pressure elevation to facilitate herniated organ reduction. A fascial closure device is introduced through a small skin incision to encircle the diaphragmatic rim in two semicircular passes, and the suture is then tightened extracorporeally to close the defect.</p><p><strong>Results: </strong>Over a 8-year period, 33 TTC repairs were performed for CDH, including 31 Bochdalek and 2 Morgagni cases. Bochdalek repairs were completed in a mean operative time of 53.68 ± 45.81 minutes (range, 10-200 minutes), with a median age of 1 day and median weight of 3.25 kg. Among them, two patients experienced recurrence at 3 months and 7 months postoperatively. During hospitalization, four patients developed pneumothorax, and one patient developed chylothorax. The two Morgagni cases were repaired in 35 and 30 minutes at 5 and 6 months of age. Respiratory support was a median of 59 hours (range, 0-352 hours) in patients who required respiratory assistance, intensive care unit stay was a median of 15 days (range, 1-91 days) in patients admitted to the intensive care unit, and hospital stay was a median of 15 days (range, 2-91 days). All patients had uneventful wound healing without rib-development complications during follow-up.</p><p><strong>Conclusion: </strong>Thoracoscopic transcutaneous closure is a feasible and effective technique to treat CDH. While possessing the advantages of minimally invasive surgery, it shortens the operative time and learning curve.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"765-770"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845484","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":"Magnetic Sphincter Augmentation after Sleeve Gastrectomy: Reassessing Erosion Rates Beyond Misconceptions.","authors":"Alberto Aiolfi, Davide Bona, Francesco Cammarata, Luigi Bonavina","doi":"10.1177/10926429261452439","DOIUrl":"10.1177/10926429261452439","url":null,"abstract":"","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"758-759"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935097","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":"Avoiding the Umbilical Incision in Obese Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Cohort Study of Wound-Related Outcomes.","authors":"Yasunori Uesato, Susumu Inamine","doi":"10.1177/10926429261445558","DOIUrl":"10.1177/10926429261445558","url":null,"abstract":"<p><strong>Background: </strong>The umbilical port is routinely used for camera insertion and specimen retrieval in laparoscopic cholecystectomy (LC). However, the umbilicus is anatomically vulnerable and may be associated with an increased risk of surgical site infection (SSI) and port-site hernia (PSH), particularly in obese patients. We evaluated the clinical impact of avoiding an umbilical incision in obese patients undergoing LC.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 75 patients with a body mass index (BMI) ≥ 32 who underwent LC between April 2019 and November 2025. Patients were divided into an umbilical incision group (<i>n</i> = 46) and a nonumbilical incision group (<i>n</i> = 29). The primary endpoint was overall postoperative complications (Clavien-Dindo grade ≥ II) within 6 months. Absolute risk differences and corrected odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>Postoperative complications occurred in six patients (12.8%) in the umbilical incision group and in none (0%) in the nonumbilical incision group (<i>P</i> = .076). Although the difference did not reach statistical significance, all observed complications occurred in the umbilical incision group. The absolute risk difference was 13.0% (95% CI 3.3%-22.8%). After Haldane-Anscombe correction, the estimated OR for complications associated with the umbilical incision approach was 9.47 (95% CI 0.51-174.76). All complications were wound-related (four SSIs and two PSHs). Operative time, blood loss, and postoperative hospital stay were significantly lower in the nonumbilical incision group. All outcome measures consistently favored the nonumbilical approach.</p><p><strong>Conclusions: </strong>Although statistical significance was not reached, all wound-related complications occurred exclusively in the umbilical incision group. Avoiding an umbilical incision in obese patients undergoing LC may represent a clinically reasonable strategy associated with a potential reduction in wound-related morbidity. Larger prospective studies are warranted.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"714-719"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822401","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":"Thoracoscopic Repair of Esophageal Atresia with Distal Tracheoesophageal Fistula: Is It Safe to Delay Surgery?","authors":"Ignacio Ibarra Rodríguez, José Andrés Molino Gahete, Sergio López Fernández, Marta Martos Rodríguez, Haider Ali Khan, César Wenceslao Ruiz, Karla Estefania, Elena Vilardell, Carmen Ribes, Gabriela Guillén","doi":"10.1177/10926429261450540","DOIUrl":"10.1177/10926429261450540","url":null,"abstract":"<p><strong>Aim of the study: </strong>Thoracoscopic repair of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is an increasingly adopted approach. However, it is a complex minimally invasive technique that should be performed by experienced surgeons under optimal conditions. This study aims to determine whether delaying surgery to ensure these conditions is safe.</p><p><strong>Methods: </strong>We conducted a retrospective observational study (2017 to 2024) analyzing historical cohorts of 41 neonates with EA and distal TEF who underwent thoracoscopic repair. Fifteen (36.5%) were operated on the first day of life (Group A), while 26 (63.5%) underwent delayed surgery (Group B). Baseline characteristics, preoperative and intraoperative morbidity and mortality, and follow-up outcomes were analyzed.</p><p><strong>Results: </strong>There were no significant differences in sex, gestational age, birth weight, or associated anomalies, including anorectal malformation. Group B neonates underwent surgery at 2.38 ± 0.76 days of life. No preoperative respiratory infections or need for emergency surgery were reported, and there were no significant differences in atelectasis (6.6% versus 11%), respiratory distress (40% versus 34%), or intubation requirement (13% versus 19%). Intraoperatively, conversion rates (6.6% versus 7.6%) and desaturation events (20% versus 19%) were comparable. Postoperatively, no differences were found in intubation days (3.3 versus 3.37), infections (6.6% versus 11.5%), atelectasis (13.3% versus 19.2%), or follow-up complications (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>Delaying the repair of EA with distal TEF is safe, allowing thoracoscopic surgery to be performed by experienced surgeons under optimal conditions without increasing morbidity due to the wait.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"760-764"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018575","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}