Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Percutaneous Biliary Drainage: Jaundice and Symptomatic Relief in a Public National Hospital.","authors":"Magdalena Bozzetti, Benjamin Romei, Patricio Reilly, Guillermo Rossini, Mariano Palermo","doi":"10.1177/10926429251380315","DOIUrl":"https://doi.org/10.1177/10926429251380315","url":null,"abstract":"<p><p><b><i>Background:</i></b> Obstructive jaundice is a common condition in daily clinical practice. Given the severity of its potential complications, prompt management and resolution are essential. Percutaneous biliary drainage is a viable therapeutic option. The aim is to evaluate the effectiveness of percutaneous biliary drainage in reducing bilirubin levels and providing symptomatic relief in patients with obstructive jaundice treated at Hospital Nacional Posadas between 2019 and 2024. <b><i>Methods:</i></b> A retrospective review was conducted using the database of Hospital Nacional Prof. A. Posadas. All patients diagnosed with obstructive jaundice (total bilirubin ≥2 mg/dL) who underwent percutaneous biliary drainage between June 2019 and May 2024 were included (<i>n</i> = 118). Data collected included age, sex, comorbidities, procedures, underlying cause, complications, laboratory results, and symptomatic improvement. <b><i>Results:</i></b> A total of 118 patients underwent percutaneous biliary drainage. Of these, 58 (49.1%) were female and 60 (50.8%) were male. The mean age was 60.43 years. The average baseline total bilirubin level was 15.44 mg/dL. Clinical presentation included jaundice (86.44%), fever (20.33%), and pain (55.08%). At 72 hours postprocedure, 59.32% of patients experienced a 50% reduction in bilirubin levels, and 70.33% reported symptomatic relief. The average total bilirubin at discharge was 8.6 mg/dL. Procedure-related complications occurred in 5.08% of patients, the most common being hemorrhage (2.54%). A second drainage procedure or catheter replacement was necessary in 31.34% of cases, and 15.25% required an additional intervention (endoscopic retrograde cholangiopancreatography or surgery) to achieve adequate bilirubin reduction. <b><i>Conclusion:</i></b> In our series, percutaneous biliary drainage proved to be an effective and safe method for reducing bilirubin levels and providing symptomatic relief, with an acceptably low complication rate.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034601","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":"Long-Term Outcomes of Liver Pathology Following a Sleeve Gastrectomy.","authors":"Lila Brody, James Alex Randall, Fatima Khambaty, Rob Young, Parini Shah, R Natalie Reed","doi":"10.1177/10926429251377372","DOIUrl":"https://doi.org/10.1177/10926429251377372","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The rising prevalence of obesity in the United States is paralleled by an increase in type II diabetes (T2D) and metabolic-associated steatotic liver disease. While lifestyle changes often do not afford sustainable weight loss, bariatric surgery, particularly sleeve gastrectomy (SG), offers a durable solution. This study investigates long-term outcomes in Veterans who underwent SG with concurrent liver biopsy. <b><i>Methods:</i></b> All patients undergoing SG with a liver biopsy from January 2018 to March 2021 were included. Baseline demographics and comorbidities included age, gender, race, preoperative BMI, hemoglobin A1c (HgbA1c), T2D, hypertension (HTN), gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), and presence of steatosis and fibrosis. Patients were followed postoperatively at 1, 3, and 5 years. Patient demographics and comorbidities were stratified by liver scores and compared pre- and postoperatively. A paired <i>t</i>-test compared variables. Multivariate linear regression assessed associations between liver pathology and BMI. Multivariate logistic regression analyzed associations between comorbidities and liver pathology. A <i>P</i> < .05 was significant. <b><i>Results:</i></b> A total of 95 patients underwent a laparoscopic SG with a liver biopsy. There was a level of steatosis (81%) or fibrosis (76.8%) in the majority of biopsies. For the entire cohort, there was a significant BMI reduction from baseline (40.6 ± 3.0 kg/m²) at 1, 3, and 5 years (33.9 ± 4.2, 35.0 ± 4.6, 34.7 ± 4.9 kg/m²; <i>P</i> < .001). At 5 years, % total weight loss (TWL) for no, low, and high liver scores was 18.3 ± 7.5, 13.5 ± 1.6, and 13.7 ± 2.5(<i>P</i> = .82). At 5 years postoperatively, there were significant reductions in mean HgbA1c level (6.2 versus 5.7, <i>P</i> < .001), T2D (47.4% versus 36.8%, <i>P</i> < .001), HTN (56.8% versus 39.0%, <i>P</i> < .001), GERD (49.5% versus 31.6%, <i>P</i> < .001), and OSA (66.3% versus 42.1%, <i>P</i> < .001). There was no significant difference in any postoperative comorbidity, BMI, or %TWL based on pathological liver scores (<i>P</i> > .05). <b><i>Conclusion:</i></b> This study underscores the long-term efficacy of SG in a predominantly African American Veteran cohort, irrespective of liver pathology. These results advocate for bariatric surgery to treat obese patients with liver disease, and even those with advanced hepatic conditions can achieve substantial health benefits.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034558","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 Intraperitoneal Onlay Mesh Versus Robotic Retromuscular for Small- and Medium-Sized Ventral Hernia Repair: A Systematic Review and Meta-Analysis.","authors":"Augusto Graziani E Sousa, Yasmin Biscola da Cruz, Júlia Copetti Burmann, Thiago Souza Silva, Leandro Totti Cavazzola, Diego Camacho, Diego Laurentino Lima","doi":"10.1177/10926429251376400","DOIUrl":"https://doi.org/10.1177/10926429251376400","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> This study aims to perform a systematic review and meta-analysis to compare the laparoscopic intraperitoneal onlay mesh (IPOM) versus the robotic retromuscular (RM) techniques and their respective outcomes for small and medium-sized ventral hernia repair. <b><i>Methods:</i></b> A comprehensive online search was conducted using PubMed, Cochrane, and Embase. Studies comparing laparoscopic IPOM to robotic RM techniques were included. The results analyzed were the length of stay (LOS), surgical site infection (SSI), surgical site occurrence (SSO), readmission, and reoperation. Statistical analysis was performed with R Studio version 4.4.1 using a random-effects model. <b><i>Results:</i></b> From 956 records, three retrospective observational studies were included, encompassing 1351 patients (laparoscopic IPOM <i>n</i> = 882; robotic RM <i>n</i> = 469). Primary hernias represented 63%, and 88% had horizontal defects between 3.1 and 3.4 cm. Overall analysis showed comparable results between groups regarding LOS (mean difference: 0.58; 95% confidence interval [CI]: -0.07 to 1.24; <i>P</i> = .08), SSI (risk ratio (RR): 0.90; 95% CI: 0.28-2.85; <i>P</i> = .85), and SSO rates (RR: 1.07; 95% CI: 0.17-6.55; <i>P</i> = .94). In addition, no statistically significant results were seen for readmission (RR: 1.50; 95% CI: 0.79-2.85; <i>P</i> = .21) and reoperation rates (RR: 1.16; 95% CI: 0.47 to 2.86; <i>P</i> = .74). <b><i>Conclusion:</i></b> This meta-analysis found similar postoperative outcomes for both laparoscopic IPOM and robotic RM techniques. Future studies are still required to evaluate the role of these operative methods following small- and medium-sized VHR.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006775","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":"Introduction to Special Edition: IFSO LAC Bariatrics.","authors":"Mariano Palermo","doi":"10.1177/10926429251380080","DOIUrl":"https://doi.org/10.1177/10926429251380080","url":null,"abstract":"","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":"35 9","pages":"695"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071092","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":"Outcomes of the Basic Laparoscopic Stamm Gastrostomy Technique With or Without Fundoplication in Children.","authors":"Sefer Tolga Okay, Hasan Deliağa, Hakan Özcan, Esra Ozçakir, Mete Kaya","doi":"10.1177/10926429251364709","DOIUrl":"10.1177/10926429251364709","url":null,"abstract":"<p><p><b><i>Background:</i></b> Various methods for gastrostomy tube (GT) placement have been described, including open, endoscopic, and laparoscopic. We present the results of the basic laparoscopic Stamm gastrostomy (LSG) method that we recently described. <b><i>Methods:</i></b> Data of patients who underwent gastrostomy with the LSG method between 2016 and 2024 were retrospectively analyzed. The patients were divided into two groups as those who had only LSG and those who had fundoplication in the same session. Primary endpoints included demographic and clinical characteristics, operative findings, and minor and major postoperative complications. <b><i>Results:</i></b> During the study period, LSG was performed in 122 patients (M/F: 68/54, median age: 2.5 years), only gastrostomy in 9 patients and with concomitant fundoplication in 113 patients. Both age and weight were significantly lower in the LSG group (<i>P</i> < 0.05). Most of patients have neurological impairment (79%). The gastrostomy indications were failure to thrive (53%) and gastroesophageal reflux symptoms (38%). There were no conversions to open surgery and no complications. The median duration of the procedure in gastrostomy, and with fundoplication was 30 and 95 minutes, respectively, the difference was significant (<i>P</i> < 0.05). The mean follow-up period was 63 months. Minor complications such as granulation, leakage, and dislocation were developed in 63 patients (52%), and adhesive bowel obstruction or peritonitis as major complications in 4 patients (4%). <b><i>Conclusion:</i></b> The LSG method is a safe, effective, and durable minimally invasive method with satisfactory midterm follow-up results and a low complication rate in patients with neurological disorders and those requiring gastrostomy due to other pathologies.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"763-769"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785838","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":"Enhancing Competency in Bariatric-Metabolic Surgery: The Impact of Simulation-Based Training on Surgeons' Experience.","authors":"Ursula Figueroa, Diego Sanhueza, Milenko Grimoldi, Enrique Cruz, Rafael Selman, Eduardo Machuca, Cristián Jarry, Gabriel Escalona, Fernando Crovari, Nicolás Quezada, Sergio Riveros, Mauricio Gabrielli, Martín Inzunza, Julián Varas","doi":"10.1177/10926429251359745","DOIUrl":"10.1177/10926429251359745","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The learning curve for a laparoscopic Roux-en-Y gastric bypass (LRYGB) requires between 50 and 150 cases to reach competency and over 500 cases to significantly reduce morbidity. Our team has developed and validated a simulation-based training program focused on LRYGB-related skills, but its impact on surgeons' clinical development has not been assessed. <b><i>Objectives:</i></b> This study aims to evaluate the perceptions of participants after a bariatric-metabolic surgery simulation-based training course (BSC), exploring potential effects on their surgical exposure and development. <b><i>Methods:</i></b> A cohort study was conducted among trainees from the 2018-2023 simulation course who were surveyed to evaluate its impact on surgical experience, proficiency, case exposure, confidence, and clinical outcomes. <b><i>Results:</i></b> From 2018 to 2023, 110 trainees completed the BSC, and 27% responded to a follow-up survey. Pre-course, 76% were practicing surgeons and 13% residents; 33% had performed >200 laparoscopic cases and 13% none. At follow-up, 57% reported very advanced experience; 97% affirmed enhancements in technique and outcomes; 90% noted increased confidence and deemed simulation essential. Procedure-specific relevance was rated 63% for exploratory laparoscopy, 66% for bypass, and 70% for sleeve gastrectomy. <b><i>Conclusions:</i></b> Feedback from trainees highlights a simulation course's role in enhancing surgical skills, confidence, and exposure to complex cases. While it is recognized that attaining surgical competency is influenced by multiple factors, this study contributes valuable trainee-centered evidence supporting the positive impact that structured simulation-based training can have in a surgical career.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"696-701"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638587","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":"Development and Validation of a Nomogram for Predicting Lymph Node Metastasis in Incidental Gallbladder Cancer before Re-Resection.","authors":"Jingbin Wang, Yuanfang Sun, Yanhao Sun","doi":"10.1089/lap.2025.0081","DOIUrl":"10.1089/lap.2025.0081","url":null,"abstract":"<p><p><b><i>Background:</i></b> Incidental gallbladder cancer (IGBC) is often diagnosed unexpectedly during or after cholecystectomy performed for presumed benign gallbladder disease. Accurate preoperative prediction of lymph node (LN) metastasis is critical for guiding surgical re-resection strategies but remains challenging. This study aimed to develop and validate a nomogram to predict LN metastasis in IGBC patients prior to re-resection. <b><i>Methods:</i></b> We retrospectively analyzed 745 IGBC patients who underwent re-resection between August 2019 and October 2024. Clinical data, including demographics, comorbidities, laboratory tests, imaging findings, and histopathological features, were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for LN metastasis. A nomogram was constructed based on these factors. The predictive performance of the nomogram was evaluated using receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA). <b><i>Results:</i></b> Multivariate analysis identified tumor size > 1 cm, advanced T stage, poor differentiation, positive LN status on preoperative computed tomography imaging, and elevated serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 as independent predictors of LN metastasis. The nomogram demonstrated good discriminative ability, with an area under the ROC curve (AUC) of 0.827. Calibration plots showed good agreement between predicted probabilities and observed outcomes. DCA indicated the clinical usefulness of the nomogram. <b><i>Conclusions:</i></b> The nomogram based on preoperative clinical, imaging, and pathological factors provides an effective tool for predicting LN metastasis in IGBC patients before re-resection. It can assist clinicians in risk stratification and optimizing surgical strategies, potentially improving patient outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"735-740"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576822","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 Efficacy and Safety of Balloon Dilation Versus Gradual Dilation in Patients with Obesity Undergoing Supine Percutaneous Nephrolithotomy.","authors":"Ubeyd Sungur, Taner Kargı, Alican Çatik, Yusuf Arıkan, Alper Bitkin, Ali İhsan Taşçı","doi":"10.1177/10926429251359731","DOIUrl":"10.1177/10926429251359731","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> We aimed to compare the safety and efficacy of gradual dilatation (GD) and balloon dilatation (BD) in supine percutaneous nephrolithotomy (PNL) in patients with obesity. <b><i>Methods:</i></b> The study was performed on 164 patients with a body mass index (BMI) ≥30 kg/m² who underwent supine PNL in the Galdakao-modified Valdivia position. Sixty patients who underwent tract creation with BD were defined as Group 1, and 104 patients who underwent tract creation with GD were defined as Group 2. Demographic characteristics, preoperative, intraoperative, and postoperative data were compared between the two groups. Then, binary logistic regression analysis was performed to predict stone-free status and complications, and parameters predicting success and safety were investigated. <b><i>Results:</i></b> There was no statistically significant difference between the two groups regarding stone-free status, transfusion rate, and the Clavien-Dindo complication grades. Fluoroscopy time and operation time were significantly lower in Group 1 than in Group 2 (<i>P</i> < .001 and <i>P</i> = .002). When the factors predicting success were analyzed, multiple stones and staghorn stones were associated with lower success in multivariate analysis. Long operation times were found to be significant in predicting the development of complications in multivariate analysis. <b><i>Conclusions:</i></b> BD and GD have similar success and complication rates as dilatation methods in patients with obesity. BD method may provide less X-ray exposure with shorter fluoroscopy and operation time, but both methods can be used safely in supine PNL in patients with obesity.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"741-746"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668862","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 Interval Appendectomy as Safe and Effective Treatment of Complicated Appendicitis after Failed Initial Conservative Approach: A Single-Center Experience.","authors":"Ciro Esposito, Fulvia Del Conte, Mariapina Cerulo, Vincenzo Coppola, Vincenzo Bagnara, Francesco Tedesco, Claudia Di Mento, Annalisa Chiodi, Giorgia Esposito, Chiara Boccarossa, Maria Escolino","doi":"10.1177/10926429251366867","DOIUrl":"10.1177/10926429251366867","url":null,"abstract":"<p><p><b><i>Background:</i></b> Following the COVID-19 pandemic, antibiotic therapy has become the first-line treatment for acute appendicitis (AA) in many centers. Interval appendectomy (IA) is often needed later due to symptom recurrence. This paper aimed to report our experience with early, unplanned laparoscopic IA (LIA) over the past 2 years. <b><i>Materials and Methods:</i></b> All patients with previous AA initially managed with antibiotics who underwent LIA due to symptom recurrence over the period January 2022-March 2024 were enrolled. Parameters assessed included patients' characteristics and operative outcomes. <b><i>Results:</i></b> The patient cohort included 40 girls and 31 boys, with a median age of 13.3 years (range 9-17). All LIAs were accomplished laparoscopically without conversions or intraoperative complications. The median operative time was 27 minutes (range 15-48). The appendix was ligated using two endoloops in 28/71 (39.4%) and resected using an automatic stapler in 43/71 (60.6%). A retrocecal appendix was found in 25/71 (35%), and adhesions between the appendix and the surrounding tissues in 31/71 (43%). Parasitic helminths were found in the lumen of the appendix in 5/71 (7%). Meckel's diverticulum was negative in all cases. The median hospitalization was 32 hours (range 26-50). No postoperative complications occurred. Pathology confirmed intramural inflammation with peri-appendiceal fibrosis in all patients. <b><i>Conclusions:</i></b> Our study confirms that early laparoscopic appendectomy is a safe and feasible option after failed nonoperative management of complicated appendicitis. All procedures were completed laparoscopically without complications. Given the presence of adhesions and retrocecal appendix in many cases, further studies are needed to refine optimal treatment strategies and timing.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"758-762"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790605","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":"Beyond the <i>P</i> Value: The Clinical Story of Pain after Inguinal Hernia Repair.","authors":"Carlos Andre Balthazar da Silveira, Ana Caroline Dias Rasador, Raquel Nogueira, Leandro Totti Cavazzola, W Scott Melvin, Diego Camacho, Diego L Lima","doi":"10.1177/10926429251374421","DOIUrl":"10.1177/10926429251374421","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Clinical studies often define their findings as statistically significant based solely on a &lt;i&gt;P&lt;/i&gt; value of less than .05. In hernia surgery, pain intensity is a key patient-reported outcome, commonly measured using the visual analogue scale (VAS). However, recent research indicates that, despite achieving statistical significance, a difference of less than 1 point on the VAS lacks clinical relevance. Our study aims to investigate how the leading journals in surgery and abdominal wall hernia surgery report superiority regarding postoperative pain using the VAS for inguinal hernia repair (IHR). &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; We searched &lt;i&gt;Hernia Journal&lt;/i&gt;, &lt;i&gt;Surgical Endoscopy&lt;/i&gt;, &lt;i&gt;Annals of Surgery&lt;/i&gt;, &lt;i&gt;Surgery&lt;/i&gt;, &lt;i&gt;World Journal of Surgery&lt;/i&gt;, and &lt;i&gt;JAMA&lt;/i&gt; for comparative articles analyzing IHR. Our search was performed according to the recent guidelines, comprising articles published since 2018. We included all the studies that used the VAS pain scale as a pain intensity analysis tool. Two authors independently screened the articles, analyzing the presence of a clinical relevance cutoff definition for the VAS tool and of statistical significance, and if it suggested superiority of an intervention or control regarding the pain intensity based solely on the &lt;i&gt;P&lt;/i&gt; value, despite having a VAS difference of less than 1 point. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; The initial search resulted in 169 articles, of which 45 articles were included. Among the studies, 21 (46.7%) were randomized controlled trials (RCTs), 15 (33.3%) were cohort studies, and 9 (20%) were meta-analyses. Fifteen (33.3%) studies compared surgical techniques, 19 (42.2%) studies analyzed surgical materials, while the other studies compared anesthetic methods, patient characteristics, and intraoperative aspects such as hernia sac and internal orifice management. Surprisingly, none of the studies defined a clinical relevance cutoff for the VAS pain scale. Twenty-five (55.6%) studies presented a statistically significant difference between the groups analyzed. Among these studies, only 11 (44%) presented a VAS difference of 1 point in their analyses. However, among the 14 studies that presented no clinically relevant VAS difference, 12 (85.7%) supported a difference in pain intensity based solely on the &lt;i&gt;P&lt;/i&gt; value, while only 2 (14.3%) highlighted that their results may not be of clinical relevance, both being meta-analyses. Interestingly, these findings were more evident among the randomized studies, of which nine (42.9%) RCTs presented statistical significance. However, only two (22.2%) among those statistically significant results presented a VAS difference of more than 1 point. Interestingly, none of the other seven RCTs highlighted that their results may not be of clinical significance. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Our findings revealed that the widely recommended clinical relevance cutoff of a 1-point difference on the VAS tool is often overlooke","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"747-752"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976927","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}