Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Age and Sex Adenoma Detection Rates in Colonoscopy and Optimization of Screening Age: A Retrospective Analysis.","authors":"Burak Sakar, Osman Zekai Oner, Ali Celik, Omer Celik, Turan Can Yıldız, Ugur Dogan, Onur Ilkay Dincer","doi":"10.1089/lap.2025.0071","DOIUrl":"10.1089/lap.2025.0071","url":null,"abstract":"<p><p><b><i>Background:</i></b> This study aimed to contribute to the ongoing debate regarding the optimal age to initiate colorectal cancer (CRC) screening by evaluating adenoma detection rates (ADRs) across different age and sex groups and to explore whether national screening guidelines should be revised in line with international trends. <b><i>Methods:</i></b> In this single-center, retrospective observational study, 1216 average-risk patients who underwent colonoscopy between January and December 2024 were analyzed. The patients were stratified into three age groups: Group 1 (40-44 years), Group 2 (45-49 years), and Group 3 (50-54 years). ADR, advanced neoplasia detection rate (ADNR), ADR by sex, Boston Bowel Preparation Scale (BBPS) score, and withdrawal times were evaluated. Patients with a history of polypectomy, family history of CRC, incomplete colonoscopy, or inadequate bowel preparation (BBPS score <6) were excluded. Group comparisons were performed using Chi-square or Fisher's exact tests, with <i>P</i> < .05 considered statistically significant. <b><i>Results:</i></b> Overall ADR and ADNR were 20.8% and 2.6%, respectively. ADRs by group were 7.6%, 15.8%, and 18.9% in Groups 1, 2, and 3, respectively. A significant difference was found between Groups 1 and 2 (<i>P</i> = .032) but not between Groups 2 and 3 (<i>P</i> = .55). ADR was significantly higher in males (30.2%) than in females (13.1%; <i>P</i> < .001). ADNR was also higher in males (3.7%) than in females (1.8%; <i>P</i> = .048). All patients had withdrawal times >6 minutes. <b><i>Conclusion:</i></b> ADR significantly increased from age 45, supporting the potential need to lower the CRC screening age and consider sex-specific strategies. Further prospective multicenter studies are warranted.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"596-601"},"PeriodicalIF":1.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036896","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 Fascial Suture Type on Postoperative Complications Following Pediatric Gastrostomy Tube Placement.","authors":"Noah Wilson, Emily K Myers, Nell Weber, Noah Keime, Nicole Becher, Suhong Tong, Connor Prendergast, Ann M Kulungowski, Jonathan L Hills-Dunlap, Jose Diaz-Miron, Shannon N Acker","doi":"10.1177/10926429251361108","DOIUrl":"10.1177/10926429251361108","url":null,"abstract":"<p><p><b><i>Background:</i></b> A variety of surgical techniques are used to secure the stomach to the abdominal wall during gastrostomy tube (GT) placement. Previous pilot data have demonstrated an increased risk of cellulitis associated with the choice of fascial suture type during gastropexy. We investigated whether fascial suture type impacted rates of common complications after GT placement. <b><i>Methods:</i></b> We conducted a single-center retrospective review of children who underwent GT placement at the Children's Hospital of Colorado from November 2020 to April 2023. Patients with a concomitant procedure labeled as wound class II or greater were excluded. Subjects were matched 2:1 by suture type to generate a convenience sample. Data collected included patient characteristics and clinical course. Outcomes included cellulitis, tube dislodgement, granulation tissue, ED visits, readmission, and reoperation. Comparisons were made based on fascial suture type, either a polyglactin braided absorbable suture or a poliglecaprone, absorbable monofilament suture. <b><i>Results:</i></b> A total of 184 patients were included, 122 in the braided group and 62 in the monofilament group. There were no differences in patient demographics. Neither the rate of granulation tissue at 2 weeks and 6 months nor the median number of granulation tissue events differed between the groups. Rates of cellulitis and tube dislodgement at 2 weeks were similar between the cohorts. Other short-term and long-term outcomes, including GT removal and subsequent gastrocutaneous fistula closure, did not differ. <b><i>Conclusions:</i></b> Fascial suture type does not significantly impact the rate of postoperative complications, including rates of cellulitis, granulation tissue, and tube dislodgement following GT placement in pediatric patients.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"677-682"},"PeriodicalIF":1.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715165","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":"What Is the Red Flag for VATS Pneumonectomy? When to Perform or Avoid the Procedure?","authors":"Melike Ülker, Volkan Erdoğu, Merve Ekinci Fidan, Ayşegül Çiftçi, Ezgi Kılıçaslan, Meral Selin Onay Mahmuti, Erdinç Denizli, Celal Buğra Sezen, Özkan Saydam, Muzaffer Metin","doi":"10.1089/lap.2025.0057","DOIUrl":"10.1089/lap.2025.0057","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The safety and efficacy of video-assisted thoracoscopic surgery (VATS) in pneumonectomy for patients with non-small cell lung cancer (NSCLC) were compared with open surgery. <b><i>Methods:</i></b> Between January 2020 and October 2024, we conducted a retrospective review of 177 pneumonectomy cases at our center. Fifty-eight cases were performed using VATS (VATS Group), while 119 were performed using thoracotomy (Thoracotomy Group). <b><i>Results:</i></b> The average age of the patients was 61.2 ± 8.3 years (range: 39-83), and the majority were male (<i>n</i> = 155, 87.6%). Perioperative blood loss (VATS Group: 152 ± 131 mL, range 100-700 mL versus Thoracotomy Group: 314 ± 455 mL, range 100-3500 mL) and hospital stay durations (VATS Group: 5.3 ± 2.4 days, range 3-13 versus Thoracotomy Group: 7.5 ± 4.1 days, range 2-22) were found to be significantly lower in the VATS Group (<i>P</i> < .001 for both). Left-sided resections were more frequent in the VATS Group (74% versus 57.1%, <i>P</i> = .049), and tumor sizes were observed to be smaller (4.8 ± 2.2 cm versus 6.2 ± 3.6 cm, <i>P</i> = .009). No significant differences were observed between the groups in terms of postoperative early morbidity and 30-day mortality (<i>P</i> = .784 and <i>P</i> = .549, respectively). <b><i>Conclusion:</i></b> VATS pneumonectomy is a method that can be preferred by experienced centers in patients with NSCLC, offering the advantages of reduced perioperative bleeding and shorter hospital stays compared with the thoracotomy approach, without compromising oncological principles.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"652-658"},"PeriodicalIF":1.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499045","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":"Simple Versus Radical Cholecystectomy for Pathological Stage T1B Gallbladder Cancer: A Systematic Review and Meta-Analysis.","authors":"Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Gabriel Henrique Acedo Martins, Caio Mendonça Magalhães, Sérgio Mazzola Poli de Figueiredo","doi":"10.1089/lap.2025.0049","DOIUrl":"10.1089/lap.2025.0049","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Gallbladder cancer (GBC) is the sixth most common gastrointestinal malignancy and the most prevalent cancer of the biliary tract. Although recent studies suggest that extended resection may be the optimal approach for managing T1b GBC, there is no clear consensus on whether simple cholecystectomy (SC) or radical cholecystectomy (RC) offers better outcomes. Therefore, we conducted this systematic review and meta-analysis to compare these two surgical techniques in the treatment of T1b GBC. <b><i>Methods:</i></b> We systematically searched PubMed, Embase, and the Cochrane Library through June 20, 2024. We pooled odds ratios (ORs) with 95% confidence intervals (CIs) for binary outcomes and assessed heterogeneity using the <i>I</i>² statistic. <b><i>Results:</i></b> We included 10 studies comprising 2,964 patients, of whom 51.5% underwent SC and 48.5% underwent RC. RC was associated with significantly higher 2 year (OR: 0.46; 95% CI: 0.28-0.77; <i>P</i> < .01; <i>I</i>² = 51%) and five-year overall survival rates (OR: 0.79; 95% CI: 0.64-0.98; <i>P</i> = .03; <i>I</i>² = 0%), and higher 5-year disease-specific survival (OR: 0.59; 95% CI: 0.35-0.99; <i>P</i> = .04; <i>I</i>² = 0%) compared with SC. However, we found no significant differences in 10-year overall survival (OR: 0.71; 95% CI: 0.45-1.13; <i>P</i> = .15; <i>I</i>² = 43%) or recurrence rates (OR 1.44; 95% CI: 0.72-2.88; <i>P</i> = .30; <i>I</i>² = 0%). <b><i>Conclusion:</i></b> RC provides a short- to medium-term survival advantage over SC in patients with T1b gallbladder cancer, but this benefit appears to diminish over time.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"614-620"},"PeriodicalIF":1.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144246","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 Early Results of Laparoscopic Transabdominal Preperitoneal and Total Extraperitoneal Repair in Recurrent Inguinal Hernia.","authors":"Cihan Atar, Emir Çapkınoğlu, Burak Yavuz, Ahmet Onur Demirel, Cihan Uras","doi":"10.1089/lap.2025.0067","DOIUrl":"10.1089/lap.2025.0067","url":null,"abstract":"<p><p><b><i>Background:</i></b> The optimal surgical approach for recurrent inguinal hernia remains controversial. Among the commonly used laparoscopic techniques, transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs are frequently performed, yet data comparing their short-term outcomes in recurrent cases are limited. This study aimed to compare early clinical outcomes of TAPP versus TEP in recurrent inguinal hernia repair. <b><i>Methods:</i></b> We retrospectively analyzed 48 patients who underwent laparoscopic surgery for recurrent inguinal hernia between January 2022 and April 2024 at two centers. Patients were assigned to TEP (<i>n</i> = 27) or TAPP (<i>n</i> = 21) groups based on surgeon preference. Demographics, intraoperative variables, and postoperative outcomes including recurrence, complications, visual analogue pain scores (visual analogue scale [VAS]), analgesic requirement, urinary retention, seroma formation, and testicular complications, were assessed. <b><i>Results:</i></b> Baseline characteristics were comparable except for age, which was significantly lower in the TAPP group (47.5 ± 14.1 versus 60.3 ± 10.2; <i>P</i> < .001). No significant differences were observed in operative time, VAS scores, or hospital stay. Although intraoperative bleeding, urinary retention, and seroma were more frequent in the TAPP group, these did not reach statistical significance. No conversions to open surgery occurred in the TEP group, while one was noted in the TAPP group. During a median follow-up of 22 months for TEP and 16 months for TAPP, a single recurrence was observed in the TAPP group (4.8%). Rates of chronic pain were similar between groups. <b><i>Conclusion:</i></b> Both TAPP and TEP are safe and effective for recurrent inguinal hernia repair, with low complication and recurrence rates. No clear superiority was demonstrated. Surgical technique should be selected based on individual patient and anatomical factors. Further randomized prospective studies are needed to better define the optimal approach in recurrent cases.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"659-663"},"PeriodicalIF":1.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267779","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 Liver Resection for Small, Solitary, Peripheral-Type Intrahepatic Cholangiocarcinoma, Based on Preoperative Prediction of Lymph Node Metastasis.","authors":"Hirotoshi Takayama, Shogo Kobayashi, Kunihito Gotoh, Kazuki Sasaki, Yoshifumi Iwagami, Daisaku Yamada, Yoshito Tomimaru, Hirofumi Akita, Tadafumi Asaoka, Takehiro Noda, Hiroshi Wada, Hidenori Takahashi, Masahiro Tanemura, Yuichiro Doki, Hidetoshi Eguchi","doi":"10.1089/lap.2025.0031","DOIUrl":"10.1089/lap.2025.0031","url":null,"abstract":"<p><p><b><i>Aim:</i></b> Laparoscopic liver resection (LLR) for intrahepatic cholangiocarcinoma (ICC) is not as widespread as LLR for hepatocellular carcinoma or liver metastasis, mainly because ICC may require a lymph node dissection (LND). However, small, solitary, peripheral-type ICC rarely have lymph node metastasis (LNM). The aim of the current study is to examine the usefulness of LLR for ICC and determine whether our criteria for applying LLR without LND to small, solitary, peripheral-type ICC was appropriate. <b><i>Methods:</i></b> We retrospectively selected 78 patients that underwent liver resections for ICC at Osaka University Hospital between 2003 and 2020. We compared LLR (<i>n</i> = 13) to open liver resection (OLR, <i>n</i> = 65) for short-term and long-term outcomes. We also analyzed a subgroup (<i>n</i> = 29) with small, solitary, peripheral-type ICC. <b><i>Results:</i></b> The LLR group had less blood loss (<i>P</i> < .001), shorter postoperative stays (<i>P</i> < .001), and significantly higher 5-year recurrence-free survival (RFS, 74.0%), compared to the OLR group (29.6%, <i>P</i> = .030). However, the OLR group included a higher proportion of patients with advanced ICC. Among patients with small, solitary, peripheral-type ICC, LLR (<i>n</i> = 10) was associated with less blood loss (<i>P</i> = .004) and shorter postoperative stays (<i>P</i> = .002), compared to OLR (<i>n</i> = 19). These groups had similar pathological findings, similar 5-year RFS (75.0% versus 56.8%; <i>P</i> = .433), and similar 5-year overall survival (75.0% versus 80.4%; <i>P</i> = .530). No patients that underwent LLR without LND for ICC experienced lymph node recurrence. <b><i>Conclusions:</i></b> Among patients with ICC, LLR provided better intraoperative and short-term outcomes than OLR, and comparable oncological outcomes. Furthermore, no patients that underwent LLR without LND for ICC experienced lymph node recurrence. LLR without LND for ICC can be performed safely and feasibly by selecting patients with small, solitary, peripheral-type ICC.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"640-651"},"PeriodicalIF":1.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327604","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 Versus Laparoscopic Surgery for Colorectal Cancer: A Trial Sequential Meta-Analysis of Randomized Trials.","authors":"Bernardo Fontel Pompeu, Luís Eduardo Braz de Moraes Alves, Beatriz D'Andrea Pigossi, Gabriel Leal Barone, Lucas Monteiro Delgado, Lucas Soares de Souza Pinto Guedes, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga","doi":"10.1089/lap.2025.0088","DOIUrl":"10.1089/lap.2025.0088","url":null,"abstract":"<p><p><b><i>Background:</i></b> Laparoscopic surgery (LS) is widely recognized as the standard minimally invasive method for colorectal cancer. Although robotic surgery (RS) has seen increased adoption, its clinical and economic advantages over LS remain uncertain. <b><i>Methods:</i></b> A systematic search was carried out across PubMed, Scopus, and the Cochrane Central Register up to March 2025. Only randomized controlled trials (RCTs) directly comparing RS and LS were included. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed via the <i>I</i>² statistic. Trial sequential analysis (TSA) was applied to assess the robustness of the cumulative evidence. <b><i>Results:</i></b> Fourteen RCTs encompassing 2867 patients were included. Compared with LS, RS significantly lowered the conversion rate to open surgery (RR = 0.54; 95% CI: 0.36-0.80; <i>P</i> = .002), time to first stool (MD = -0.33 days; 95% CI: -0.60 to -0.06; <i>P</i> = .016), and positive circumferential resection margin (CRM) (RR = 0.65; 95% CI: 0.46-0.93; <i>P</i> = .017). Sensitivity analysis revealed a slight benefit for RS in time to first flatus (MD = -0.13 days; <i>P</i> = .03). RS was associated with a longer surgery duration (MD = +49.4 minutes; 95% CI: 18.0-80.7; <i>P</i> = .002). No significant differences were observed for intraoperative blood loss, postoperative complications, or cancer recurrence. TSA confirmed definitive findings for selected outcomes, while others remained underpowered. <b><i>Conclusions:</i></b> RS and LS showed equivalent results for postoperative complications and cancer-related outcomes. RS was advantageous in reducing conversion and CRM positivity, despite longer operative time.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"621-639"},"PeriodicalIF":1.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310700","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 Long-Term Complication with Increasing Incidence: Intravesical Hem-o-Lok® Clip Migration after Robot-Assisted Laparoscopic Radical Prostatectomy.","authors":"Bulent Onal, Ahmet Vural, Kadir Can Sahin, Feyyaz Irmak, Huseyin Kocan, Elif Altınay Kırlı, Emre Akkus","doi":"10.1089/lap.2025.0089","DOIUrl":"10.1089/lap.2025.0089","url":null,"abstract":"<p><p><b><i>Background:</i></b> Hem-o-lok® clips (HOLC) (Weck Surgical Instruments, Teleflex Medical, Durham, NC) are commonly used to achieve athermal hemostasis and control the lateral vascular pedicles of the prostate, especially in nerve-sparing surgery during robot-assisted laparoscopic radical prostatectomy (RALP). However, an increasing number of studies have demonstrated intravesical HOLC migrations. This study aims to describe the clinical presentation, symptoms, management, and outcomes of intravesical HOLC migration to the vesicourethral anastomotic site (VUAS). <b><i>Methodology:</i></b> A retrospective analysis was conducted on 386 RALP procedures performed by an experienced surgeon at a tertiary care center between November 2017 and November 2024. The data of all patients who have experienced intravesical HOLC migration during long-term follow-up and were treated for this reason were compiled. Cystoscopy findings, HOLC localizations, the number of HOLCs removed, procedures, and patient follow-up data were analyzed. <b><i>Results:</i></b> Of 386 patients, 5 (1.2%) experienced intravesical HOLC migration at follow-up. Two of these patients received adjuvant radiotherapy. The mean time to identify HOLC migration was 27.8 ± 18.3 months. Following a single cystoscopic intervention, none of the patients' HOLC migration-related symptoms recurred, and no further procedures were required. During follow-up, bladder neck stenosis occurred in 2 patients. <b><i>Conclusion:</i></b> In long-term follow-up of RALP, the lower urinary tract symptoms and persistent dysuria may be related to intravesical HOLC migration. In surgical practice, avoiding using HOLC close to the VUAS and reducing the number of HOLC utilized may help prevent complications.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"672-676"},"PeriodicalIF":1.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334336","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":"Risk Factors for Postoperative Complications of Ileostomy Reversal.","authors":"Si-Qi Li, Quan Lv, Zheng Xiang, Xiao-Su Hui","doi":"10.1089/lap.2025.0092","DOIUrl":"10.1089/lap.2025.0092","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> The aim of this study was to investigate the risk factors for postoperative complications following ileostomy reversal. <b><i>Materials and methods:</i></b> The databases PubMed, Embase, and Cochrane Library were independently searched by the two authors from inception to December 30, 2024. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled up for describing dichotomous variables. Stata 16 was performed for data. <b><i>Results:</i></b> After pooling up the data, a total of 19 studies involving 11108 patients were included in this study. The outcomes showed that any complication after primary procedure (OR = 2.51, 95% CI = 1.66 to 3.79, <i>I</i>² = 1.97%, <i>P</i> < .01) were associated with ileostomy reversal complications. In addition, obesity (OR = 1.45, 95% CI = 1.17 to 1.79, <i>I</i>² = 0.00%, <i>P</i> < .01), linear wound closure (OR = 6.63, 95% CI = 1.59 to 27.76, <i>I</i>² = 0.00%, <i>P</i> < .01), higher American Society of Anesthesiologists (ASA) scores (OR = 1.70, 95% CI = 1.33 to 2.18, <i>I</i>² = 3.33%, <i>P</i> < .01), and longer operative time (OR = 1.30, 95% CI = 1.11 to 1.53, <i>I</i>² = 97.32%, <i>P</i> < .01) were associated with wound infection. <b><i>Conclusion:</i></b> For patients with complications after the initial surgery, surgeons should be aware of the risks of complications following ostomy reversal. Obesity, longer operative time, and higher ASA scores were risk factors for wound infections. Purse-string skin closure had certain advantages over linear skin closure in reducing incision infections.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"664-671"},"PeriodicalIF":1.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250611","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":"Strategies for Resection of Esophageal and Gastroesophageal Junction Submucosal Tumors.","authors":"Mohammad Alomari, Daniel Knewitz, Rocio Castillo Larios, Jamii St Julien, Mathew Thomas, Enrique F Elli, Steven P Bowers","doi":"10.1089/lap.2025.0079","DOIUrl":"10.1089/lap.2025.0079","url":null,"abstract":"<p><p><b><i>Background:</i></b> Submucosal tumors (SMT) of the esophagus and gastroesophageal junction (GEJ) are rare entities, which often present a significant challenge to surgeons. Prior studies have reported only single-modality approaches. We report our experience with SMTs using multiple surgical techniques with the intent of margin-negative resection and organ preservation. <b><i>Methods:</i></b> Between 2001 and 2022, a total of 55 patients underwent surgical resection for SMT of the esophagus or GEJ at our institution. We reviewed the electronic medical records to obtain demographic information and details of the operation. We also report peri- and early (<30 days) postoperative outcomes. <b><i>Results:</i></b> Median age at operation was 62 years (22-93), and 54.5% were male. Endoscopic ultrasound was used in 45 (81.8%) patients preoperatively to classify tumors as possibly amenable for enucleation versus requiring mucosal resection. Forty-eight (87.3%) patients underwent minimally invasive procedures. Enucleation was performed in 23 (41.8%) patients, whereas 32 (58.2%) required full-thickness resection (wedge: 18; segmental: 11) or tumor resection with mucosectomy. One patient experienced Clavien-Dindo grade III or greater complications. There were no reoperations or postoperative mortality. Pathology revealed gastrointestinal stromal tumor in 25 (45.5%) patients, leiomyoma in 22 (40%), and other histology in 8 (14.5%). Negative surgical margins were achieved in 100% of the cases. Involvement of the cardia was associated with the need for full-thickness or tumor resection with mucosectomy (68.4% versus 31.5%, <i>P</i> = .0214). Surveillance was conducted in 20 (36.4%) patients with a median follow-up of 656 days (210-3091). One patient had progressive multifocal disease, and another went on to develop metastatic disease. <b><i>Conclusion:</i></b> Minimally invasive approaches are appropriate in most esophageal and GEJ SMTs and are associated with low complication rates and disease recurrence. Involvement of the gastric cardia increases the likelihood of requiring full-thickness resection or tumor resection with mucosectomy rather than enucleation.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"564-569"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103017","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}