Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Experience With an Innovative Surgical Treatment Option for Gastroesophageal Reflux Disease: Results of 28 Patients in a Retrospective Analysis.","authors":"Moustafa Elshafei","doi":"10.1089/lap.2024.0390","DOIUrl":"10.1089/lap.2024.0390","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Standard-of-care gastroesophageal reflux disease (GERD) procedures are associated with adverse events (AEs) (i.e., dysphagia, gas-bloating). RefluxStop has been developed to circumvent these outcomes. This study presents the results of 28 patients managed with RefluxStop in Germany. <b><i>Methods:</i></b> Between July 2021 and November 2023, 28 patients with GERD underwent RefluxStop surgery, a novel laparoscopic antireflux procedure. Retrospective chart analysis with patient-informed consent was conducted to determine clinical outcomes, such as GERD Health-Related Quality of Life (GERD-HRQL) score, proton pump inhibitors (PPI) use, symptomatology, patient satisfaction, and perioperative AEs. <b><i>Results:</i></b> Baseline characteristics (<i>n</i> = 28): age 47 ± 13.1 years; 67.9% female; body mass index (BMI) 27.3 ± 4.1 kg/m²; 93% PPI use for 5.6 ± 2.7 years; and hiatal hernia in 100% of cases of mean (standard deviation [SD]) size 3.4 (0.8) cm, whereof 35.7% were large hiatal hernia (4-6 cm). At a mean (SD) follow-up of 14.1 (4.7) months, patients experienced 88.6% improvement in median (IQR) total GERD-HRQL score from a baseline of 35 (7.7) to 4 (4.2) at follow-up (<i>P</i> < .05). Preoperative dysphagia (35.7%) resolved completely in all patients (<i>P</i> < .001). The mean (SD) GERD-HRQL heartburn subdomain decreased by 90.6% from a baseline of 18.1 (6.1) to 1.7 (1.2) at follow-up and all patients (100%) had scores <5. Similarly, the mean (SD) regurgitation subdomain decreased from a baseline of 13.2 (4.7) to 2 (1.6) at follow-up and all patients (100%) had scores <5. Patient satisfaction was achieved in 96.4% of patients with no PPI use required in 93% of patients (<i>P</i> < .001); only one patient required PPIs for persistent GERD symptoms. No cases of reoperation or esophageal dilatation were performed. Minor intraoperative AEs occurred in seven patients (i.e., neck emphysema). <b><i>Conclusion:</i></b> RefluxStop provides excellent safety and effectiveness outcomes for GERD treatment. Dysphagia completely resolved (0%) with 88.6% improvement in median GERD-HRQL score and satisfaction achieved in 96.4% of patients. These promising results reproduced the outcomes noted in the RefluxStop CE trial in real-world settings.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"357-364"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732868","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":"Robot-Assisted Pull-Through for Anorectal Malformations: Comparative Observational Study of Functional Outcomes with an Open Approach.","authors":"Quentin Ballouhey, Pierre Meignan, Pauline Lopez, Karim Braik, Jenna Houari, Laurent Fourcade, Alexis Belgacem, Hubert Lardy","doi":"10.1089/lap.2024.0215","DOIUrl":"10.1089/lap.2024.0215","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Robotic surgery has gained acceptance in the field of pediatric surgery but is still under assessment. Some limitations of this device are particularly encountered when performing specific tasks in small cavities, such as neonatal pelvis. The aim of this study was to compare the functional results of robot-assisted anorectal pull-through (RAARP) with posterior sagittal anorectoplasty (PSARP) in children with \"high\" types of anorectal malformations (ARMs). <b><i>Materials and Methods:</i></b> In this multicenter experience, we reviewed the patients operated for ARMs using the da Vinci® system between 2007 and 2020 in our national robotic program. Two groups of patients according to the surgical technique (robotic versus open) were compared based on the postoperative outcomes and long-term functional results using Kelly and Krickenbeck scores at 3 years of age. <b><i>Results:</i></b> Ten patients operated using RAARP were compared with 10 patients operated using PSARP (mean weight 8.1 ± 1.2 kg versus 8.6 ± 1.1 kg, respectively). The two groups were comparable in terms of the ARM classification and patient demographics. The clinical Kelly score was significantly lower for the PSAAP group (<i>P</i> = .012). The Krickenbeck constipation score was significantly lower for the RAARP group (<i>P</i> = .02), whereas no statistical difference was found for the soiling score and voluntary bowel movements. <b><i>Conclusions:</i></b> A concomitant laparoscopic approach using a robotic platform appears to be an alternative technique to the criterion standard for performing anorectal malformation surgery with satisfactory functional results. The enhanced potential of preserving perirectal nerves requires confirmation through longer follow-up studies focusing on functional assessment.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"425-430"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626645","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":"Educational Quality of YouTube^TM Videos on Laparoscopic Radical Prostatectomy.","authors":"Ender Akdemir, Muhammet Çiçek, Battal Selçuk Çakmak, Mehmet Levent Akbulut, Muhammet Serdar Buğday","doi":"10.1089/lap.2025.0002","DOIUrl":"10.1089/lap.2025.0002","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Prostate cancer is the most prevalent urogenital cancer among males. Radical prostatectomy remains the gold standard for localized prostate cancer treatment, with minimally invasive procedures (laparoscopic, robot-assisted laparoscopic) increasingly replacing open surgeries. YouTube™, a popular digital platform, hosts a substantial volume of prostate cancer-related videos, presenting a mix of accurate and misleading content. Given these challenges, researchers have proposed evaluation frameworks to assess the quality of YouTube™ videos. This study evaluates the educational adequacy and contextual relevance of laparoscopic radical prostatectomy (LRP) videos on YouTube™ using established video evaluation criteria. <b><i>Methods:</i></b> A search using the keyword \"Laparoscopic Radical Prostatectomy\" yielded 200 YouTube™ videos. After applying inclusion and exclusion criteria, 131 videos were analyzed by three laparoscopic prostatectomy specialists. An evaluation was performed using scoring systems, including LAP-VEGaS, DISCERN, JAMA, GQS, and video power index (VPI). <b><i>Results:</i></b> Of the 131 videos, 88 (67%) were from individual participants (Group 1), and 43 (33%) were from corporate channels (Group 2). Group 2 demonstrated significantly higher JAMA, GQS, and mDISCERN scores (<i>P</i> = .028, .005, and .001, respectively). The LAP-VEGaS score was also higher in Group 2 (7.09 ± 0.43) compared to Group 1 (5.08 ± 0.26; <i>P</i> < .001). VPI values were significantly greater in Group 2 (<i>P</i> = .008). <b><i>Conclusion:</i></b> This study highlights a critical gap in the educational quality of LRP videos on YouTube™. Using comprehensive scoring systems, corporate channels consistently provided higher-quality educational content compared to individual contributors.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"373-378"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674468","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":"Effectiveness of Snare Traction-Facilitated Endoscopic Resection for Gastric Submucosal Tumors ≥ 2 cm: A Propensity Score-Matched Study.","authors":"Yangyang Zhou, Shimeng Zheng, Jinghao Li, Deliang Li, Yuhu Song","doi":"10.1089/lap.2025.0015","DOIUrl":"https://doi.org/10.1089/lap.2025.0015","url":null,"abstract":"<p><p><b><i>Aim:</i></b> The aim of this study was to assess the efficacy of the snare traction technique in assisting the endoscopic resection (ER) procedure in gastric submucosal tumors (SMTs) ≥ 2 cm. <b><i>Methods:</i></b> Between January 2015 and December 2022, we retrospectively reviewed data from patients with gastric SMTs ≥ 2 cm who were treated by ER at the first affiliated hospital of Zhengzhou University. Then, propensity score matching (PSM) (1:3) between snare traction-assisted and conventional ER procedures was used to overcome selection bias. The success rate, en bloc resection rate, dissection time, dissection speed, and perioperative complications were compared. <b><i>Results:</i></b> A total of 314 patients were included in this study. After PSM, 34 patients were enrolled in the snare traction-assisted endoscopic resection group (STAER) and 102 patients were enrolled in the conventional endoscopic resection group (CER). STAER group had a higher dissection speed (6.60 vs. 5.20 mm²/min; <i>P</i> = .030) and shorter dissection time (76.00 vs. 76.50 minutes, <i>P</i> = .003). There were no significant differences in technique success rate, en bloc resection rate, and perioperative complications between the two groups. In subgroup analysis, the dissection speed of STAER was significantly higher than that of CER when the lesion length was 2-5 cm, underwent endoscopic full-thickness resection, and was located in the gastric antrum. <b><i>Conclusions:</i></b> STAER demonstrated a higher efficiency for gastric SMTs ≥ 2 cm, without increasing the perioperative complications. Further prospective studies are needed to assess the efficiency and safety of the STAER method.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":"35 5","pages":"406-411"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024103","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":"Rare Congenital Lung Lesions in Even Rarer Locations: A Single-Institution Experience with Extrathoracic Congenital Lung Lesions.","authors":"Yeu Sanz Wu, Juan Garcia, Nicholas Schmoke, Christopher Nemeh, Mark C Liszewski, Vincent R Duron","doi":"10.1089/lap.2024.0384","DOIUrl":"10.1089/lap.2024.0384","url":null,"abstract":"<p><p><b><i>Background:</i></b> Extrathoracic congenital lung lesions (CLLs) are a rare anomaly of lung development. Management and surgical approach are variable. We present our institutional experience with extrathoracic CLLs for the past 18 years. <b><i>Methods:</i></b> We retrospectively reviewed all patients younger than 18 years diagnosed with a CLL from January 2005 to June 2023. Only patients with suspected extrathoracic CLLs on prenatal imaging were included. <b><i>Results:</i></b> A CLL was identified in 381 patients and was extrathoracic in 25 patients (6.6%). Six patients (24%) with other congenital anomalies were excluded, and 3 were lost to follow-up. The prenatal course and delivery of the 16 study patients were unremarkable and all were asymptomatic. Larger lesions, both prenatally and postnatally, were more likely to undergo surgical resection (11.8 ± 8.2 cm³ versus 3.9 ± 3.3 cm³, <i>P</i> = .05; 6.1 ± 5.1 cm³ versus 2.5 ± 2.5 cm³, <i>P</i> = .10, respectively). Seven patients (7/16; 44%) underwent resection-5 thoracoscopic and 2 laparoscopic. Thoracoscopic transdiaphragmatic approach was favored for lesions extending >50% above the diaphragm. Five lesions were intradiaphragmatic, one infradiaphragmatic, and one intrathoracic. Four lesions (4/7; 57%) were hybrid lesions on pathology. No malignancy was identified. Nine patients (9/16; 56%) underwent surveillance. Imaging modality for surveillance varied. Duration of follow-up ranged from 0.5 to 83 months. <b><i>Conclusions:</i></b> We provide the largest case series to date describing both operative and nonoperative management of extrathoracic CLLs. Surveillance appears to be appropriate for small lesions. If surgical excision is pursued, the thoracoscopic approach is safe and preferred if diaphragmatic involvement is suspected.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"342-350"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524862","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":"Diagnosis of Acute Appendicitis with Machine Learning-Based Computer Tomography: Diagnostic Reliability and Role in Clinical Management.","authors":"Osman Sibic, Erkan Somuncu, Serhan Yilmaz, Ercan Avsar, Emre Bozdag, Adem Ozcan, Mahmut Ozan Aydin, Cenk Ozkan","doi":"10.1089/lap.2024.0374","DOIUrl":"10.1089/lap.2024.0374","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Acute appendicitis (AA) is a common surgical emergency affecting 7-8% of the population. Timely diagnosis and treatment are crucial for preventing serious morbidity and mortality. Diagnosis typically involves physical examination, laboratory tests, ultrasonography, and computed tomography (CT). This study aimed to evaluate the effectiveness of artificial intelligence (AI) in analyzing CT images for the early diagnosis of AA and prevention of complications. <b><i>Methods:</i></b> CT images of patients who underwent surgery for AA at the General Surgery Clinic of Kanuni Sultan Suleyman Health Application and Research Center between January 1, 2019, and June 31, 2023, were analyzed. A total of 1200 CT images were evaluated using four different AI models. The model performance was assessed using a confusion matrix. <b><i>Results:</i></b> The median age of the patients was 28 years, with a similar sex distribution. No significant differences were observed in terms of age or sex (<i>P</i> = .168 and <i>P</i> = .881, respectively). Among the AI models, MobileNet v2 showed the highest accuracy (0.7908) and precision (0.8203), whereas Inception v3 had the highest F-score (0.7928). In the receiver operating characteristic analysis, MobileNet v2 achieved an area under the curve (AUC) of 0.8767. <b><i>Conclusion:</i></b> AI's role in daily life is expanding. In the present study, the highest sensitivity and specificity were 77% and 86%, respectively. Supporting CT imaging with AI systems can enhance the accuracy of AA diagnoses.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"313-317"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450836","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 Surgical Outcomes of Emergent Laparoscopic Cholecystectomy for Acute Cholecystitis Between Attending Surgeons and Residents: A Retrospective Study in Single Medical Center.","authors":"Ching-Wei Tu, Ding-Ping Sun, Khaa-Hoo Ong, Jie-Pu Chen, Chung-Han Ho, Chih-Ying Lu","doi":"10.1089/lap.2024.0393","DOIUrl":"10.1089/lap.2024.0393","url":null,"abstract":"<p><p><b><i>Background:</i></b> With improvements in skills and evidence of safety, emergent laparoscopic cholecystectomy is routinely performed for acute cholecystitis, if indicated, at our hospital. However, resident operations are concerned with the dilemmas of training programs and patient safety. Hence, our aim was to clarify the safety and feasibility of emergency laparoscopic cholecystectomy performed by attending surgeons and residents. <b><i>Materials and Methods:</i></b> Our study was a retrospective review of 923 patients, who underwent laparoscopic cholecystectomy between January 2021 and June 2022 at our hospital. We excluded combined surgery, single-port methods, laparoscopic common bile duct exploration, elective surgery, and patients with Mirizzi symptoms. Of the 191 patients who underwent emergency laparoscopic cholecystectomy, 118 were operated on by residents, and 73 were operated on by attending surgeons. Patient demographics, surgical and postoperative outcomes, and length of hospital stay were compared between the groups. <b><i>Results:</i></b> No significant differences were observed in sex, age, body mass index (BMI), or surgical history. Older age (60 versus 52 years) and higher BMI (26.29 versus 25.46) were observed in the attending group, and the severity was greater than that in the resident group. No significant differences were observed in the operative results, including mortality (both groups, <i>n</i> = 0), morbidity, blood loss, or length of stay. However, the operation time was significantly shorter in the attending group obviously (86.41 versus 117.89 minutes, <i>P</i> < .0001) significantly. <b><i>Conclusion:</i></b> Emergent laparoscopic cholecystectomy for acute cholecystectomy performed by a resident under supervision appears feasible and safe. The resident operator was associated with increased operative times, however, not complications. This study confirms that residents can also finish surgery in precisely selected cases, and the more important concept is knowing the limits of asking for help.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"286-293"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of a Novel Handheld Robotic Needle Holder Versus Conventional Instrument in Laparoscopic Ureterolithotomy: A Multicenter, Randomized, Single-Blind, Positive Parallel Controlled, and Noninferiority Clinical Trial.","authors":"Zhiyong Wen, Yonglian Guo, Ziqiang Dong, Kun Yang, Xinghuan Wang","doi":"10.1089/lap.2024.0394","DOIUrl":"10.1089/lap.2024.0394","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This study aimed to validate the efficacy and safety of the HTH-1 handheld robotic needle holder versus conventional instrument in laparoscopic ureterolithotomy. <b><i>Methods:</i></b> This is a noninferiority clinical trial conducted in three hospitals. Patients were enrolled and randomly allocated into the experimental or control group on whom laparoscopic ureterolithotomy was performed with the ureteral incision sutured using the HTH-1 and conventional needle holder, respectively. The average suture time per stitch (STPS) of ureter was calculated as the primary efficacy indicator. Postoperative drainage volumes were recorded, and the instruments' operating performance was subjectively evaluated and compared between groups. Adverse events occurred during the trial and interference of the instruments to the monitor were assessed as the safety indicators. <b><i>Results:</i></b> From April to September 2018, 50 patients were enrolled with 25 ones in each group. For the efficacy indicators, the noninferiority of the STPS was determined when the noninferiority margin was 40 seconds. The postoperative drainage volumes were not significantly different between groups. The instruments' operating performance was rated as smooth in all cases of both groups. For the safety indicators, no adverse events or interference of the instruments to the monitor occurred during surgery in any case. Clavien 1 complications occurred in 7 (4 in the experimental group versus 3 in the control group, <i>P</i> = 1.000) patients after surgery. <b><i>Conclusions:</i></b> The HTH-1 is effective and safe and noninferior to conventional needle holder in laparoscopic ureterolithotomy. Adequate training and skills assessment are needed before application on patients. <b><i>Clinical trial registration:</i></b> The clinical trial registration was completed in Jiangsu Provincial Drug Administration (record number: Suxielinbei 20180018).</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"294-299"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694293","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":"One Less: Single-Incision Laparoscopic Appendectomy Facilitates Postoperative Opioid Avoidance.","authors":"Paul M Jeziorczak, Casey J Goodyear, Olivia A Perham, Riley S Frenette, Charles J Aprahamian","doi":"10.1089/lap.2022.0489","DOIUrl":"10.1089/lap.2022.0489","url":null,"abstract":"<p><p><b><i>Background:</i></b> Opioid use has become an epidemic problem. There has been a recent push toward strategies that minimize postoperative opioid use. Appendectomy is one of the most common procedures performed in the pediatric population. Single-incision appendectomy through the umbilicus is a safe and well-tolerated procedure. The aim of this project was to review opioid utilization in children who have undergone single incision appendectomy for perforated and nonperforated appendicitis. <b><i>Methods:</i></b> A retrospective review, approved by the University of Illinois College of Medicine Institutional Review Board, of 500 patients at a single institution under the age of 18 who had an appendectomy between May 1, 2018, and December 1, 2021, was performed. A final population cohort of 432 was assembled after excluding non-single-incision cases (67) and non-appendectomy cases (1). Outcomes of interest were length of stay, age, appendix perforation status, and opioids at discharge status. All patients were sent home without opioids. <b><i>Results:</i></b> A total of 432 patients underwent a single incision laparoscopic appendectomy, with an overall average length of stay of 2.1 days, average age of 11.1 years, and zero patients were sent home on opioids. The perforated appendix population (<i>n</i> = 169) yielded a less than 4-day stay, an average age of 10.33 years, and 61.5% male. Meanwhile, the nonperforated appendix population (<i>n</i> = 264) revealed a 0.8-day stay, an average age of 11.59, years and 54.2% male. The differences between perforated and nonperforated appendectomies are significant for average length of stay (<i>P</i> < .001) and average age (<i>P</i> < .01). <b><i>Conclusion:</i></b> Being cognizant of opioid utilization in the management of postoperative pain control is important to address the current opioid crisis. The single incision laparoscopic approach for pediatric appendectomy can potentially decrease the need for postoperative narcotics. No children were sent home with narcotics in our population. The procedure is well tolerated and can be performed with traditional laparoscopic equipment.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"339-341"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450837","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 Common Bile Duct Exploration for Choledocholithiasis in the Elderly: A Systematic Review and Meta-Analysis.","authors":"Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Caio Mendonça Magalhães, Eric Pasqualotto, Gabriel Henrique Acedo Martins, Abraão Alcantara de Medeiros Filho, Lucas Soares de Souza Pinto Guedes, Sergio Mazzola Poli de Figueiredo","doi":"10.1089/lap.2024.0382","DOIUrl":"10.1089/lap.2024.0382","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Laparoscopic common bile duct exploration (LCBDE) is a well-established and effective minimally invasive surgical approach for managing choledocholithiasis. However, its safety in the elderly population is not well established. Therefore, this study compares surgery-related outcomes in elderly patients undergoing LCBDE. <b><i>Methods:</i></b> We systematically searched PubMed, Embase, and Cochrane Library for studies comparing elderly and young patients undergoing LCBDE. Binary outcomes were compared using odds ratios (ORs), with 95% confidence intervals (CIs). Heterogeneity was assessed with <i>I</i>² statistics. Statistical analysis was performed using Software R, version 4.3.3. <b><i>Results:</i></b> Twelve studies comprising 3791 patients were included, of whom 1411 patients (37%) were from the elderly group. Elderly patients were associated with an increase in mortality (OR: 3.42; 95% CI: 1.08-10.85; <i>P</i> = .04; <i>I</i>² = 0%), overall postoperative complications (OR: 1.60; 95% CI: 1.11-2.22; <i>P</i> = .01; <i>I</i>² = 52%), and pneumonia (OR: 4.37; 95% CI: 2.00-9.55; <i>P</i> < .01; <i>I</i>² = 0%) rates. However, there were no significant differences between groups in remnant stones (OR: 1.37; 95% CI: 0.70-2.68; <i>P</i> = .36; <i>I</i>² = 0%) and recurrent stones (OR: 1.37; 95% CI: 0.64-2.95; <i>P</i> = .42; <i>I</i>² = 0%) pancreatitis (OR: 0.98; 95% CI: 0.16-5.95; <i>P</i> = .98; <i>I</i>² = 0%) and bile leakage (OR: 1.24; 95% CI: 0.75-2.07; <i>P</i> = .40; <i>I</i>² = 0%). <b><i>Conclusion:</i></b> In this meta-analysis, elderly patients who underwent LCBDE experienced increased mortality, overall complications, and pneumonia rates compared with young patients. Furthermore, there were no significant differences between the groups in remnant and retained stones, pancreatitis, and bile leakage.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"318-328"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505778","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}