Journal of laparoendoscopic & advanced surgical techniques. Part A最新文献

{"title":"Conversion to Open Radical or Partial Nephrectomy Associated with Unplanned Hospital Readmission After Attempted Minimally Invasive Approach.","authors":"Shirin Razdan,&nbsp;Kennedy Okhawere,&nbsp;Michael Wilson,&nbsp;William Nkemdirim,&nbsp;Talia Korn,&nbsp;Kirolos Meilika,&nbsp;Ketan Badani","doi":"10.1089/lap.2021.0537","DOIUrl":"https://doi.org/10.1089/lap.2021.0537","url":null,"abstract":"<p><p><b><i>Introduction/Objectives:</i></b> We endeavored to explore the rates of unplanned hospital readmission (UHR) in patients who underwent minimally invasive radical or partial nephrectomy who were subsequently converted to open surgery. <b><i>Patients and Methods:</i></b> The National Cancer Database (NCDB) was used for this study. Patients diagnosed with renal cancer and who had minimally invasive partial or radical nephrectomy from 2004 to 2016 were included in the study. Patients were categorized as converted or not converted to open surgery. UHR was the outcome of the study and was defined as UHR within 30 days of discharge. We conducted a one-to-one nearest-neighbor propensity-score matching using baseline clinical, tumor, and facility characteristics. To evaluate the relationship between conversion to open surgery and UHR, we conducted a multivariable logistic regression on the propensity-matched cohort, a propensity score-matched model without controlling for any covariate, and a propensity score-adjusted model, controlling for only the propensity score. <b><i>Results:</i></b> A total of 142,040 patients were identified, with a 2.98% conversion rate. There was an overall decrease in the rate of conversion to open surgery from 2010 (4.11%) to 2016 (2.43%). Laparoscopic radical nephrectomy remained a significant contributor to the rate of conversion (at least 50% per year). In the unmatched cohort, the UHR rate was higher among those who had a conversion to open surgery (<i>n</i> = 710, 0.52% versus <i>n</i> = 44, 1.04%; <i>P</i> < .001). Similarly, in the propensity score-matched cohort, the UHR rate was higher among those who had a conversion to open (<i>n</i> = 22, 0.52% versus <i>n</i> = 44, 1.04%; <i>P</i> = .007). After controlling for other factors, conversion to open remained independently associated with UHF. <b><i>Conclusion:</i></b> Conversion to open radical or partial nephrectomy from a minimally invasive approach is independently associated with an increased risk of 30-day UHR.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"823-831"},"PeriodicalIF":1.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39769538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pure Laparoscopic Versus Open Approach for Living Donor Right Hepatectomy: A Systematic Review and Meta-Analysis.","authors":"Yufu Peng,&nbsp;Bo Li,&nbsp;Hongwei Xu,&nbsp;Kang Chen,&nbsp;Yonggang Wei,&nbsp;Fei Liu","doi":"10.1089/lap.2021.0583","DOIUrl":"https://doi.org/10.1089/lap.2021.0583","url":null,"abstract":"<p><p><b><i>Background:</i></b> Pure laparoscopic liver donor right hepatectomy (LLDRH) remains challenging, and its value is still unclear compared with open liver donor right hepatectomy (OLDRH). <b><i>Objective:</i></b> To provide comprehensive evidence about the safety and efficacy of LLDRH. <b><i>Methods:</i></b> The MEDLINE, Embase, Web of Science, and Cochrane Library electronic databases were searched from the date of inception to July 2021. A fixed-effects or random-effects model was used to analyze the pooled data by using Review Manager Version 5.3. <b><i>Results:</i></b> A total of 1940 patients from 6 studies were enrolled in this meta-analysis. For perioperative outcomes of donors, LLDRH had a longer operative time than OLDRH (weighted mean difference [WMD] = 29.75 [4.23-55.26] minutes, <i>P</i> = .02), but it had lower overall morbidity (odds ratio [OR] = 0.67 [0.45-0.99], <i>P</i> = .04), fewer pulmonary complications (OR = 0.47 [0.29-0.76], <i>P</i> = .002), and shorter hospital stays (WMD = -1, <i>P</i> < .001) than OLDRH. However, major complications, biliary complications, portal vein problems, and intra-abdominal bleeding were comparable between the 2 groups. With regard to the postoperative data of recipients, the risks of biliary problems, hepatic artery problems, portal vein problems, hepatic vein problems, and postoperative liver failure were similar between the 2 groups. <b><i>Conclusions:</i></b> LLDRH for living donors is safe and effective, and it offers superior perioperative outcomes to OLDRH.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"832-841"},"PeriodicalIF":1.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39674821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Secondary and Primary Minimally Invasive Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis.","authors":"Tianci Du,&nbsp;Peng Qi,&nbsp;Liangzhi He,&nbsp;Shujun Yang,&nbsp;Biao Zhang,&nbsp;Panfeng Shang","doi":"10.1089/lap.2021.0771","DOIUrl":"https://doi.org/10.1089/lap.2021.0771","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To compare the outcomes of secondary minimally invasive pyeloplasty (MIP) versus primary MIP for the patients with ureteropelvic junction obstruction (UPJO). <b><i>Materials and Methods:</i></b> We searched all the literature of PubMed, Web of Science, EMBASE, and Cochrane Library comparing secondary MIP and primary MIP and performed a systematic review and meta-analysis. <b><i>Results:</i></b> We included 15 studies involving 1637 patients with 1371 in the primary MIP group and 266 in the secondary MIP group. There were no significant differences in length of hospital stays, and the risk of hematuria, urinary tract infection, intestinal obstruction, stent complications, and overall complications (<i>P</i> > .05). Comparing with the secondary MIP group, the primary MIP group has shorter operative time (mean difference [MD] = -36.91 minutes, 95% confidence interval [CI]: -50.21 to -23.62, <i>P</i> < .00001), less estimated blood loss (MD = -16.70 mL, 95% CI: -31.60 to -1.80, <i>P</i> = .03), lower risk of urinary leakage and injury of blood vessel (relative risk [RR] = 0.32, 95% CI: 0.11-0.93, <i>P</i> = .04) (RR = 0.10, 95% CI: 0.02-0.61, <i>P</i> = .01), and higher success rate (RR = 1.07, 95% CI: 1.02-1.11, <i>P</i> = .003). The robot-assisted pyeloplasty is superior to the laparoscopic pyeloplasty in controlling the amount of blood loss in the secondary operation. <b><i>Conclusions:</i></b> Considering the poorer outcomes of secondary surgery, we believe that special attention should be paid to not missing crossing vessels, and it would be more prudent to perform a more definitive procedure with pyeloplasty instead of endopyelotomy for primary UPJO.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"871-883"},"PeriodicalIF":1.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40316292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Surgery for Lung Cancer Following Neoadjuvant Therapy in the United States.","authors":"Mohamed K Kamel,&nbsp;Adam N Sholi,&nbsp;Sebron W Harrison,&nbsp;Benjamin Lee,&nbsp;Jeffrey L Port,&nbsp;Nasser K Altorki,&nbsp;Brendon M Stiles","doi":"10.1089/lap.2021.0706","DOIUrl":"https://doi.org/10.1089/lap.2021.0706","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Pulmonary resections following neoadjuvant therapy (NT) can be technically demanding. There is a paucity of data regarding the use of minimally invasive surgery (MIS) approaches in that setting on the National level. In this study, we explored the trends of using MIS approaches following NT and its associated outcomes. <b><i>Methods:</i></b> The study included all adult patients with non-small cell lung cancer who underwent pulmonary resection following NT between 2010 and 2016. Propensity score (PS) matching (MIS versus open) was performed and the perioperative outcomes were compared. <b><i>Results:</i></b> The study included 11,287 patients who underwent pulomonary resection after NT. The percentage of patients undergoing MIS lung resection and the number of hospitals performing one or more MIS increased from 19% and 166 (2010) to 41% and 305 (2016), respectively. When compared with thoracotomy, MIS lung resections were more frequently performed in academic centers in patients with higher income (<i>P</i> < .001). In PS matched groups, the use of MIS was associated with shorter hospital length of stay (5 days versus 6 days; <i>P</i> < .001), compared with open approach. However, there were no differences between the two groups in readmission rate (<i>P</i> = .513), or 30-/90-day mortality (<i>P</i> = .145/.685). In multivariable regression analysis, MIS approach was not associated with worse long-term, all-cause, survival (confidence interval: 0.91-1.09). <b><i>Conclusion:</i></b> The use of MIS approaches after NT increased significantly over the study period and was associated with perioperative outcomes and long-term survival comparable to those noted with the open approach.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"860-865"},"PeriodicalIF":1.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39829945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adding Laparoscopic Iliopubic Tract Repair to Transabdominal Preperitoneal Hernioplasty for Treatment of Recurrent Inguinal Hernia After Totally Extraperitoneal Hernioplasty.","authors":"Sung Ryul Lee","doi":"10.1089/lap.2022.0068","DOIUrl":"https://doi.org/10.1089/lap.2022.0068","url":null,"abstract":"<p><p><b><i>Background:</i></b> In patients with recurrent inguinal hernia (IH) after totally extraperitoneal (TEP) hernioplasty, re-TEP hernioplasty is difficult because of fibrotic adhesions. Re-laparoscopic hernioplasty is possible by changing the approach from extraperitoneal to transabdominal. If iliopubic tract repair (IPTR), mainly used in the past for the open approach, is added as a laparoscopic procedure, re-laparoscopic hernioplasty is possible when treating recurrent IH. We aimed to evaluate the safety and feasibility of alternate transabdominal preperitoneal (TAPP) hernioplasty supplemented by IPTR for treating recurrent IH after TEP hernioplasty. <b><i>Methods:</i></b> We retrospectively evaluated 2600 patients with IHs who underwent TAPP hernioplasty from January 2015 to December 2020. Among patients with recurrent IH, those who underwent primary TEP were included in the study. For reoperation, TAPP hernioplasty was performed and IPTR was added. IPTR was performed by suture closure of the internal inguinal ring by the iliopubic tract and medial aponeurotic arch of the transversus abdominis muscle. <b><i>Results:</i></b> Of the 35 patients (33 males and 2 females) with recurrent IH after primary TEP hernioplasty, 51% (18/35) of patients had recurrence within 2 years of the first operation. There were 28 recurrent IHs of the same type as the original, and 7 cases of a different type. The mean TAPP operation time was 41 minutes. Chronic inguinodynia and re-recurrence was not observed. One patient had inferior epigastric vessel injury, which was successfully repaired. <b><i>Conclusion:</i></b> Adding laparoscopic IPTR to TAPP hernioplasty is safe feasible treatment for recurrent IH after TEP hernioplasty.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"896-901"},"PeriodicalIF":1.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40316294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a Laparoscopic Training Model for Pediatric Surgeons During COVID-19 Pandemic: A Single-Center Experience.","authors":"Benedetta Lepore,&nbsp;Giuseppe Autorino,&nbsp;Vincenzo Coppola,&nbsp;Rachele Borgogni,&nbsp;Roberto Carulli,&nbsp;Mariapina Cerulo,&nbsp;Gianluigi Califano,&nbsp;Roberto Cardone,&nbsp;Maria Escolino,&nbsp;Ciro Esposito","doi":"10.1089/lap.2022.0158","DOIUrl":"https://doi.org/10.1089/lap.2022.0158","url":null,"abstract":"Background: During COVID-19 pandemic, many restrictions were applied in the field of health care. For this reason, we decided to adopt the laparoscopic simulator Laparo® Analytic to allow the trainees of our pediatric surgery training program to continue their training activity, and we determined its impact on their surgical education. Methods: We used Laparo Analytic Simulator for laparoscopic surgery training among the residents of our center. Fifteen residents from different years of the pediatric surgery program participated in this study. Each participant performed a 2-hour training session per week, consisting of three different exercises: Rubber Bands, Knotting, and Suturing. For each training session, the following parameters were analyzed: training time, economy of movement, smoothness, instrument activity (IA), instrument visibility (IV), and instrument symmetry. Results: Results were collected after the first training session (T0), at 3 months after the beginning of the study (T1) and at 6 months after the beginning of the study (T2). At T2 of training with Laparo Analytic Simulator, residents were able to complete their tasks significantly faster (P = .001) and had a significant improvement in smoothness of movements, IA, IV, and instrument symmetric movements during the tasks analyzed. Conclusion: On the basis of our results, we believe that Laparo analytic is an excellent system to adopt in minimally invasive surgery (MIS) training programs, in particular, during periods of surgical restrictions, as COVID-19 pandemic, or in centers with a limited MIS activity.","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"907-912"},"PeriodicalIF":1.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40477202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study of Laparoscopic Versus Open Liver Resection in Gallbladder Cancer.","authors":"Mizelle D'Silva,&nbsp;Ho-Seong Han,&nbsp;Yoo-Seok Yoon,&nbsp;Jai Young Cho","doi":"10.1089/lap.2021.0670","DOIUrl":"https://doi.org/10.1089/lap.2021.0670","url":null,"abstract":"<p><p><b><i>Background:</i></b> In recent decades, laparoscopic liver resection (LLR) has been gradually adopted at high-volume centers, particularly for hepatocellular carcinoma and liver metastasis. However, LLR in patients with gallbladder cancer (GBC) is a controversial issue, and there are few studies of LLR for GBC. Our aim was to compare the outcomes of patients who underwent laparoscopic or open liver resection for GBC. <b><i>Materials and Methods:</i></b> All patients admitted with stage II or III GBC requiring liver resection, together with cholecystectomy and lymphadenectomy, were analyzed retrospectively. Patients with thickness of the resected liver specimen >2 cm in pathology reports were included. <b><i>Results:</i></b> A total of 56 patients with stage II or III GBC were included in this study; 23 (41.1%) underwent laparoscopic surgery and 33 (58.9%) underwent open surgery. Propensity score matching was performed using a 1:1 matching scheme. After matching, 12 patients were included in each group. The preoperative characteristics of both groups were similar, as were the operative times (laparoscopic versus open group: 237.5 minutes versus 272.5 minutes, respectively; <i>P</i> = .319) and blood loss (300 mL versus 275 mL, respectively; <i>P</i> = .307). The laparoscopic group had a significantly shorter postoperative hospital stay than the open surgery group (4.5 days versus 8 days, respectively; <i>P</i> = .012). There were no major complications in either group. There was no difference between the groups in the number of lymph nodes harvested at surgery (<i>P</i> = .910). There were no differences between the two groups in disease-free (<i>P</i> = .503) or overall (<i>P</i> = .719) survival. <b><i>Conclusion:</i></b> LLR extended to GBC provides outcomes similar to those of open surgery. With increasing experience, LLR can be a viable alternative to open surgery for GBC.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"854-859"},"PeriodicalIF":1.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39764607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Feasibility of Laparoscopic Transabdominal Preperitoneal Hernia Repair for Octo- and Nonagenarians.","authors":"Atsushi Kohga,&nbsp;Akihiro Kawabe,&nbsp;Akihiro Makino,&nbsp;Kiyoshige Yajima,&nbsp;Takuya Okumura,&nbsp;Kimihiro Yamashita,&nbsp;Jun Isogaki,&nbsp;Kenji Suzuki","doi":"10.1089/lap.2021.0616","DOIUrl":"https://doi.org/10.1089/lap.2021.0616","url":null,"abstract":"<p><p><b><i>Background:</i></b> The feasibility of laparoscopic hernia repair in octo- and nonagenarians has not been investigated in detail. The aim of this retrospective study was to evaluate the safety and feasibility of laparoscopic hernia repair in octo- and nonagenarians. <b><i>Methods:</i></b> This study included 607 patients who underwent transabdominal preperitoneal laparoscopic hernia repair at our hospital between April 2014 and October 2020. Patients were divided into an over 80 group (112 patients aged 80 years and older) and a control group (495 patients younger than 80 years). The clinical outcomes were compared between the groups. In addition, among patients aged 80 years and older, those who underwent elective laparoscopic hernia repair (laparoscopic group: 111 patients) were compared with patients who underwent elective open hernia repair during the same study period (open group: 79 patients). <b><i>Results:</i></b> The number of patients who underwent bilateral hernia repair was significantly larger in the over 80 group (26.7% versus 11.7%, <i>P</i> < .001). The incidence of postoperative complications was not significantly different between the over 80 group and the control group. Compared with open group, the number of patients who underwent bilateral hernia repair was significantly larger in the laparoscopic group (27.0% versus 2.5%, <i>P</i> < .001). The incidence of postoperative complications (2.7% versus 10.1%) and the incidence of readmission (0.9% versus 6.3%) were significantly greater in the open group. <b><i>Conclusions:</i></b> Laparoscopic hernia repair in octo- and nonagenarian patients yields safe and noninferior outcomes. Laparoscopic hernia repair in octo- and nonagenarian patients is considered more suitable for detecting and repairing contralateral hernias simultaneously.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"848-853"},"PeriodicalIF":1.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39764169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Training for Transanal Total Mesorectal Excision in a Live Animal Model: A Preliminary Experience.","authors":"Michele Grieco,&nbsp;Ugo Elmore,&nbsp;Andrea Vignali,&nbsp;Maria Emiliana Caristo,&nbsp;Roberto Persiani","doi":"10.1089/lap.2021.0845","DOIUrl":"https://doi.org/10.1089/lap.2021.0845","url":null,"abstract":"<p><p><b><i>Background:</i></b> In this preliminary experience, the feasibility and effectiveness of surgical training with an animal model for transanal total mesorectal excision (TaTME) were evaluated. <b><i>Methods:</i></b> The training was conducted in two experimental animal laboratories in Italy authorized by the Italian Ministry of Health, using female Danish Landrace pigs under the supervision of surgeons with extensive experience in TaTME, animal laboratory training and cadaver laboratory training. The procedure was divided into separate steps, and all the participants were guided step-by-step throughout the entirety of the procedure. <b><i>Results:</i></b> During all the editions of the animal laboratory, all the procedures were completed with no major damage to the anatomical structures or intraoperative death of the animals. Live animal tissue is very similar to human tissue, helping trainees improve their tactile feedback. The bleeding effect improved the value of the training and taught the participants how to address this complication. The lack of mesorectal tissue in pigs compared with humans was the main difference. Animal laboratories should not be considered alternatives to cadaver laboratories but as complementary training activities due to their effectiveness and lower costs. <b><i>Conclusions:</i></b> Surgical training in animal models for TaTME seems to be effective and could be an opportunity to improve training alongside the use of a cadaver laboratory and proctoring.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"866-870"},"PeriodicalIF":1.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39615826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Transhepatic Gallbladder Drainage Combined with Laparoscopic Cholecystectomy Versus Emergency Laparoscopic Cholecystectomy for the Treatment of Moderate Acute Cholecystitis: A Meta-Analysis.","authors":"Jingzhao Han,&nbsp;Dongdong Xue,&nbsp;Hongfang Tuo,&nbsp;Ze Liang,&nbsp;Chuncheng Wang,&nbsp;Yanhui Peng","doi":"10.1089/lap.2021.0579","DOIUrl":"https://doi.org/10.1089/lap.2021.0579","url":null,"abstract":"Background: We compared the clinical outcomes of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) with those of emergency LC (ELC) in patients with moderate acute cholecystitis (AC) as per the Tokyo Guidelines. Methods: A meta-analysis of clinical comparative studies investigating the efficacy of PTGBD combined with LC (PTGBD + LC) versus ELC for moderate AC patients was performed. Results: The PTGBD + LC group had a shorter operative time (mean difference [MD] = -25.02 minutes; 95% confidence interval [95% CI] -35.50 to -14.54; P < .00001), less intraoperative bleeding (MD = -33.38 mL; 95% CI -45.43 to -21.33; P < .00001), shorter postoperative hospital stay (MD = -2.37 days; 95% CI -3.30 to -1.44; P < .00001), lower conversion rate (odds ratio [OR] 0.23; 95% CI 0.11-0.48; P < .0001), and lower total postoperative morbidity (OR 0.26; 95% CI, 0.10-0.67; P = .005) compared with the ELC group. There was no significant difference in total hospital stay (MD = 1.71 days; 95% CI -0.17 to 3.60; P = .08) and the incidence of bile leak (OR 0.30; 95% CI 0.07-1.29; P = .11). Conclusions: Compared with ELC, LC after PTGBD can effectively reduce the difficulty of operation, total postoperative morbidity, and conversion rate, and shorten the postoperative hospital stay and operative duration in patients with moderate AC as per the Tokyo Guidelines. In clinical practice, it is necessary to formulate individualized treatment plans based on the condition and willingness of the patients.","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"733-739"},"PeriodicalIF":1.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39866771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}