Application of Pelvic Peritoneum Closure Combined with Extraperitoneal Colostomy in Laparoscopic Surgery for Low Rectal Cancer

Background:In the treatment of colorectal cancer,laparoscopic surgery has seen a significant amount of success.Reducing the risk of postoperative complications and improving patients’quality of life can be accomplished by appropriately employing pelvic peritoneal repair and sigmoid colostomy when appropriate.Objective:To compare fusion closure of pelvic peritoneum combined with extraperitoneal colostomy with non-closure of pelvic peritoneum combined with intraperitoneal colostomy in patients with low rectal cancer who had permanent colostomy.Methods:Low rectal cancer patients admitted to Hengshui People’s Hospital for permanent colostomy were evaluated.The participants were divided into two groups:an observation and a control group.All 30 cases in the observation group underwent pelvic peritoneum closure and extraperitoneal colostomy,while the other 30 cases in the control group underwent intraperitoneal colostomy.The C-reactive protein(CRP)levels of the participants in both groups were evaluated for 6 months to 2 years(24 h before,24 h after,48 h after,96 h after surgery).Results:Comparing the colostomy operative time,time to first passage of flatus postoperatively,time to first defecation postoperatively,length of hospital stay,laboratory indicators,stoma-related complications,colostomy function,etc.,the colostomy operative time significantly differed between the two groups(P<0.05);the observation group did considerably better than the control group in terms of stoma-related complications and bowel movement control 6 months after surgery(P<0.05);and although serum CRP levels increased in both groups 48 h after surgery,the difference was significant(P<0.05).Conclusion:Extraperitoneal colostomy can improve the quality of life of patients with permanent stoma and reduce the occurrence of stoma-related complications.Thus,this technique is worthy of promotion in clinical practice.

Evolution of endoscopic extraperitoneal radical prostatectomy （EERPE）： technique and outcome

Endoscopic extraperitoneal radical prostatectomy （EERPE） is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refined with the expansion of anatomical knowledge. The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure＇s established benefits in terms of potency, continence and oncological management. In this study, the technique and its evolution are presented in detail, along with an analysis of its clinical efficacy. We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy, and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.

Utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection

AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.

Laparoscopic Extraperitoneal Inguinal Hernia Repair Using a Novel Mesh with Self-Fixating Properties

Laparoscopic totally extraperitoneal (TEP) hernia repair is a well-accepted technique for inguinal hernia repair. Different types of mesh and fixation methods have been described. Recently, a novel, self-fixating mesh has been introduced and used successfully in open inguinal hernia repairs. We report the first initial experience using this mesh for TEP repairs.

Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty

BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.

A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System

To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy(epR-spRP)and extraperitoneal robotic multiport radical prostatectomy(epR-mpRP)performed with the da Vinci Si Surgical System,comparison was performed between 30 single-port(SP group)and 26 multiport(MP group)cases.Comparisons included operative time,estimated blood loss(EBL),hospital stay,peritoneal violation,pain scores,scar satisfaction,continence,and erectile function.The median operation time and EBL were not different between the two groups.In the SP group,the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients(P<0.001).The median postoperative hospital stay in the SP group was shorter than that in the MP group(P<0.001).The rate of peritoneal damage in the SP group was less than that in the MP group(P=0.017).The pain score and overall need for pain medications in the SP group were lower than those in the MP group(P<0.001 and P=0.015,respectively).Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively(P=0.007).At 3 months,the cancer control,recovery of erectile function,and urinary continence rates were similar between the two groups.It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system.Therefore,epR-spRP can be a treatment option for localized prostate cancer.Although epR-spRP still has a learning curve,it has advantages for postoperative pain and self-assessed cosmesis.In the absence of the single-port robotic surgery platform,we can still provide minimally invasive surgery for patients.

Comparison of the extraperitoneal and transperitoneal laparoscopic radical prostatectomy

The laparoscopic radical prostatectomy （LRP） is a developing technique for treatment of localizedprostate cancer, while the extraperitoneal approach has been highlighted recently.1 From May 2003 to April 2006, we performed laparoscopic radical prostatectomy by transperitoneal or extraperitoneal approaches in 31 patients with localized prostate cancer. Some parameters of these patients are compared in this article.

A study of laparoscopic extraperitoneal sigmoid colostomy after abdomino-perineal resection for rectal cancer

Objective:To established a procedure for laparoscopic extraperitoneal ostomy after abdomino-perineal resection(APR)and study safety aspects and complications.Method:From July 2011 to July 2012,36 patients with low rectal cancer undergoing APR were included in the study and divided into extraperitoneal ostomy group(n=18)and intraperitoneal ostomy group(n=18).Short-and long-term complications were compared between the two groups.All patients were followed up and the median duration was 17 months(range:12-24).Results:The rates of short-term complication related to colostomies were comparable between the two groups,except the rate for stoma edema was higher in the extraperitoneal group(33.3%vs 0%;P=0.008).In the intraperitoneal ostomy group,two patients developed stoma prolapse,one had stoma stenosis,and two had parastomal hernia.In contrast,no long-term complications related to colostomies occurred in the extraperitoneal ostomy group.The rate of long-term complication was lower in the extraperitoneal ostomy group(0%vs 22.2%;P=0.036).Conclusion:The laparoscopic extraperitoneal ostomy is a relatively simple and safe procedure,with fewer long-term complications related to colostomy.However the follow-up period was not too long and needs to be extended.

Huge pelvi-abdominal malignant inflammatory myofibroblastic tumor with rapid recurrence in a 14-year-old boy

Inflammatory myofibroblastic tumor(IMT) is an uncommon benign neoplasm with locally aggressive behavior but malignant change is rare.We report an unusual case of pelvic-abdominal inflammatory myofibroblastic tumor with malignant transformation in a 14-year-old boy presenting with abdominal pain and 9 kg body weight loss in one month.Computed tomography revealed a huge pelvi-abdominal mass(30 cm),possibly originating from the pelvic extraperitoneal space,protruding into the abdomen leading to upward displacement of the bowel loops,downward displacement of the urinary bladder,massive central necrosis,a well-enhanced peripheral solid component with prominent peritumoral vascularity.Subsequent examination confirmed the computed tomographic findings.Histopathologic examination revealed proliferative epitheloid and spindle cells,inflammatory cell infiltration and high mitotic counts.Immunohistochemistry was strongly positive for anaplastic lymphoma kinase and revealed a high proliferative index(ki-67 = 40%).DNA sequencing and electronic microscopy further confirmed the primitive fibroblastic cell phenotype of the tumor and a final diagnosis of inflammatory myofibroblastic tumor with malignant transformation was established.Rapid tumor recurrence was noted 20 d after radical tumor resection.To our knowledge,this is the largest documented case of IMT in a pediatric patient and the first report of IMT with malignant transformation originating from the pelvic extraperitoneal space.

Influence of bladder neck suspension stitches on early continence after radical prostatectomy： a prospective randomized study of 180 patients

Several techniques have been introduced to improve early postoperative continence. In this study, we evaluated the impact of bladder neck （vesicourethral anastomosis） suspension on the outcome of extraperitoneal endoscopic radical prostatectomy （EERPE）. In this research, a total of 180 patients underwent EERPE. Group 1 included patients who underwent nerve-sparing EERPE （nsEERPE） （n=45）, and Group 2 included patients who underwent nsEERPE with bladder neck suspension （BNS, n=45）. Groups 3 （n=45） and 4 （n=45） included patients who received EERPE and EERPE with BNS, respectively. Patients were randomly assigned to receive BNS with their nsEERPE or EERPE procedure. Perioperative parameters were recorded, and continence was evaluated by determining the number and weight of absorbent pads （pad weighing test） on the second day after catheter removal and by a questionnaire 3 months postoperatively. Two days after catheter removal, 11.1% of Group 1, 11.1% of Group 2, 4.4% of Group 3 and 8.9% of Group 4 were conti nent. The average urine loss was 80.4, 70.1, 325.0 and 291.3 g for the each of these groups, respectively. At 3 months, 76.5% of Group I and 81.3% of Group 2 were continent. The continence figures for Group 3 and 4 were 48.5% and 43.8%, respectively. Similar overall rates were observed in all groups. In conclusion, although there are controversial reports in the literature, early continence was never observed to be significantly higher in the BNS groups when compared with the non-BNS groups, regardless of the EERPE technique performed.

Retroperitoneal kidney transplantation with liver and native kidney mobilization:a safe technique for pediatric recipients

Background Pediatric kidney transplant(KT)using larger,deceased or living donor adult kidneys can be challenging in the pediatric population due to limited space in the retroperitoneum.Liver and native kidney(L/NK)mobilization techniques can be used in smaller and younger transplant recipients to aid in retroperitoneal placement of the renal allograft.Here,we compare the clinical outcomes of pediatric retroperitoneal KT with and without L/NK mobilization.Methods We retrospectively analyzed pediatric renal transplant recipients treated between January 2015 and May 2021.Donor and recipient demographics,intraoperative data,and recipient outcomes were included.Recipients were divided into two groups according to the surgical technique utilized:with L/NK mobilization(Group 1)and without L/NK mobilization(Group 2).Baseline variables were described using frequency distributions for categorical variables and means and standard errors for continuous variables.Tests of association with the likelihood of using L/NK mobilization were performed using standardχ2 tests,t tests,and the log-rank test.Results Forty-six pediatric recipients were evaluated and categorized into Group 1(n=26)and Group 2(n=20).Recipients in Group 1 were younger(6.7±0.8 years vs.15.3±0.7,P<0.001),shorter(109.5±3.7 vs.154.2±3.8 cm,P<0.001)and weighed less(21.4±2.0 vs.48.6±3.4 kg,P<0.001)than those in Group 2.Other baseline characteristics did not difer between Groups 1 and 2.One urologic complication was encountered in Group 2;no vascular or surgical complications were observed in either group.Additionally,no stents or drains were used in any of the patients.There were no cases of delayed graft function or graft primary nonfunction.The median follow-up of the study was 24.6 months post-transplant.Two patients developed death-censored graft failure(both in Group 2,P=0.22),and there was one death with a functioning graft(in Group 2,P=0.21).Conclusions Retroperitoneal liver/kidney mobilization is a feasible and safe technique that facilitates implantation of adult kidney allografts into pediatric transplant recipients with no increased risk of developing post-operative complications,graft loss,or mortality.