Laparoscopic appendectomy,stump closure and endoloops:A meta-analysis

BACKGROUND Acute appendicitis(AA)is one of the main indications for urgent surgery.Laparoscopic appendectomy(LA)has shown advantages in terms of clinical results and cost-effectiveness,even if there is still controversy about different devices to utilize,especially with regards to the endoloop(EL)vs endostapler(ES)when it comes to stump closure.AIM To compare safety and cost-effectiveness of EL vs ES.METHODS From a prospectively maintained database,data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery-St Orsola University Hospital,Bologna(Italy)were retrieved.A metaanalysis was performed in terms of surgical complications,in comparison to the international literature published from 1995 to 2021.RESULTS The meta-analysis showed no evidence regarding wound infections,abdominal abscesses,and total post-operative complications,in terms of superiority of a surgical technique for the stump closure in LA.CONCLUSION Even when AA is complicated,the routine use of EL is safe in most patients.

Transgastric endoscopic gastrojejunostomy using holing followed by interrupted suture technique in a porcine model

AIM: To demonstrate the feasibility and reproducibility of a pure natural orifice transluminal endoscopic surgery(NOTES) gastrojejunostomy using holing followed by interrupted suture technique using a single endoloop matched with a pair of clips in a non-survival porcine model.METHODS: NOTES gastrojejunostomy was performed on three female domestic pigs as follows: Gastrostomy, selection and retrieval of a free-floating loop of the small bowel into the stomach pouch, hold and exposure of the loop in the gastric cavity using a submucosal inflation technique, execution of a gastro-jejunal mucosal-seromuscular layer approximation using holing followed by interrupted suture technique with endoloop/clips, and full-thickness incision of the loop with a Dual knife.RESULTS: Pure NOTES side-to-side gastrojejunostomy was successfully performed in all three animals. No leakage was identified via methylene blue evaluation following surgery.CONCLUSION: This novel technique for preforming a gastrointestinal anastomosis exclusively by NOTES is technically feasible and reproducible in an animal model but warrants further improvement.

腹腔镜下阑尾切除术中两种阑尾残端处理方式的效果比较

目的探讨微乔线缝合法和Endoloop套扎法在腹腔镜下阑尾切除术(LA)中的应用效果。方法将126例行LA手术患者根据术中阑尾残端处理的方式分为缝合组(n=65)和套扎组(n=61)。缝合组术中于阑尾根部行丝线结扎后,行荷包缝合法包埋残端。套扎组术中采用Endoloop套扎法处理阑尾残端。观察2组手术时间、住院时间、住院费用和手术成功率、并发症(包括腹盆腔脓肿、右下腹戳孔感染、残端瘘等)发生率。结果2组均无中转开腹病例。缝合组手术时间长于套扎组(P<0.05),2组住院时间、住院费用比较差异无统计学意义(P>0.05)。缝合组手术成功率高于套扎组(100.0%比90.0%,P<0.05)。2组均无腹盆腔脓肿、残端瘘发生。缝合组右下腹戳孔感染发生率与套扎组比较差异无统计学意义(4.6%比3.3%,P>0.05)。结论LA手术患者采用微乔线缝合法和Endoloop套扎法处理阑尾残端各有优缺点,但缝合法更有优势。

Endoscopic repair of delayed stomach perforation caused by penetrating trauma:A case report

BACKGROUND Primary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated;however,there are very few studies on the efficacy of endoscopic management of delayed traumatic gastric perforation.Herein,we report a novel case of a patient who was successfully treated for delayed traumatic stomach perforation using an alternative endoscopic modality.CASE SUMMARY A 39-year-old woman presented with multiple penetrating traumas in the back and left abdominal cavity.Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation.An emergency primary repair of the disrupted diaphragm with omental reduction and suturing of the lacerated lung was performed;however,delayed free perforation of the gastric wall was noted on computed tomography after 3 d.Following an emergency abdominal surgery for the primary repair of the gastric wall,re-perforation was noted 15 d postoperatively.The high risk associated with re-surgery prompted an endoscopic intervention using 2 endoloops and 11 endoscopic clips using a novel modified purse-string suture technique.The free perforated gastric wall was successfully repaired without additional surgery or intervention.The patient was discharged after 46 d without any complications.CONCLUSION Endoscopic closure with endoloops and clips can be a useful therapeutic alternative to re-surgery for delayed traumatic gastric perforation.

腹腔镜阑尾切除术阑尾根部3种处理方法的对比分析

目的:探讨腹腔镜阑尾切除术阑尾根部3种处理方法的临床效果。方法:收治行腹腔镜阑尾切除术患者90例,随机分成3组,各30例,在进行阑尾根部处理时,A组采取Hem-o-lok夹闭方法,B组采取丝线结扎法,C组采取Endoloop套扎方法,比较3组的治疗效果。结果:3组的并发症发生率及住院时间的差异不存在统计学意义(P>0.05);3组手术时间的差异存在统计学意义(P<0.05)。结论:对行腹腔镜阑尾切除术患者选用何种阑尾根部处理方法,应结合患者阑尾根部水肿、患者的经济状况以及操作者腹腔镜下操作的熟练程度等因素来综合考虑。

Percutaneous transgastric endoscopic tube ileostomy in a porcine survival model

AIM To introduce natural orifice transgastric endoscopic surgery(NOTES) tube ileostomy using pelvis-directed submucosal tunneling endoscopic gastrostomy and endoscopic tube ileostomy.METHODS Six live pigs(three each in the non-survival and survival groups) were used. A double-channeled therapeutic endoscope was introduced perorally into the stomach. A gastrostomy was made using a 2-cmtransversal mucosal incision following the creation of a 5-cm longitudinal pelvis-directed submucosal tunnel. The pneumoperitoneum was established via the endoscope. In the initial three operations of the series, a laparoscope was transumbilically inserted for guiding the tunnel direction, intraperitoneal spatial orientation and distal ileum identification. Endoscopic tube ileostomy was conducted by adopting an introducer method and using a Percutaneous Endoscopic Gastrostomy Catheter Kit equipped with the Loop Fixture. The distal tip of the 15 Fr catheter was placed toward the proximal limb of the ileum to optimize intestinal content drainage. Finally, the tunnel entrance of the gastrostomy was closed using nylon endoloops with the aid of a twin grasper. The gross and histopathological integrity of gastrostomy closure and the abdominal wall-ileum stoma tract formation were assessed 1 wk after the operation.RESULTS Transgastric endoscopic tube ileostomy was successful in all six pigs, without major bleeding. The mean operating time was 71 min(range: 60-110 min). There were no intraoperative complications or hemodynamic instability. The post-mortem, which was conducted 1-wk postoperatively, showed complete healing of the gastrostomy and adequate stoma tract formation of ileostomy.CONCLUSION Transgastric endoscopic tube ileostomy is technically feasible and reproducible in an animal model, and this technique is worthy of further improvement.

腹腔镜阑尾切除术采用Endoloop套扎法与单纯结扎处理残端的效果比较

对比腹腔镜阑尾切除术后Endoloop套扎法与单纯结扎两种处理残端方式的效果;方法:从2016年1月开始至2019年1月为止在我院接受腹腔镜阑尾切除术的患者中盲抽98例患者,通过盲抽分组法将其分为实验组与对照组(49例/组),患者术后残端采用单纯结扎处理作对照组,实验组患者术后残端采用Endoloop套扎法处理,考察两组患者手术时间、治疗费用及住院时间,计算两组患者术后各类并发症发生率;结果:(1)98例患者均顺利完成手术,无术中转开腹患者,实验组手术时间、出血量、治疗费用及住院时间均低于对照组(P<0.05);(2)实验组术后并发症发生率为8.16%(4/49),对照组术后并发症发生率为14.29%(7/49),两组对比差异不具有统计学意义(P>0.05);结论:腹腔镜阑尾切除术后残端采取Endoloop套扎法处理手术时间及患者住院时间更短,治疗费用更少,且术后并发症发生率与单纯结扎处理类似,具有较好的临床应用前景。

Hem-o-lok结扎锁在腹腔镜阑尾切除术残端处理的应用

目的探讨Hem-o-lok结扎锁在腹腔镜阑尾切除中夹闭阑尾残端的应用效果。方法急性阑尾炎行腹腔镜阑尾切除术患者105例,采用2种方法处理阑尾残端:HL组39例,用Hem-o-lok结扎锁;EL组66例,用ENDOLOOP结扎圈套器双重结扎。回顾性分析两组相关临床资料。结果两组均成功完成腹腔镜阑尾切除术,术中无患者中转开腹;均无术中并发症发生。HL组术后有1例、EL组术后有2例发生主操作孔切口感染,所有伤口感染经换药、抗感染治疗后治愈。两组术后平均住院时间相仿[(5.2±1.6)d vs.(5.3±2.3)d](P>0.05)。HL组材料费少于EL组(196元vs.660元)(P<0.01)。结论腹腔镜阑尾切除术中应用Hem-o-lock结扎锁或ENDOLOOP结扎圈套器处理阑尾残端均安全有效;前者特别适用于阑尾根部炎症适度、直径小于10mm的急性阑尾炎患者,且花费少。

Hem-o-lok结扎锁和Endoloop套扎在腹腔镜阑尾切除术中的临床研究

目的在腹腔镜下阑尾炎切除术中比较Hem-o-lok结扎锁和Endoloop套扎处理阑尾根部的手术效果。方法 2017年5月～2018年5月对我院120例成人急性阑尾炎患者实施腹腔镜下阑尾切除术,根据手术方法分为H组和E组,每组60例。H组采用Hem-o-lok结扎锁对阑尾根部处理,E组采用Endoloop套扎阑尾根部,并比较两组患者手术时间、住院时间、手术费用、手术并发症等情况。结果 H组手术时间(42.83±6.52)min,住院时间(4.23±0.78)d,手术费用(4273.6±51.22)元,手术并发症4例(6.66%)。E组手术时间(46.10±7.07)min,住院时间(4.17±0.70)d,手术费用(5137.2±83.17)元,手术并发症6例(10.00%)。两组患者病理类型、住院时间、手术并发症的发生率比较,差异无统计学意义(P>0.05),而E组患者的手术时间、住院的手术费高于H组,差异有统计学意义(P<0.05)。结论 Hem-o-lok结扎锁和Endoloop套扎均可以在腹腔镜阑尾切除术中安全有效的处理阑尾炎根部,但使用Hem-o-lok结扎锁的手术时间更短,手术相关费用更低,具有很好的运用前景。