Laparoscopic surgery in patients with cystic fibrosis: A systematic review

a.lsfakia shared this article with you from Inoreader Laparoscopic surgery in patients with cystic fibrosis: A systematic review Via Asian Journal of Endoscopic Surgery Abstract Introduction Laparoscopic surgery may be advantageous for cystic fibrosis (CF) patients because it leads to fewer complications than open surgery. However, it could still lead to pulmonary and cardiovascular complications in CF patients. We aimed to systematically review the use of laparoscopic surgery in CF patients. Methods A systematic review was performed in compliance with PRISMA guidelines. A literature search was performed using PubMed/MEDLINE, ScienceDirect, EMBASE, and Google Scholar, with "cystic fibrosis and laparoscopic surgery" and "cystic fibrosis and minimally invasive surgery" used as the search terms. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were applied. The protocol was registered with the PROSPERO register. Results Six studies met the predetermined inclusion criteria; accordingly, two studies provided high‐quality evidence and four provided moderate‐quality evidence. The interrater correlation was convincing (r s = .95, P = .02, two‐tailed). Therefore, three quantitative studies and three qualitative studies were assessed and evidence‐graded in accordance with the GRADE protocol. Conclusion The benefits of laparoscopic surgical interventions for patients with CF were supported with good evidential value and recognized as a safe and suitable surgical option. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intestinal blood flow evaluation using the indocyanine green fluorescence imaging method

a.lsfakia shared this article with you from Inoreader Intestinal blood flow evaluation using the indocyanine green fluorescence imaging method in a case of incarcerated obturator hernia: A case report Via Asian Journal of Endoscopic Surgery Abstract In surgery for incarcerated hernia, intestinal blood flow is an important factor in intraoperative decision‐making given that irreversible ischemia can result in intestinal necrosis. Here, we report a case of incarcerated obturator hernia in which the bowel was successfully preserved by evaluating intestinal blood flow with the indocyanine green fluorescence imaging method. A woman in her 80s was diagnosed with incarcerated right obturator hernia, and a laparoscopic operation was performed. The small bowel tissue that had been incarcerated exhibited dark red discoloration. Fluorescence examination of the bowel wall indicated that the ischemic changes were reversible, and accordingly, the bowel was not resected. The postoperative course was uneventful. The indocyanine green fluorescence imaging method is a useful new source of evidence that will improve intraoperative decision‐making regarding bowel ischemia. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Primary anterior perineal hernia: A case report and review of the literature

a.lsfakia shared this article with you from Inoreader Primary anterior perineal hernia: A case report and review of the literature Via Asian Journal of Endoscopic Surgery Abstract Perineal hernia is a type of pelvic floor hernia and an extremely rare pathologic state. Perineal hernias can be classified into anterior and posterior types according to their positional relationship to the superficial transverse perineal muscle. A 49‐year‐old woman presented with bulging of the right labium major while standing. Standing external ultrasonography revealed a mass in the bulge, which could not be identified by transvaginal ultrasonography, CT, or MRI. Although hernia content could not be identified preoperatively, the patient was given a diagnosis of primary perineal hernia and underwent laparoscopic repair. Symptoms resolved postoperatively, and no sign of relapse has been noted for 8 months postoperatively. Here, we report the case details and review previous case reports. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of postoperative plasma D‐dimer levels between patients undergoing laparoscopic resection and conventional open resection for colorectal cancer

a.lsfakia shared this article with you from Inoreader Comparison of postoperative plasma D‐dimer levels between patients undergoing laparoscopic resection and conventional open resection for colorectal cancer Via Asian Journal of Endoscopic Surgery Abstract Introduction D‐dimer is widely used in clinical pretests for venous thromboembolism exclusion, and its elevation suggests the presence of thrombus. The extent of hypercoagulability after colorectal surgery has not been systematically compared between patients who have undergone laparoscopic surgery and open surgery. The present study measured D‐dimer levels sequentially in patients undergoing colorectal surgery and compared the extent of hypercoagulability between laparoscopic surgery and open surgery. Methods A prospective cohort study involving 169 patients who underwent resection of colorectal cancer at Saitama Medical Center, Dokkyo Medical University, was conducted between January 2013 and September 2014. To measure D‐dimer level, peripheral blood was obtained on postoperative day (POD) 1, POD4, and POD7. Enoxaparin sodium was administered twice daily as the routine prophylactic anticoagulant therapy on POD2 to 7. Results D‐dimer levels on POD1, POD4, and POD7 were significantly higher after open surgery than after laparoscopic surgery. Older age, pathologically advanced stage cancer, greater intraoperative blood loss and higher preoperative D‐dimer levels were significantly associated with higher D‐dimer levels on POD1, POD4, and POD7. Patients who completed the course of postoperative enoxaparin injections had significantly lower D‐dimer levels on POD7 than those who did not receive postoperative enoxaparin injections. Multiple regression analyses of postoperative D‐dimer level showed that laparoscopic surgery was a significant and independent factor affecting D‐dimer level on POD4 and POD7. Conclusion This study showed that postoperative D‐dimer levels were lower after laparoscopic surgery than after open surgery. The limited invasiveness of laparoscopic surgery may be beneficial to reduce the risk of postoperative deep vein thrombosis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Is laparoscopic and endoscopic cooperative surgery (LECS) for gastric subepithelial tumor at the esophagogastric junction safe?

a.lsfakia shared this article with you from Inoreader Is laparoscopic and endoscopic cooperative surgery (LECS) for gastric subepithelial tumor at the esophagogastric junction safe? Via Asian Journal of Endoscopic Surgery Abstract Introduction With technique improvements, indications for laparoscopic and endoscopic cooperative surgery (LECS) for gastric subepithelial tumor (SET) are gradually expanding for tumors technically difficult to resect. However, surgical outcomes of LECS, including for esophagogastric junction (EGJ) tumors requiring advanced skills, remain unknown. Methods We reviewed patients in whom LECS had initially been attempted for gastric SET at the Cancer Institute Hospital in Tokyo from June 2006 to May 2018. Indications for LECS at the EGJ have gradually expanded during the study period to include tumors with esophageal invasion up to 2 cm, or less than half the EJG circumference, preoperatively. Surgical outcomes and risk factors for conversion to other procedures were investigated. Results Twenty (9.3%) of the 214 total patients had EGJ tumors. Four patients (20%) with EGJ tumors developed postoperative complications (Clavien‐Dindo grade ≥ II). Among 12 patients in whom LECS could be completed for EGJ tumors, only one non‐serious complication occurred. Eight patients required conversion to another operation for EGJ tumors (two laparotomy, six proximal gastrectomy). Among conversion cases with EGJ tumors, anastomotic leakage occurred in both patients undergoing laparotomy after LECS, necessitating additional defect closure. There was only one non‐serious complication in six proximal gastrectomy patients. On multivariate analysis, EGJ tumor was an independent risk factor for conversion to another operation. Conclusion LECS at the EGJ may be a risk factor for conversion operation, and when performing LECS at the EGJ is difficult, conversion to proximal gastrectomy, which can be performed safely, should be considered. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Causes of peritoneal injury during laparoscopic totally extraperitoneal inguinal hernia repair and methods of repair

a.lsfakia shared this article with you from Inoreader Causes of peritoneal injury during laparoscopic totally extraperitoneal inguinal hernia repair and methods of repair Via Asian Journal of Endoscopic Surgery Abstract Introduction Peritoneal injury during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is an intraoperative complication that affects accomplishment. We retrospectively examined the causes of peritoneal injury and methods of TEP repair. Methods This study examined 58 patients with inguinal hernia (43 unilateral, 15 bilateral) who had undergone TEP repair; all procedures were performed by the same surgeon. The incidence of peritoneal injury, clinical characteristics that could have influenced peritoneal injury, and management of the injury were analyzed. Results Peritoneal injury was noted in 16 inguinal hernias (21.9%, 16 /73). Injury occurred more frequently in right‐sided hernias than in left‐sided hernias (31.6% vs 11.4%, P = .049). No other factors were related to injury. Peritoneal injury occurred due to anatomical misrecognition in five hernias (31.3%, 5/16) and unintentional dissection in six hernias (37.5%, 6/16). All injuries due to unintentional dissection occurred in right‐sided hernias. The procedures used for peritoneal injury repair were endoscopic suturing for 4 hernias, pre‐tied loop ligation for 1 hernia, and ligation clips in 11 hernias. Additional techniques were required in three hernias repaired by endoscopic suturing (75% 3/4). After introduction of the ligation clips, endoscopic suturing was discontinued, and no additional techniques were needed. Conclusion Peritoneal injury more frequently occurred in right‐sided inguinal hernia than in left‐sided inguinal hernia during TEP repair. The common reasons for peritoneal injury were anatomical misrecognition and unintentional dissection. Repair using ligation clips is the best option for peritoneal injuries that occur during TEP repair. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Finite element method for nerve root decompression in minimally invasive endoscopic spinal surgery

a.lsfakia shared this article with you from Inoreader Finite element method for nerve root decompression in minimally invasive endoscopic spinal surgery Via Asian Journal of Endoscopic Surgery Abstract Introduction Diagnosis is the key to improving spinal surgery outcomes. Improvements in the diagnosis of radiculopathy have created new indications for full‐endoscopic spine surgery. We assessed the finite element method (FEM) to visualize and digitize lesions not detected by conventional diagnostic imaging. Methods We used FEM in two patients: a lumbar patient and a cervical patient. The lumbar patient was a 67‐year‐old woman with a history of rheumatoid arthritis; she also had osteoporosis and pulmonary fibrosis. She had left L3 radiculopathy due to an L3 vertebral fracture. The cervical patient was a 61‐year‐old woman with left C6 radiculopathy due to C5‐C6 disc herniation. We performed full endoscopic foraminotomy per the patients's request. Based on preoperative and postoperative CT Digital Imaging and Communications in Medicine data of 0.5‐mm slices, 3‐D imaging data were reproduced, and kinetic simulation of FEM was performed. Results Postoperatively, both patients' radiculopathy disappeared, improving their activities of daily living and enabling them to walk and work. Also, the total contact area and maximum contact pressure of the nerve tissue decreased from 30% to 80% and from 33% to 67%, respectively. Conclusions A new method for perioperative evaluation and simulation, FEM can be to visualize and digitize the conditions of the lesion causing radiculopathy. FEM that can overcome both time and economic constraints in routine clinical practice is needed. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.