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Widjaja J, Yang J, Dong W, Wang R, Yang D, Song Z, Gu Y. Single-Port One Anastomosis Sleeve Gastrectomy with Transit Bipartition: Initial Experience and Technique. Obes Surg 2024; 34:2739-2743. [PMID: 38773010 PMCID: PMC11217073 DOI: 10.1007/s11695-024-07295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Sleeve gastrectomy with transit bipartition (SG-TB) procedure has been gaining traction recently. While being a relatively novel procedure, it shows potentials to improve the standalone SG outcomes, such as diabetes remission and reflux. This article aims to show insights on performing SG-TB in one anastomosis fashion (SG-OATB) and single-port approach. METHODS Three patients who underwent laparoscopic single-port SG-OATB at our hospital were included. The parameters included in this study comprised of age, gender, height, weight, body mass index (BMI), type 2 diabetes mellitus (T2DM) assessment, gastroesophageal reflux disease (GERD) assessment, length of the small bowel, the duration of the procedure, and 30-day readmission rate. RESULTS The mean preoperative assessments for the three patients were as follows: two females vs. one male; age 38.7 ± 5.5 years old; weight 105.7 ± 5.4 kg; height 1.64 ± 0.11 m; BMI 39.3 ± 4.7 kg/m2; fasting blood glucose 6.7 ± 1.2 mmol/L; glycosylated hemoglobin level 7.1 ± 1.3%; GERD-Questionnaire score 6.3 ± 1.5; two patients with esophagitis grade A and B following endoscopy. The total duration of the procedure was 170.0 ± 26.5 min; there was no need for conversion to multiple-port in all patients. The 30-day readmission rate for all patients was 0%. CONCLUSION In our small cases of patients, single-port SG-OATB is feasible and safe. We found the closure of the anastomosis defect to be most technically demanding. To understand better the outcome of single-port SG-OATB, studies with larger sample and longer follow-up will be needed in the future.
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Affiliation(s)
- Jason Widjaja
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Jianjun Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China.
| | - Wenpei Dong
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Rui Wang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Dongchao Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Zhicheng Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Yan Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
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Barakat HB, Elmahdy TM, El‐sherpiny WY, Moussa GI. Trocar site hernia after laparoscopic bariatric surgery: Incidence with
non‐fascial
closure. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hosam B. Barakat
- Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Faculty of Medicine Tanta University Tanta Egypt
| | - Tamer M. Elmahdy
- Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Faculty of Medicine Tanta University Tanta Egypt
| | - Waleed Y. El‐sherpiny
- Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Faculty of Medicine Tanta University Tanta Egypt
| | - Gamal I. Moussa
- Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Faculty of Medicine Tanta University Tanta Egypt
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Gutierrez M, Stuparich M, Behbehani S, Nahas S. Does closure of fascia, type, and location of trocar influence occurrence of port site hernias? A literature review. Surg Endosc 2020; 34:5250-5258. [PMID: 32728766 DOI: 10.1007/s00464-020-07826-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/15/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Since the introduction of laparoscopic surgery, it has become more popular with many advantages over open surgery including faster recovery, shorter hospital stays, and decreased tissue trauma. Despite its benefits, laparoscopic surgery can result in its own unique complications, such as the formation of a trocar site hernia (TSH), which have been reported in approximately 0-1.0% of laparoscopic cases when using non-bladed trocars. METHODS A literature review was performed from June 1990 to June 2019. PubMed was searched using the keywords "laparoscopic surgery," "trocar site hernia," and "port site hernia." Only articles in English were identified but not limited to the USA. RESULTS The total number of patients in all articles was 18,533 with a mean follow-up period of 22.50 ± 1.76 months. The overall trocar site hernia rate was 0.104%. When comparing open vs. closed ports, there was no significant difference in the hernia incidence rate for 5-mm and 10-mm ports. When comparing bladed versus non-bladed trocars left open, there was a statistically significant difference with lower hernia incidence rates for non-bladed trocars over bladed trocars for 5-mm, 10-mm, and 12-mm ports. And when comparing trocar location from midline versus off-midline, there was a statistically significant higher TSH incidence in midline trocar locations. CONCLUSION Results suggest that TSH rate is lower when using non-bladed trocars for any size of trocar. When comparing whether fascial closure had an effect, the 5-mm and 10-mm ports had no difference in incidence rates and leaving the fascia open can reduce operative time, risk of needlestick injuries, and overall procedural cost. In addition, trocars at midline locations resulted in higher TSH incidence rates. Future research is still needed to assess for other factors that may influence hernia formation and how it can be minimized.
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Affiliation(s)
- Monica Gutierrez
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA.,, Rancho Cucamonga, CA, USA
| | - Mallory Stuparich
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA
| | - Sadikah Behbehani
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA
| | - Samar Nahas
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA.
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Domen A, Stabel C, Jawad R, Duchateau N, Fransen E, Vanclooster P, de Gheldere C. Postoperative ileus after laparoscopic primary and incisional abdominal hernia repair with intraperitoneal mesh (DynaMesh®-IPOM versus Parietex™ Composite): a single institution experience. Langenbecks Arch Surg 2020; 406:209-218. [PMID: 32504204 DOI: 10.1007/s00423-020-01898-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/17/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Laparoscopic primary or incisional abdominal hernia repair with intraperitoneal mesh placement is a well-accepted and safe technique. Evidence for complications however remains inconclusive, and little is known about the occurrence of postoperative ileus secondary to postoperative intra-abdominal adhesions with different types of IPOM meshes used. Therefore, we retrospectively compared the occurrence of postoperative ileus between two of the different meshes used in our center. METHODS Three hundred seventy-five patients who underwent ventral hernia repair with intraperitoneal mesh placement, either with a DynaMesh®-IPOM (FEG Textiltechnik mbH, Aachen, Nordrhein-Westfalen, Germany) or a Parietex™ Composite mesh (Medtronic, Minneapolis, MN, USA), at the Heilig-Hart Hospital in Lier (Antwerp, Belgium) between 2012 and 2017 were retrospectively compared with regard to the occurrence of postoperative ileus until 6 weeks postoperatively. Baseline demographics and clinical data up to 6 weeks postoperatively of the patients in the two mesh groups are provided. RESULTS The DynaMesh®-IPOM mesh group was associated with a significantly higher incidence of postoperative ileus compared with the Parietex™ Composite mesh group with a cutoff limit at postoperative day 1 (n = 17, 6.8% vs. n = 0, 0.0%; P = 0.003) and postoperative day 4 (n = 13, 5.2% vs. n = 0, 0.0%, P = 0.006), even with a mesh surface area of ≤ 300 cm2 and when both meshes were fixated with the same method of fixation (Securestrap™) with a cutoff limit for postoperative ileus at postoperative day 1 (n = 4, 7.7% vs. n = 0, 0.0%; P = 0.013) and postoperative day 4 (n = 3, 5.8% vs. n = 0, 0.0%, P = 0.040). Of the 17 patients with a postoperative ileus, 9 (52.9%) had a suspicion of adhesive small bowel obstruction on CT scan (P = 0.033) with definitive confirmation of small bowel adhesions with the DynaMesh®-IPOM mesh at laparoscopy in 2 patients. CONCLUSION Our results confirm current literature available regarding postoperative ileus secondary to postoperative intra-abdominal adhesions with the DynaMesh®-IPOM mesh. However, further research with well-designed, multicenter randomized controlled studies to evaluate the use and related complications of these meshes is needed.
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Affiliation(s)
- Andreas Domen
- Department of General Surgery, Heilig-Hart Hospital, Mechelsestraat 24, Lier, Belgium
| | - Cedric Stabel
- Department of General Surgery, Heilig-Hart Hospital, Mechelsestraat 24, Lier, Belgium
| | - Rami Jawad
- Department of General Surgery, Heilig-Hart Hospital, Mechelsestraat 24, Lier, Belgium
| | - Nicolas Duchateau
- Department of General Surgery, Heilig-Hart Hospital, Mechelsestraat 24, Lier, Belgium
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Patrick Vanclooster
- Department of General Surgery, Heilig-Hart Hospital, Mechelsestraat 24, Lier, Belgium
| | - Charles de Gheldere
- Department of General Surgery, Heilig-Hart Hospital, Mechelsestraat 24, Lier, Belgium.
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Chelala E, El Hajj Moussa W, Rizk S, Assaker N. Consecutive Versus Selective Primary and Revisional Single Incision Laparoscopic Bariatric Surgery: Personal Experience in 330 Cases. Obes Surg 2019; 30:1515-1526. [PMID: 31858397 DOI: 10.1007/s11695-019-04356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND This paper aims to retrospectively evaluate the feasibility, safety, and standardization for both consecutive primary and revisional SILS bariatric surgeries, and to analyze incisional hernia's prevalence, technical improvements, and limiting factors. METHODS A retrospective database review was undertaken involving, in Part I (Belgium), 290 consecutive SILS, including 80.68% primary bariatric surgeries, and 19.32% revisional gastric bypass, followed in Part II (Lebanon), by 40 selective primary SILS. Training for and standardization of the trans-umbilical technique was done for the operating room team, and was executed in part II. RESULTS The procedure of single incision was successfully completed in all of the 330 cases part I & part II. There was a need for additional salvage for one or two trocars in respectively 3.1% and 2.75% of the cases. There were no deaths or conversions in either group. Early complications included one medically healed fistula after revisional GB, and two secondary gastric and intestinal perforation requiring reoperations. Late surgical complications were: "3 patients (1.03%) in Part I and 2 (5%) in Part II suffered occlusions, requiring laparoscopic mesenteric defect's closure on an internal herniation." Twelve patients (4.1%) from part I and 5 (12.5%) in part II suffered an incisional hernia. CONCLUSION Selective SILS, when standardized, tends to be superior to consecutive SILS in terms of overall morbidity, operative time, and need for additional salvage trocars. Cost effectiveness and higher midterm rate of umbilical port site incisional hernia should be weighed against the beneficial cosmetic effect for the patient.
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Affiliation(s)
- Elie Chelala
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon. .,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon. .,General Surgery Department, University Hospital of Tivoli, La Louvière, Belgium.
| | - Wissam El Hajj Moussa
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon.,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Simon Rizk
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon.,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Nidal Assaker
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon.,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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Single Incision Pediatric Endoscopic Surgery: From Myth to Reality a Case Series. ACTA ACUST UNITED AC 2019; 55:medicina55090574. [PMID: 31500274 PMCID: PMC6780980 DOI: 10.3390/medicina55090574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/27/2022]
Abstract
Laparoscopic surgery has continued to evolve to minimize access sites and scars in both the adult and pediatric populations. In children, single-incision pediatric endoscopic surgery (SIPES) has been shown to be effective, feasible, and safe with comparative results to multiport equivalents. Thus, the use of SIPES continues over increasingly complex cases, however, conceptions of its efficacy continue to vary greatly. In the present case series and discussion, we review the history of SIPES techniques and its current application today. We present this in the setting of five common myths about SIPES techniques: limitations against complex cases, restrictions to specialized training, increased morbidity outcomes, increased operative lengths, and increased operative costs. Regarding the myth of SIPES being limited in application to simple cases, examples were highlighted throughout the literature in addition to the authors’ own experience with three complex cases including resection of a lymphatic malformation, splenectomy with cholecystectomy, and distal pancreatectomy with splenectomy. A review of SIPES learning curves shows equivalent operative outcomes to multiport learning curves and advancements towards practical workshops to increase trainee familiarity can help assuage these aptitudes. In assessing comorbidities, adult literature reveals a slight increase in incisional hernia rates, but this does not correlate with single-incision pediatric data. In experienced hands, operative SIPES times average approximate multiport laparoscopic equivalents. Finally, regarding expenses, SIPES represents an equivalent alternative to laparoscopic techniques.
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Trocar site closure with a novel anchor-based (neoClose ®) system versus standard suture closure: a prospective randomized controlled trial. Surg Endosc 2019; 34:1270-1276. [PMID: 31183797 DOI: 10.1007/s00464-019-06891-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patients with obesity have a higher risk of trocar site hernia. The objective of the present study was to compare a standard suture passer versus the neoClose® device for port site fascial closure in patients with obesity undergoing laparoscopic bariatric surgery. METHODS This is a randomized, controlled trial with two parallel arms. Thirty five patients with BMI ≥ 35 kg/m2 and undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass were randomized to each group. Port site fascial closure for trocars ≥ 10 mm was performed with the neoClose® device in the study group and the standard suture passer in the control group. Primary outcomes were time required to complete closure and intensity of postoperative pain at the fascial closure sites. Secondary outcomes were intraabdominal needle depth and incidence of trocar site hernia. RESULTS The use of the neoClose® device resulted in shorter closure times (20.2 vs 30.0 s, p = 0.0002), less pain (0.3 vs 0.9, p = 0.002) at port closure sites, and decreased needle depth (3.3 cm vs 5.2 cm, p < 0.0001) compared to the standard suture passer. There was no trocar site hernia at the one-year follow-up in either group. CONCLUSIONS Use of the neoClose® device resulted in faster fascial closure times, decreased intraoperative needle depth, and decreased postoperative abdominal pain at 1 week as compared to the standard suture passer. These data need to be confirmed on larger cohorts of patients with longer follow-up.
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Rebibo L, Demouron M, Dembinski J, Dhahri A, Yzet T, Regimbeau JM. Impact of Routine 12 mm Epigastric Trocar Site Closure on Incisional Hernia After Sleeve Gastrectomy: a Prospective Before/After Study. Obes Surg 2019; 29:3500-3507. [DOI: 10.1007/s11695-019-03971-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Garofalo F, Pescarus R, Denis R, Atlas H, Garneau P, Philie M, Sayegh K. Laparoscopic Sleeve Gastrectomy: A Radiological Guide to Common Postsurgical Failure. Can Assoc Radiol J 2018; 69:184-196. [DOI: 10.1016/j.carj.2017.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/14/2017] [Accepted: 10/23/2017] [Indexed: 12/19/2022] Open
Abstract
Laparoscopic sleeve gastrectomy is one of the most common bariatric procedures worldwide. It has recently gained in popularity because of a low complication rate, satisfactory resolution of comorbidities, and excellent weight loss outcome. This article reviews the surgical technique, expected postsurgical imaging appearance, and imaging findings of common complications after laparoscopic sleeve gastrectomy. Understanding of the surgical technique of laparoscopic sleeve gastrectomy and of the normal postsurgical anatomy allows accurate interpretation of imaging findings in cases of insufficient weight loss, weight regain, and postsurgical complications.
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Affiliation(s)
- Fabio Garofalo
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Radu Pescarus
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Ronald Denis
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Henri Atlas
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Garneau
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Michel Philie
- Département de Radiologie, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Karl Sayegh
- Department of Radiology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
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10
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Port site hernia after laparoscopic sleeve gastrectomy: a retrospective cohort study of 352 patients. Updates Surg 2017; 70:91-95. [DOI: 10.1007/s13304-017-0501-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/08/2017] [Indexed: 12/31/2022]
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Abstract
BACKGROUND The impact of laparoscopy on the prevalence of incisional hernias remains unclear. The aim of this study is to determine (1) surgeon perceptions of port-site hernias (PSHs), (2) the true incidence of PSH. MATERIALS AND METHODS A survey on PSH was given to determine the surgeon-reported rate of PSH. A literature review was performed for studies with a primary outcome of PSH. Studies were evaluated using checklists, and scores were used to compare risk of bias. Risk of bias was graphed against PSH incidence. RESULTS From 38 surgeons surveyed, the surgeon perceived rate of PSH was a median (range) of 0.5% (0% to 5%) for ports ≤5 mm, 5% (0.1% to 20%) for ports extended, and 5% (0.1% to 40%) for ports ≥10 mm. Thirty studies showed a PSH rate from 0% to 39.3%. Higher quality studies reported higher rates of PSH. CONCLUSIONS Surgeons underestimate the incidence of PSH, but high-quality literature suggests that it may be nearly 40%.
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Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up. Surg Endosc 2016; 31:1469-1477. [PMID: 27495336 DOI: 10.1007/s00464-016-5140-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic ventral hernia repair (LVHR) has become widely used. This study evaluates outcomes of LVHR, with particular reference to complications, seromas, and long-term recurrence. METHODS A review of a prospective database of consecutive patients undergoing LVHR with intraperitoneal onlay mesh (IPOM) was performed at a single institution. Patient's characteristics, surgical procedures, and postoperative outcomes were analyzed and related to long-term recurrence. RESULTS From 2005 to 2014, 417 patients underwent LVHR. Mean age and body mass index (BMI) were 54 years and 31 kg/m2. Mesh fixation was carried out with transfascial sutures, completed with absorbable tacks (72 %), metal tacks (24 %), or intraperitoneal sutures (4 %). Intraoperative complications occurred in three patients. Overall morbidity included 8.25 % of minor complications and 2.5 % of major complications without mortality. The overall recurrence rate was 9.8 %. Median time for recurrence was 15.3 months (3-72) and median follow-up was 31.6 months (8-119). In a multivariate analysis, previous interventions (OR 1.44; CI 1.15-1.79; p = 0.01), postoperative complications (OR 2.57; CI 1.09-6.03; p = 0.03), and Clavien-Dindo score >2 (OR 1.43; CI 1.031-1.876; p = 0.02) appeared as independent prognostic factors of recurrence. Minor complications were associated with 14.7 % of recurrence and major complications with 30 % of recurrence. Emergency LVHR (6 %) did not increase the rate of complications. Overall seroma rate was 18.7 %, with 1.4 % of persisting or complicated seroma. BMI (OR 1.05; CI 1.01-1.08; p = 0.026) and vascular surgery history (OR 5.74; CI 2.11-15.58; p < 0.001) were independent predictive factors for seroma. Recurrence did not appear to be related to seroma. CONCLUSION LVHR combines the benefits of laparoscopy with those of mesh repair. Seroma formation should no longer be considered as a complication. It is spontaneously regressive in most cases. Postoperative complications and their degree of severity appear to be independent prognostic factors for recurrence, which can be limited with a standardized technique and may make IPOM-LVHR a reference procedure.
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Gaillard M, Tranchart H, Lainas P, Ferretti S, Perlemuter G, Dagher I. Single-port laparoscopic sleeve gastrectomy as a routine procedure in 1000 patients. Surg Obes Relat Dis 2016; 12:1270-1277. [DOI: 10.1016/j.soard.2016.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/23/2015] [Accepted: 01/12/2016] [Indexed: 01/26/2023]
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14
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Chouillard E, Alsabah S, Daher R, Younan A, Greco VJ, Chahine E, Abdullah B, Biagini J. Single-Incision Laparoscopy Could Be Better than Standard Laparoscopy in Right Colectomy for Cancer. J Laparoendosc Adv Surg Tech A 2016; 26:371-8. [PMID: 26959941 DOI: 10.1089/lap.2015.0231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Human natural orifice transluminal endoscopic surgery (NOTES) is slowed down by technical hurdles. Concomitantly, single-incision laparoscopy has been increasingly reported as an alternative. By reducing the invasiveness of standard laparoscopy, we may further reduce postoperative pain, decrease morbidity, preserve abdominal wall, and enhance cosmesis. Such techniques have been widely applied, including in colorectal surgery. The aim of this multicenter study is to compare the results of single-incision right colectomy (SIRC) with the results of the standard laparoscopic right colectomy (SLRC) in patients with colon cancer. METHODS The files of patients who underwent right colectomy for cancer in five hospitals between January 2010 and December 2013 have been reviewed. Exclusion criteria were open surgery, emergency setting, and American Society of Anesthesiologists (ASA) score >3. Patients were distributed in Groups A (SIRC) or B (SLRC). RESULTS Five hundred ninety-two patients were included in this study, 336 in Group A and 256 in Group B. Mean operative time was 129.0 minutes (range 65-245) in Group A and 168.1 minutes in the Group B (range 70-290), respectively (P < .001). No mortality occurred in either group. The overall 30-day morbidity rates were 21.4% in Group A and 25% in Group B, respectively (P = .64). The median length of hospital stay was 4.95 days (range 3-14) in Group A and 5.5 days in Group B (range 3-12), respectively (P = .28). Conversion to laparotomy occurred in four patients in each group (P = 1). Length of skin incision was significantly shorter in Group A than in Group B (2.99 ± 0.63 cm versus 4.94 ± 0.65 cm, P < .001). Histological analysis of the operative specimens showed no significant differences. CONCLUSION SIRC is feasible and sure for patients with colon cancer. As compared with SLRC, SIRC may offer some advantages, including lower operative morbidity, shorter hospital stay, and better cosmoses, without compromising the oncological quality of the resected specimen.
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Affiliation(s)
- Elie Chouillard
- 1 Department of General and Minimally Invasive Surgery, Poissy/Saint-Germain Medical Center , Poissy, France
| | - Salman Alsabah
- 2 Department of General Surgery, Al Amiri Hospital , Kuwait City, Kuwait
| | - Ronald Daher
- 1 Department of General and Minimally Invasive Surgery, Poissy/Saint-Germain Medical Center , Poissy, France
| | - Antoine Younan
- 3 Department of Digestive Surgery, Bellevue Medical Center , Beirut, Lebanon
| | - Vincenzo James Greco
- 4 Unit of General and Minimally Invasive Surgery, La Madonnina Medical Center , Cosenza, Italy
| | - Elias Chahine
- 1 Department of General and Minimally Invasive Surgery, Poissy/Saint-Germain Medical Center , Poissy, France
| | - Bassam Abdullah
- 1 Department of General and Minimally Invasive Surgery, Poissy/Saint-Germain Medical Center , Poissy, France
| | - Jean Biagini
- 5 Department of General and Digestive Surgery, Saint-Joseph Hospital , Beirut, Lebanon
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Pourcher G, Ferretti S, Akakpo W, Lainas P, Tranchart H, Dagher I. Single-port sleeve gastrectomy for super-obese patients. Surg Obes Relat Dis 2016; 12:522-527. [DOI: 10.1016/j.soard.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 11/23/2015] [Accepted: 12/01/2015] [Indexed: 01/07/2023]
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16
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Liu XZ, Fan J, Zhang YQ, Xu MJ, Zhao DB. Single-incision or conventional laparoscopic adjustable gastric banding: A systematic review. MINIM INVASIV THER 2015; 25:62-9. [PMID: 26471295 DOI: 10.3109/13645706.2015.1096288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Single-incision laparoscopic surgery (SILS) in gastric banding (SI-LAGB) has been reported to be a safe and technically feasible procedure among various operating methods. However, there is little evidence with regard to the question whether SI-LAGB has more advantages and should be recommended compared with conventional LAGB (CLAGB). Thus, this study was performed to assess the safety and efficacy of SI-LAGB. MATERIAL AND METHODS A computerized search of the electronic databases PubMed and EMBASE was performed. Data regarding operative parameters, postoperative recovery parameters, follow-up time, percentage of excess weight loss, and postoperative complication were pooled and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. RESULTS Ten comparative studies including 2,073 patients (1,038 patients who received SI-LAGB and 1,035 patients who received CLAGB) were included and analyzed. Compared with CLAGB, a similar weight loss could be obtained using SI-LAGB. The postoperative complications of SI-LAGB were within the acceptable range, but one study reported one perioperative death. SI-LAGB required a longer operative time. Other outcome variables, such as blood loss, days of hospitalization, pain score, and hospitalization costs, were not significantly different between the two groups. CONCLUSIONS SI-LAGB might be a safe and effective alternative to C-LAGB when performed by experienced surgeons, but available data do not allow to give a definitive answer and randomized controlled trials are needed.
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Affiliation(s)
- Xing-Zhen Liu
- a The First Department of Recovery , Hangzhou Sanatorium of Nanjing Military Command Region , Hangzhou , China.,c Department of Rheumatology , Changhai Hospital, The Second Military Medical University , Shanghai , China
| | - Jie Fan
- a The First Department of Recovery , Hangzhou Sanatorium of Nanjing Military Command Region , Hangzhou , China
| | - You-Qin Zhang
- a The First Department of Recovery , Hangzhou Sanatorium of Nanjing Military Command Region , Hangzhou , China
| | - Mao Jin Xu
- b Department of Endocrinology , Changhai Hospital, The Second Military Medical University , Shanghai , China
| | - Dong-Bao Zhao
- c Department of Rheumatology , Changhai Hospital, The Second Military Medical University , Shanghai , China
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Rebibo L, Dhahri A, Chivot C, Cyril C, Yzet T, Regimbeau JM. Trocar site hernia after laparoscopic sleeve gastrectomy using a specific open laparoscopy technique. Surg Obes Relat Dis 2015; 11:791-6. [DOI: 10.1016/j.soard.2014.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/06/2014] [Accepted: 11/30/2014] [Indexed: 01/13/2023]
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Bury K, Pawlak M, Śmietański M, Muysoms F. Single-incision port-site herniation: meta-analysis vs. nationwide cohort study. Hernia 2015; 20:11-2. [PMID: 26122884 PMCID: PMC4742509 DOI: 10.1007/s10029-015-1401-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- K Bury
- Department Cardiac and Vascular Surgery, Medical University of Gdansk, Debinki 7, 80-211, Gdańsk, Poland.
| | - M Pawlak
- Department Cardiac and Vascular Surgery, Medical University of Gdansk, Debinki 7, 80-211, Gdańsk, Poland
| | - M Śmietański
- II Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - F Muysoms
- Department of Surgery, AZ Maria Middelares, Ghent, Belgium
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Sangster W, Kulaylat AN, Stewart DB, Schubart JR, Koltun WA, Messaris E. Hernia incidence following single-site vs standard laparoscopic colorectal surgery. Colorectal Dis 2015; 17:250-6. [PMID: 25307082 DOI: 10.1111/codi.12797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/18/2014] [Indexed: 12/24/2022]
Abstract
AIM Compared with standard laparoscopic (SDL) approaches, less is known about the incidence of hernias after single-site laparoscopic (SSL) colorectal surgery. This study hypothesized that SSL colorectal surgery was associated with an increased risk of hernia development. METHOD Institutional retrospective chart review (September 2008-June 2013) identified 276 evaluable patients who underwent laparoscopic colorectal procedures. The following data were collected: demographic data, risk factors for the development of a hernia, operative details and postoperative course including the development of a hernia. Patients were stratified by laparoscopic technique to compare the characteristics of those undergoing SDL and SSL. Patients were subsequently stratified by the presence or absence of a hernia to identify associated factors. RESULTS One hundred and nineteen patients (43.1%) underwent SDL and 157 patients (56.9%) underwent SSL surgery. The development of an incisional hernia was observed in 7.6% (9/119) of SDL patients compared with 17.0% (18/106) of SSL patients (P = 0.03) over a median 18-month follow-up. Similar proportions of patients developed parastomal hernias in both groups [SDL 16.7% (10/60) vs SSL 15.9% (13/80)]. Hernias were diagnosed at a median of 8.1 (SDL) and 6.5 (SSL) months following the index operation and were less likely to be incarcerated in the SSL group [SDL 38.9% (7/18) vs SSL 6.5% (2/31), P = 0.01]. CONCLUSION SSL colorectal surgery is associated with an increase in the incidence of incisional hernias but not parastomal hernias. Site of specimen extraction in SSL may contribute to the development of an incisional hernia.
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Affiliation(s)
- W Sangster
- Division of Colorectal Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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Daher R, Chouillard E, Panis Y. New trends in colorectal surgery: Single port and natural orifice techniques. World J Gastroenterol 2014; 20:18104-18120. [PMID: 25561780 PMCID: PMC4277950 DOI: 10.3748/wjg.v20.i48.18104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/28/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.
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Yao D, Wu S, Tian Y, Fan Y, Kong J, Li Y. Transumbilical single-incision laparoscopic distal pancreatectomy: primary experience and review of the English literature. World J Surg 2014; 38:1196-204. [PMID: 24357245 DOI: 10.1007/s00268-013-2404-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) may represent an improvement over conventional laparoscopic surgery, and has been applied in many surgical procedures. However, for pancreatic surgery, experience is rather limited. METHODS The clinical records of 11 cases in which transumbilical single-incision laparoscopic distal pancreatectomy (TUSI-LDP) was performed at our institution since June 2009 were retrospectively analyzed, and all the literatures concerning TUSI-LDP were retrospectively reviewed. RESULTS All the 11 patients were female. The ages ranged from 20 to 73 years, with an average age of 38.0 years. The average body mass index (BMI) was 22.67 (18.6-26.2). Most TUSI-LDPs were successfully performed, with only one conversion to multi-incision surgery. Splenic preservation was performed in six cases. The mean operation time was 163.18 ± 63.18 minutes (range 95-300), and the mean intraoperative blood loss was 159.09 ± 181.02 ml (range 10-500 ml). The surgical wounds healed well, with good cosmetic wound healing, and the patients were discharged from hospital in a mean of 7.45 ± 1.44 days (range 5-10). Only one patient developed pancreatic leakage, which ceased spontaneously with only a drain for 61 days. The parameters were comparable with those found in the English literature. CONCLUSIONS These recent experiences suggest that SILS in pancreatic surgery is feasible for a select group of patients with relatively small lesions and low BMI, and that, with the gradual accumulation of surgeons' experience with SILS and improvement of laparoscopic instruments, it might become a safe option for some patients.
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Affiliation(s)
- Dianbo Yao
- Department of Vascular and Bile Duct Surgery, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Heping District, Shenyang, 110004, Liaoning Province, China
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Chen Y, Wu S, Kong J. Transumbilical single-incision laparoscopic combined cholecystectomy and appendectomy: a retrospective comparative study. J Laparoendosc Adv Surg Tech A 2014; 24:702-6. [PMID: 25244670 DOI: 10.1089/lap.2014.0182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) developed rapidly in recent years. This report describes our initial experience on SILS combined cholecystectomy and appendectomy (SILSC&A) with a unique method of umbilical reconstruction. In addition, a retrospective comparison with conventional combined laparoscopic cholecystectomy and appendectomy (LC&A) was analyzed. MATERIALS AND METHODS Between April 2009 and December 2013, 62 patients with benign gallbladder and appendix disease underwent laparoscopic combined cholecystectomy and appendectomy at our institution. Of these, 34 (54.8%) underwent SILSC&A (Group 1), and 28 (45.2%) underwent LC&A (Group 2). Demographic, intraoperative, and postoperative data were analyzed retrospectively and compared between the two groups. RESULTS No significant differences were identified in the preoperative patient characteristics between the two groups. SILSC&A was associated with a shorter operative time (62.2 ± 19.7 versus 77.5 ± 21.4 minutes, respectively; P = .005) and better cosmetic results (4.6 ± 0.7 versus 4.1 ± 0.6, respectively; P = .004). There were no significant differences between the two groups with respect to other postoperative variables. CONCLUSIONS The present study suggests that SILSC&A is as safe and efficacious as conventional LC&A in experienced hands. A uniform method of umbilical reconstruction is helpful in improving cosmesis and decreasing hernia rate. Long-term follow-up and further prospective randomized trials are anticipated.
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Affiliation(s)
- Yongsheng Chen
- Department of General Surgery, Shengjing Hospital of China Medical University , Shenyang, China
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Saber AA. Comment on: Single incision laparoscopic bariatric surgery: a systematic review. Surg Obes Relat Dis 2014; 11:257-8. [PMID: 25012776 DOI: 10.1016/j.soard.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Alan A Saber
- Weill Cornell Medical College The Brooklyn Hospital Center Brooklyn, New York
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Aytac E, Turina M, Gorgun E, Stocchi L, Remzi FH, Costedio MM. Single-port laparoscopic colorectal resections in obese patients are as safe and effective as conventional laparoscopy. Surg Endosc 2014; 28:2884-9. [PMID: 24853841 DOI: 10.1007/s00464-014-3542-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/07/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Obese patients pose additional operative technical difficulties, and it is unclear if the outcomes of single-port colorectal surgery are equivalent to those of conventional laparoscopy in such patients. The aim of this study was to compare perioperative variables and short-term outcomes of single-port versus conventional laparoscopy in obese patients undergoing colorectal surgery. PATIENTS AND METHODS Obese patients (BMI ≥ 30 kg/m(2)) undergoing single-port laparoscopic colorectal resections between March 2009 and September 2012 were case matched 1:1 with obese counterparts undergoing conventional (multi-port) laparoscopic surgery based on diagnosis and operation type. RESULTS Thirty-seven patients who underwent single-port surgery were matched with 37 conventional laparoscopic counterparts. Male gender predominated in the single-port group (26 vs 15, p = 0.02). The number of patients with a history of previous abdominal operations (17 vs 13, p = 0.48) and ASA score (3 vs 2, p = 0.6) were similar between the groups. No differences were observed with respect to conversion rate (2 vs 5, p = 0.43), operative time (146 vs 150 min, p = 0.48), estimated blood loss (159 vs 183 ml, p = 0.99), time to first flatus (3 vs 3 days, p = 0.91), time to first bowel movement (3 vs 4 days, p = 0.62), length of hospital stay (7 vs 6 days, p = 0.37), or reoperation (2 vs 1, p > 0.99), and readmission rates (2 vs 2, p > 0.99). There were no deaths. CONCLUSION For obese patients undergoing colorectal resections, single-port laparoscopy appears to be as safe and effective as conventional laparoscopy.
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Affiliation(s)
- Erman Aytac
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Clinic Main Campus Mail Code A30, 9,500 Euclid Ave., Cleveland, OH, 44195, USA
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High incidence of trocar site hernia after laparoscopic or robotic Roux-en-Y gastric bypass. Surg Endosc 2014; 28:2890-8. [DOI: 10.1007/s00464-014-3543-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/08/2014] [Indexed: 01/10/2023]
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Markar SR, Karthikesalingam A, Di Franco F, Harris AM. Systematic review and meta-analysis of single-incision versus conventional multiport appendicectomy. Br J Surg 2014; 100:1709-18. [PMID: 24227355 DOI: 10.1002/bjs.9296] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to compare clinical outcomes following single-incision laparoscopic appendicectomy (SILA) and conventional multiport laparoscopic appendicectomy (CLA) for the treatment of acute appendicitis. METHODS An electronic search of MEDLINE, Embase, Web of Science and Cochrane Library databases was performed. Publications were included if they were clinical trials randomizing patients with appendicitis to SILA or CLA. Outcome measures evaluated included operating time, length of hospital stay, total postoperative complications, and, specifically, wound infection, intra-abdominal collection and ileus. Weighted mean difference was calculated for the effect size of SILA on continuous variables, and pooled odds ratios were calculated for discrete variables. RESULTS The literature search identified seven randomized clinical trials that met the inclusion criteria for meta-analysis. In total, 1108 appendicectomies were included, 555 SILA and 553 CLA procedures. There were no significant differences between the groups in the incidence of total postoperative complications, wound infection, intra-abdominal collection, ileus or length of hospital stay. However, SILA was associated with a significantly longer operating time compared with CLA (weighted mean difference 6·96 (95 per cent confidence interval 3·79 to 10·12) min; P < 0·001). Insertion of an additional port was required in 7·6 per cent of patients undergoing SILA. CONCLUSION SILA is a safe procedure for the treatment of acute appendicitis, with comparable clinical outcome to CLA when undertaken by experienced laparoscopic surgeons.
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Affiliation(s)
- S R Markar
- Department of Laparoscopic and Upper Gastro-Intestinal Surgery, Hinchingbrooke Healthcare NHS Trust, Huntingdon
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