Total endoscopic sublay mesh repair for umbilical hernias.

ABSTRACT: Umbilical hernias constitute some of the most common surgical diseases addressed by surgeons. Endoscopic techniques have become standard of care together with the conventional open techniques for the treatment of umbilical hernias. Several different approaches were described to achieve laparoscopic sublay repair.We prospectively collected and reviewed the medical records of 10 patients with umbilical hernias underwent total endoscopic sublay repair (TES) at our institution from November 2017 to November 2019. All operations were performed by a same surgical team. The demographics, intraoperative details, and postoperative complications were evaluated.All TES procedures were successfully performed without conversion to an open operation. No intraoperative morbidity was encountered. The average operative time was 109.5 minutes (range, 80-140 minutes). All the patients resumed an oral diet within 6 hours after the intervention. The mean time to ambulation was 7.5 hours (range, 4-14 hours), and mean postoperative hospital stay was 2.2 day (range, 1-4 days). One patient developed postoperative seroma. No wound complications, chronic pain, or recurrence were registered during the follow-up.Initial experiences with this technique show that the TES is a safe, and effective procedure for the treatment of umbilical hernias.

Trans-umbilical single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty of inguinal hernia by self-made glove port.

Laparoscopic inguinal herniorrhaphy has been well established for the management of primary and recurrent inguinal hernias. Single-incision laparoscopic surgery (SILS) has now been accepted as a less invasive alternative to conventional laparoscopic surgery. However, commercially available access devices for SILS had disadvantages such as rigidness and crowding. This series aimed to analyze the feasibility and safety of single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty (SILS-TAPP) by applying our self-made device for managing inguinal hernia.We collected and reviewed the medical records of patients who received SILS-TAPP using a self-made glove-port device between January 2014 and January 2016. All operations were performed by the same surgical team. The demographics and intra- and perioperative outcomes were evaluated.SILS-TAPP was successfully performed in 105 patients (131 inguinal hernia repairs). No major intra- and postoperative morbidities were encountered, and no conversion to a conventional 3-port approach or open surgery was required. The mean operative time was 73.5 min and the mean postoperative hospital stay was 2.1 days. Three minor short-term complications were noted, which were resolved without surgical intervention. One recurrence was diagnosed during follow-up and treated using a second TAPP procedure.SILS-TAPP was shown to be a feasible, safe procedure in patients with an inguinal hernia. A simple self-made glove-port device was proven as a practical method of SILS-TAPP.

Modified laparoscopic Sugarbaker repair of parastomal hernia with a three-point anchoring technique.

AIM: To retrospectively evaluate the safety and feasibility of a new modified laparoscopic Sugarbaker repair in patients with parastomal hernias. METHODS: A retrospective study was performed to analyze eight patients who underwent parastomal hernia repair between June 2016 and January 2018. All of these patients received modified laparoscopic Sugarbaker hernia repair treatment. This modified technique included an innovative three-point anchoring and complete suturing technique to fix the mesh. All procedures were performed by a skilled hernia surgeon. Demographic data and perioperative outcomes were collected to evaluate the safety and efficacy of this modified technique. RESULTS: Of these eight patients, two had concomitant incisional hernias. All the hernias were repaired by the modified laparoscopic Sugarbaker technique with no conversion to laparotomy. Three patients had in-situ reconstruction of intestinal stoma. The median mesh size was 300 cm2, and the mean operative time was 205.6 min. The mean postoperative hospitalization time was 10.4 d, with a median pain score of 1 (visual analog scale method) at postoperative day 1. Two patients developed postoperative complications. One patient had a pocket of effusion surrounding the biologic mesh, and one patient experienced an infection around the reconstructed stoma. Both patients recovered after conservative management. There was no recurrence during the follow-up period (6-22 mo, average 13 mo). CONCLUSION: The modified laparoscopic Sugarbaker repair could fix the mesh reliably with mild postoperative pain and a low recurrence rate. The technique is safe and feasible for parastomal hernias.

Laparoscopic repair via the transabdominal preperitoneal procedure for bilateral lumbar hernia: Three cases report and review of literature.

A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting with right-sided abdominal pain, and the other two patients presented with bilateral lumbar masses. The previous bilateral lumbar hernia reported in the literature was repaired by open surgery. The laparoscopic approach via the transabdominal preperitoneal (TAPP) procedure with the self-gripping Parietex ProGrip™ mesh was performed at our center. The laparoscopic repair was conducted by a skilled hernia surgeon, and was successfully performed in the three patients. The patients resumed a semi-liquid diet and had no activity restriction after six hours following the operation. No antibiotics were used after the surgery. The operative times of the three patients were 120 min, 85 min, and 130 min. The blood loss volumes of the three patients were 20 mL, 5 mL, and 5 mL. The visual analogue scale pain scores of the three patients were 1, 2, and 2 on postoperative day 1, and were 1, 2, and 1 on postoperative day 3. No perioperative complications, such as bulge, wound infection and hematoma, occurred after the surgery. All of the patients were discharged on the third day after the operation. There was no chronic pain and no hernia recurrence during the follow-up. This study showed that the laparoscopic TAPP approach with the self-gripping mesh is safe and feasible, and can be considered an alternative method for the treatment of bilateral lumbar hernias.

Efficacy of Magnetic Sphincter Augmentation versus Nissen Fundoplication for Gastroesophageal Reflux Disease in Short Term: A Meta-Analysis.

Background. The efficacy of Magnetic Sphincter Augmentation (MSA) and its outcomes for Gastroesophageal Reflux Disease (GERD) are uncertain. Therefore, we aimed to summarize and analyze the efficacy of two treatments for GERD. Methods. The meta-analysis search was performed, using four databases. All studies from 2005 to 2016 were included. Pooled effect was calculated using either the fixed or random effects model. Results. A total of 4 trials included 624 patients and aimed to evaluate the differences in proton-pump inhibitor use, complications, and adverse events. MSA had a shorter operative time (MSA and NF: RR = -18.80, 95% CI: -24.57 to -13.04, and P = 0.001) and length of stay (RR = -14.21, 95% CI: -24.18 to -4.23, and P = 0.005). Similar proton-pump inhibitor use, complication (P = 0.19), and severe dysphagia for dilation were shown in both groups. Although there is no difference between the MSA and NF in the number of adverse events, the incidence of postoperative gas or bloating (RR = 0.71, 95% CI: 0.54-0.94, and P = 0.02) showed significantly different results. However, there is no significant difference in ability to belch and ability to vomit. Conclusions. MSA can be recommended as an alternative treatment for GERD according to their short-term studies, especially in main-features of gas-bloating, due to shorter operative time and less complication of gas or bloating.

Laparoscopic colonic anastomosis using a degradable stent in a porcine model.

AIM: To explore the feasibility and safety of laparoscopic colonic anastomosis using a degradable stent in a porcine model. METHODS: Twenty Bama mini-pigs were randomly assigned to a stent group (n = 10) and control group (hand-sewn anastomosis, n = 10). The anastomotic completion and operation times were recorded, along with histological examination, postoperative general condition, complications, mortality, bursting pressure, and the average anastomotic circumference (AC). RESULTS: All pigs survived postoperatively except for one in the stent group that died from ileus at 11 wk postoperatively. The operation and anastomotic completion times of the stent group were significantly shorter than those of the control group (P = 0.004 and P = 0.001, respectively). There were no significant differences in bursting pressure between the groups (P = 0.751). No obvious difference was found between the AC and normal circumference in the stent group, but AC was significantly less than normal circumference in the control group (P = 0.047, P < 0.05). No intestinal leakage and luminal stenosis occurred in the stent group. Histological examination revealed that the stent group presented with lower general inflammation and better healing. CONCLUSION: Laparoscopic colonic anastomosis with a degradable stent is a simple, rapid, and safe procedure in this porcine model.

[Laparoscopic anti-reflux surgery with biological mesh in treatment of gastroesophageal reflux disease].

OBJECTIVE: To evaluate the application of biological mesh in laparoscopic anti-reflux procedure for gastroesophageal reflux disease (GERD). METHODS: The clinical data of 20 consecutive GERD patients underwent anti-reflux surgery in Sir Run Run Shaw Hospital from December 2012 to April 2014 were retrospectively analyzed. The laparoscopic hiatal repair with 360 fundoplicaiton was performed and the biological mesh (BiodesignTM, Surgsis) was implanted for reinforcement of hiatal repair. RESULTS: All laparoscopic procedures were successful, no conversion and no intra-operative complications occurred. The pre-operative complains were relieved in all patients, and no recurrence was observed during 3-18 month of follow-up. Six patients got dysphagia after operation; 5 of them were controlled through medication and psychological induction; 1 received esophageal dilatation by bougie. CONCLUSION: The application of biological mesh in laparoscopic anti-reflux procedure for gastroesophageal reflux disease is satisfactory.

[Laparoscopic resection of Spiegel lobe].

OBJECTIVE: To evaluate the feasibility and experience of laparoscopic resection for Spiegel lobe associated with left liver lobe. METHODS: Three patients underwent laparoscopic resection of Spiegel lobe associated with left liver lobe. Left hemihepatectomy or left lateral lobectomy was carried out firstly and then Spiegel lobe resected through the left-sided approach. RESULTS: A total of 3 cases were performed successfully. The median operative time was 197 min and the median blood loss 467 ml. The postoperative period was uneventful without hemorrhage, bile leakage, infection or abdominal effusion. CONCLUSION: Laparoscopic resection of Spiegel lobe associated with left liver lobe is safe and feasible when performed in selected cases and by experienced surgeons in laparoscopic hepatectomy.

[Laparoscopic radical resection for gallbladder carcinoma].

OBJECTIVE: To evaluate the feasibility and efficacy of laparoscopic radical resection of gallbladder carcinoma. METHODS: The clinical feature, pathological stage, surgical procedure, postoperative recovery and follow-up results of 4 patients undergoing laparoscopic radical resection of gallbladder carcinoma were retrospectively analyzed. RESULTS: A total of 4 cases were successfully performed. No operative deaths and complications happened. Two patients died of recurrence at 17 and 40 months respectively. There were no port-site and abdominal wall metastases occurred. CONCLUSION: Laparoscopic radical resection of gallbladder carcinoma is a safe and feasible procedure on basis of technique. Nonetheless prospective randomization study with a greater number of cases and a longer follow-up will be needed to evalut the long-term results of it.

Laparoscopic hepatectomy by curettage and aspiration: a new technique.

BACKGROUND: Laparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few institutions worldwide. Lack of efficient and safe techniques for liver transaction is the major obstacle preventing from its further development. We developed a new technique for laparoscopic hepatectomy by curettage and aspiration in 1998. In this paper we analyze the clinical outcomes of this technique after 7 years of practice. METHODS: Altogether 59 consecutive patients underwent laparoscopic hepatectomy by curettage and aspiration from August 1998 to January 2005 at our institution. These patients included 33 males and 26 females, with a mean age of 47 years. For liver transection laparoscopic Peng's multifunctional operative dissector (LPMOD) was used. Lesions included malignant liver tumors in 19 patients, benign liver tumors in 17, intrahepatic calculus in 18, and other liver lesions in 5. Procedures included local resections in 30 patients, left lateral segmentectomy in 28, and right hemihepatectomy in 1. RESULTS: Laparoscopic operation was completed in 57 patients. Two patients (3.4%) had the operation converted to laparotomy. The mean operating time was 143 minutes and the mean intraoperative blood loss was 456 ml. The mean length of postoperative hospital stay was 7 days. Complications occurred in 2 patients (3.4%), and there was no perioperative death. CONCLUSION: Laparoscopic hepatectomy by curettage and aspiration is efficient and safe for liver resection.

Polypropylene mesh-reinforced pancreaticojejunostomy for periampullar neoplasm.

AIM: To evaluate the effect of polypropylene mesh-reinforced pancreatojejunostomy on pancreatic leakage. METHODS: Seventeen consecutive patients with paraampullar malignancy received polyprolene mesh-reinforced pancreatodudeonectomy and the Child's method was used to rebuild the alimentary tract. RESULTS: The mean time of polyprolene mesh-reinforced pancreatojejunostomy was 22 min. Anastomosis could endure 30-500 cm H(2)O pressure during operation. All patients recovered without pancreatic leakage. CONCLUSION: Polyprolene mesh-reinforced pancreato-jejunostomy is a feasible and reliable procedure to prevent pancreatic leakage.

[Laparoscopic treatment of esophageal hiatal hernia: analysis of 11 cases].

OBJECTIVE: To investigate the effect and safety of laparoscopic treatment in patients with esophageal hiatal hernia. METHODS: Eleven patients with esophageal hiatal hernia, 9 males and 2 females, with the mean age of 56, accepted laparoscopic treatment. Two cases were treated by hernia repair merely and 9 cases were treated by hernia repair and fundoplication (Nissen's operation) one of which accepted laparoscopic cholecystoectomy at the same time. RESULTS: All patients were treated successfully. The operation time was 2.5 hours (1.5 - 5 hours) and the blood loss was between 20 - 200 ml. The patients began to accept liquid diet 24 - 36 hours after operation. There was no postoperative complication and all the clinic symptoms disappeared. The mean hospitalization time was 8 days (6 - 15d). CONCLUSION: Laparoscopic treatment of esophageal hiatal hernia provides a safe and minimal invasive procedure.

[Laparoscopic liver resection for benign liver tumors].

OBJECTIVE: To assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors. METHODS: Fourteen patients with benign liver tumors, including 11 cases of hepatic hemangioma, 1 case of hepatic focal nodular hyperplasia, 1 case of hepatic granulomatous inflammation, and 1 case of liver cyst with hyaline degeneration and calcification underwent laparoscopic liver resection by PMOD. RESULTS: Hepatectomy was performed successfully under laparoscope in these 14 patients. There was no conversion to open approach, no postoperative mortality and no postoperative complication. The mean postoperative hospital stay was 6.4 days without recurrence. CONCLUSION: Laparoscopic liver resection of benign liver tumors by PMOD is feasible and safe for patients with symptomatic and undetermined hepatic tumor, and is applicable in hepatic hemangioma complicated with cholecystitis.

Ciliated hepatic foregut cyst: report of first case in China and review of literature.

OBJECTIVE: To report the first case of ciliated hepatic foregut cyst in China, and review of literature to introduce the characteristics of this disease for doctors to recognize this disease. METHOD: Report the clinical procedure of diagnosis and treatment for the first case of ciliated hepatic foregut cyst in China, and to review the embryologic genesis, incidence, clinical manifestation, radiologic features and therapeutic principle of this disease. RESULTS: We performed the resection for ciliated hepatic foregut cyst under laparoscopy; the patient recovered well after the procedure. CONCLUSION: Ciliated hepatic foregut cyst is quite rare clinically, belongs to non-parasitic, solitary and unilocular cystic lesion, is always less than 4 cm in diameter, mostly seen in the left lobe, and has the tendency of malignant change. It should be removed as soon as diagnosed.