Systematic review and meta-analysis of randomized controlled trials comparing single incision versus conventional laparoscopic appendectomy.

BACKGROUND: Single incision laparoscopic appendectomy (SILA) has been proposed as an alternative to conventional laparoscopic appendectomy (CLA). OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of SILA when compared with CLA through a systematic review. METHODS: We performed an electronic search of EMBASE, PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) that compared SILA with CLA were included. RESULTS: Six RCTs met eligibility criteria, which included a total of 800 patients, 401 in the SILA group and 399 in the CLA group. There were no significant differences in terms of overall complications (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.59-1.47; p = 0.77). SILA had a higher technical failure rate (OR 3.30; 95% CI 1.26-8.65; p = 0.01) and required a longer operative time (mean difference [MD] 4.67; 95% CI 1.76-7.57; p = 0.002). SILA was associated with better cosmetic results (standardized MD -0.4; 95% CI -0.64 to -0.16; p = 0.001) and earlier return to normal activity (MD -0.64; 95% CI -1.09 to -0.20; p = 0.005), although these advantages should be taken with caution due to the small number of studies reporting these two items and the short follow-up in the evaluation of cosmetic results. There were no significant differences in terms of postoperative pain or length of hospital stay between groups. CONCLUSIONS: SILA is comparable to CLA in selected patients, although it is associated with a higher technical failure rate and longer operative time. Further randomized trials are needed to determine if SILA really offers benefits over CLA.

Cirugía laparoscópica a través de incisión única / Single incision laparoscopic surgery

Uno de los objetivos de las nuevas tecnologías y técnicas en cirugía mínimamente invasiva es lograr una cirugía sin o con mínimas cicatrices visibles. La cirugía a través de orificios naturales podría considerarse como un paradigma de este desarrollo pero todavía no ha sido posible su completa implantación. Sin embargo, la innovación resultante de la investigación en cirugía a través de orificios naturales ha permitido introducir una serie de «tecnologías puente» que permiten desarrollar la cirugía mínimamente invasiva con los estándares de eficacia y seguridad exigibles, siendo la cirugía laparoscópica a través de incisión única el concepto más atractivo en este momento. El objetivo de este trabajo es revisar el concepto de cirugía laparoscópica a través de incisión única y clasificar las herramientas disponibles para su implantación y desarrollo (AU)

One of the aims of the new technologies and techniques in minimally invasive surgery (MIS) is to achieve a surgery without or with minimal visible scars. Natural orifice transluminal endoscopic surgery (NOTES) might be considered to be a paradigm of this development but it has not yet been possible to implement this universally. Nevertheless, the resultant innovation of research into NOTES has enabled “bridge technologies" to be introduced that allow MIS to be developed with the required standards of efficiency and safety. The aim of this paper is to review the concept of single incision surgery and to classify the available tools for its development and implementation (AU)

La eventración paraestomal (EP) es la complicación tardía más frecuente del estoma quirúrgico. Solo un tercio de éstas se intervienen, hecho que en parte se explica por el alto índice de recidivas observadas tras la reparación. La utilización de materiales protésicos ha mejorado los resultados, aunque siguen siendo por debajo de lo ideal. Por esta razón, se ha propuesto que la mejor solución puede estar en prevenir la aparición de la EP. Varios trabajos muestran resultados prometedores con reducciones muy llamativas en el porcentaje de EP al colocar una prótesis periestomal profiláctica. En este artículo presentamos una revisión de los factores de riesgo asociados a la EP y una clasificación de la diversidad de técnicas de reparación existentes, y se propone un algoritmo para el tratamiento de la EP, incluyendo la prevención de esta (AU) / Parastomal hernia (PH) is the most common delayed complication in stoma surgery. Only a third of these are operated on, something which is partly explained by the high recurrence rate observed after repair. The use of prosthetic materials has improved the results, although they continue to be below the ideal. For this reason, it has been proposed that the best solution may be in preventing the PH. Several studies show promising results, with very marked reductions in the percentage of IH, on placing a prophylactic peristomal prosthesis. In this article we present a review of the risk factors associated with PH, a classification of the existing diversity of repair techniques, and an algorithm is proposed for the management of PH, including its prevention (AU)

La eventración paraestomal (EP) es la complicación tardía más frecuente del estoma quirúrgico. Solo un tercio de éstas se intervienen, hecho que en parte se explica por el alto índice de recidivas observadas tras la reparación. La utilización de materiales protésicos ha mejorado los resultados, aunque siguen siendo por debajo de lo ideal. Resumen Por esta razón, se ha propuesto que la mejor solución puede estar en prevenir la aparición de la EP. Varios trabajos muestran resultados prometedores con reducciones muy llamativas en el porcentaje de EP al colocar una prótesis periestomal profiláctica. Resumen En este artículo presentamos una revisión de los factores de riesgo asociados a la EP y una clasificación de la diversidad de técnicas de reparación existentes, y se propone un algoritmo para el tratamiento de la EP, incluyendo la prevención de esta (AU)

Parastomal hernia (PH) is the most common delayed complication in stoma surgery. Only a third of these are operated on, something which is partly explained by the high recurrence rate observed after repair. The use of prosthetic materials has improved the results, although they continue to be below the ideal. Abstract For this reason, it has been proposed that the best solution may be in preventing the PH. Several studies show promising results, with very marked reductions in the percentage of IH, on placing a prophylactic peristomal prosthesis. Abstract In this article we present a review of the risk factors associated with PH, a classification of the existing diversity of repair techniques, and an algorithm is proposed for the management of PH, including its prevention (AU)

Cirugía laparoscópica con puerto único: ampliación del espectro de utilización / Single port laparoscopic surgery: Widening the spectrum of use

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[Single incision laparoscopic surgery]. / Cirugía laparoscópica a través de incisión única.

One of the aims of the new technologies and techniques in minimally invasive surgery (MIS) is to achieve a surgery without or with minimal visible scars. Natural orifice transluminal endoscopic surgery (NOTES) might be considered to be a paradigm of this development but it has not yet been possible to implement this universally. Nevertheless, the resultant innovation of research into NOTES has enabled "bridge technologies" to be introduced that allow MIS to be developed with the required standards of efficiency and safety. The aim of this paper is to review the concept of single incision surgery and to classify the available tools for its development and implementation.

[Parastomal hernias: background, current status and future prospects]. / Eventración paraestomal: antecedentes, estado actual y expectativas de futuro.

Parastomal hernia (PH) is the most common delayed complication in stoma surgery. Only a third of these are operated on, something which is partly explained by the high recurrence rate observed after repair. The use of prosthetic materials has improved the results, although they continue to be below the ideal. For this reason, it has been proposed that the best solution may be in preventing the PH. Several studies show promising results, with very marked reductions in the percentage of IH, on placing a prophylactic peristomal prosthesis. In this article we present a review of the risk factors associated with PH, a classification of the existing diversity of repair techniques, and an algorithm is proposed for the management of PH, including its prevention.

Prevention of trocar site hernias: description of the safe port plug technique and preliminary results.

The aim of this study was to describe a new technique to prevent the development of incisional hernias in trocar sites. Between March and June 2006, a pilot study was conducted to determine the feasibility of the safe port plug technique using the Bioabsorbable Hernia Plug to prevent incisional hernia in trocar sites. The device was implanted in the umbilical trocar site (10-11 mm) of 17 patients undergoing laparoscopic surgery during the study period. The mean follow-up of patients was 14.6 months. Implantation of the Bioabsorbable Hernia Plug device by the safe port plug technique was possible in all cases. No patient presented complications in the follow-up. Our preliminary experience suggests that this technique is simple and feasible, and we hypothesized that this technique could be superior to conventional fascial closure: a hypothesis that must be proven in a randomized prospective trial that is currently in progress.

Division of the small bowel with the LigaSure Atlas device during the right laparoscopic colectomy.

BACKGROUND: Bowel division and anastomosis were facilitated greatly with the advent of stapling techniques. Since then, there have not been any new evolving technologies to facilitate these maneuvers. For this reason, we recently applied the LigaSure Atlas device (Valleylab, Boulder, CO) to the division of the small bowel during this procedure to obtain a reliable and low-cost division of the ileum. METHODS: After vessel ligation and ileocolic mobilization, the terminal ileum is sealed and divided with the LigaSure Atlas. This device is applied sequentially along the small bowel twice to ensure an adequate seal before the cut. A terminolateral ileotransversostomy is performed extracorporeally with a mechanical circular stapling device, installing the anvil of the circular stapler into the ileal stump. RESULTS: We have not encountered any problems with this technique since its introduction in our institution, and no leakage or bursting of the ileal stumps. CONCLUSIONS: This technique enables an easy, reliable, and inexpensive technical option to optimize the right laparoscopic colectomy procedure.