Comparison of Intestinal Stent Placement Followed By Laparoscopic Surgery and Emergency Surgery in Obstructive Colorectal Cancer: A Retrospective Analysis and Meta-analysis

Background: For patients with colorectal cancer and malignant intestinal obstruction, it is still controversial to perform endoscopic intestinal stent placement followed by laparoscopic surgery. This study compares the endoscopic intestinal stent placement followed by laparoscopic surgery and emergency surgery in patients with colorectal cancer and malignant intestinal obstruction.Method: 11 compliant publications from Pubmed, Cochrane and Embase databases were analyzed using Revies Manager 5.2 software. SPSS 21 was used to retrospectively analyze 99 patients admitted to our center from 2014 to 2019.Results: There were significant differences between the two groups in three of the five criteria. In the SBTS group, the perioperative mortality rate was lower, with an OR of 0.46 (95% CI: 0.22-0.95, P=0.04), the incidence of postoperative wound infection was lower; OR was 0.44 (95% CI: 0.24-0.82, P=0.009); Postoperative hospital stay was shorter, MD was -2.07 (95% CI: -2.55--1.59, P<0.00001).Retrospective analysis of the clinical outcome differences between the SBTS group and ES group in our center: Compared to the ES group, the SBTS group displayed lower infection rate of surgical incision (χ2=3.94,P =0.04) ); no difference in the frequency of occurrence of anastomotic leakage (χ2=0.18,P=0.67), did not reduce perioperative mortality (χ2=0.94,P=0.33);shorter operating time (204.13±37.35 min) (t=5.08,P=0.000), lower intraoperative blood loss (155.65±94.90 ml) (t=3.90,P=0.001); and shorter postoperative hospital stay (12.91±5.47 d) (t=2.64, P=0.01).Conclusion: Compared the emergency surgery group, endoscopic intestinal stent placement followed by the laparoscopic surgery can reduce perioperative mortality, postoperative wound infection, intraoperative blood loss, and the length of postoperative hospital stay. There was no difference between the two methods as far as the incidence of posterior anastomotic leakage and operating time were concerned.

Trocar-site hernia following laparoscopic salpingo-oophorectomy in a middle-aged Japanese woman: an initial case report after 40 years of experience at a single center and a brief literature review

Background In gynecology, the number of laparoscopic surgeries performed has increased annually because laparoscopic surgery presents a greater number of advantages from a cosmetic perspective and allows for a less invasive approach than laparotomy. Trocar site hernia (TSH) is a unique complication that causes severe small bowel obstruction and requires emergency surgery. Its use has mainly been reported with respect to gastrointestinal laparoscopy, such as for cholecystectomy. Contrastingly, there have been few reports on gynecologic laparoscopy because common laparoscopic surgeries, such as laparoscopic salpingo-oophorectomy, are considered low risk due to shorter operative times. In this study, we report on a case of a woman who developed a TSH 5 days postoperatively following a minimally invasive laparoscopic surgery that was completed in 34 min. Case presentation A 41-year-old woman who had undergone laparoscopic salpingo-oophorectomy 5 days previously presented with the following features of intestinal obstruction: persistent abdominal pain, vomiting, and inability to pass stool or flatus. A computed tomography scan of her abdomen demonstrated a collapsed small bowel loop that was protruding through the lateral 12-mm port. Emergency surgery confirmed the diagnosis of TSH. The herniated bowel loop was gently replaced onto the pelvic floor and the patient did not require bowel resection. After the surgical procedure, the fascial defect at the lateral port site was closed using 2-0 Vicryl sutures. On the tenth postoperative day, the patient was discharged with no symptom recurrence. Conclusions The TSH initially presented following laparoscopic salpingo-oophorectomy; however, the patient did not have common risk factors such as obesity, older age, wound infection, diabetes, and prolonged operative time. There was a possibility that the TSH was caused by excessive manipulation during the tissue removal through the lateral 12-mm port. Thereafter, the peritoneum around the lateral 12-mm port was closed to prevent the hernia, although a consensus around the approach to closure of the port site fascia had not yet been reached. This case demonstrated that significant attention should be paid to the possibility of patients developing TSH. This will ensure the prevention of severe problems through early detection and treatment.

Durable results of preserved valve and root after acute type A aortic dissection surgery in bicuspid aortic valve

Background and aims of the study. Data on emergency surgery for acute type A aortic dissection in patients with bicuspid aortic valve were limited. Long-term results on the fate of the preserved bicuspid valve and aortic root were even rare. We sought to assess the clinical outcome of emergency acute type A aortic dissection surgery in patients with bicuspid aortic valve. Methods. From 2004 to 2021, 121 patients underwent emergency surgery for acute type A aortic dissection using a conservative aortic resection. Hospital and late outcomes were assessed in patients with bicuspid aortic valve. Results. Eight patients (6.6%) had bicuspid aortic valve with 6 males (75%) and median age of 49.5 years (range, 34 to 71). Four (50%) had significant aortic valve dysfunction. Operation included ascending aortic grafting with aortic valve preservation in 4, ascending aortic grafting with aortic valve replacement in 3 and ascending aortic grafting with Bentall root replacement in 1. Hospital mortality rate was 12.5% (1/8). With a median follow-up of 14.4 years, there was one late death and no proximal reoperation of 6 preserved roots and 3 preserved valves. Median diameter of preserved aortic roots changed from 42 (range, 33-43) to 38.5 mm (range, 35-46) with the average time of 11 years after surgery. Conclusions. Acute type A aortic dissection in bicuspid aortic valve was not associated with worse outcome. Aortic valve replacement was often required. Simultaneous root replacement was not always necessary. Preservation of normally functioning bicuspid valve and non-dilated root showed durable long-term results.

Torsion of a Wandering Spleen Treated by Laparoscopic Surgery: A Case Report

The spleen is an organ located in the upper left portion of the abdomen. Wandering spleen is defined as the location of the spleen is the shift to other parts of the abdomen rather than the left upper quadrant. Wandering spleen is a rare clinical condition and can lead to hilar torsion and subsequent infarction requiring emergency surgery. The author presents a case of torsion of a wandering spleen in a 34-year-old female presenting with abdominal pain. The patients underwent emergent laparoscopic splenectomy. She had an uncomplicated postoperative course and recovered well.