P122 LAPAROSCOPIC APPROACH TO THE ABDOMINAL WALL WITH CLOSURE OF THE DEFECT, OUR INITIAL RESULTS

Aim The aim of the study is to evaluate the closure of the defect in postoperative pain, seroma and recurrence. Material and Methods Inclusion criteria were; defect width of 2 - 4 cm and body mass index ≤ 35 kg / m2, or previous intraperitoneal surgery. A prospective database of perioperative variables have been collected. We consider postoperative pain as a value ≥5 on the Visual Analogue Scale, seroma types III and IV of the Morales-Conde classification. Results 32 patients were operated with laparoscopic closure of the defect (LCD) between 2018 and 2020. The mean age was 59 years and body mass index was 31 kg / m2. 14 patients had incisional hernia. 90% of the cases were M2-3 with a mean defect diameter of 2.7 cm. In 5 cases, a preperitoneal mesh was placed without takers, the mean size of the mesh was 15 cm. The mean duration of the procedures was 96.1 min. Seven (22%) patients presented postoperative pain, of which 5 had 24 h limited and in two cases it lasted up to 48 h. No patient presented pain at the 30-day evaluation. The mean length of stay was 1.8 days. The mean follow-up was 23 months, one seroma (3.1%) and three (9.4%) recurrences were diagnosed. Conclusions In our initial experience, we considered LCD a safe technique with benefits for selected patients.

Incidence of Symptomatic Internal Hernia following Minimal Invasive colorectal surgery: A Single Center Experience

Laparoscopy has been adopted in the surgical specialties and colorectal surgery for treatment of benign and malignant diseases. Recent reviews suggest that the incidence of symptomatic internal hernias after laparoscopic colorectal resection is from 0.39 to 0.65%. Unlike in open surgery, laparoscopic closure of a mesenteric defect is inherently challenging as inadvertent injury to the marginal vessels may compromise blood supply to the anastomosis. For these reasons, many surgeons leave the defect open during laparoscopic surgery. But this may lead to development of post-operative internal hernia through the defect. This is a retrospective study where we included 149 patients who underwent laparoscopic/ robotic colorectal surgeries from March 2019 to March 2020. Data pertaining for following variables were collected which included age, sex, indication for surgery, location of the pathology, splenic flexure mobilization. The incidence of internal hernia among these patients were calculated and assessed using SPSS 20. Incidence of internal hernia was found to be 0.67% which was diagnosed and treated on the 18th post-operative day of initial surgery. Internal hernia is a rare but important complication of laparoscopic/robotic colorectal surgery with a high mortality rate if not diagnosed early. Defect closure is still controversial during the initial surgery and probably not indicated for all patients and depends on surgeon’s preference.

Study of the Comparison of Endoscopic Closure and Laparoscopic Repair of Defect of Gastric Wall

Objective: To make analysis on the curative effect on the technique of endoscopic closure and laparoscopic closure, and explore the effect and safety of acute perforation of the endoscopic closure technique. Methods: Analysis on the 40 therapeutic cases of laparoscopic repair and endoscopic closure treatments, respectively, to submucosal tumours (SMT) of the stomach removed through ESE/EFR. According to the double-sample t-test, the differences of operation time and medical expenses between the two closure methods were compared and analyzed. And used the chi-square test to compare the difference in terms of operational difficulty and effects. Results: Postoperative pathology of 76 therapeutic cases operated through ESE and EFR was diagnosed as mesenchymal tumor and 4 cases as leiomyoma, among which 34 cases were in fundus ventriculi, 30 in corpus ventriculi and 16 in antrum. Endoscopic closure is significantly lower than laparoscopic closure in operation time span (endoscopic closure VS laparoscopic repair 74.70±23.55min vs 178.35±38.98min, p < 0.001) , medical expenses (endoscopic closure VS laparoscopic repair 28463.55±8228.96rmb vs 61848.75±8812.12rmb, p < 0.001) and inpatient days (endoscopic closure VS laparoscopic repair 10.50±3.49days vs. 16.95±4.58days, P < 0.01), while there is no significant difference in terms of technical difficulty and effects (P > 0.05). Conclusion: With the training and technical progress of endoscopic closure, it is safe, effective and quick in recovery to have non-laparoscopic assisted surgery on gastric wall closure.

Study of the Comparison of Endoscopic Closure and Laparoscopic Repair of Defect of Gastric Wall

Objective: To make analysis on the curative effect on the technique of endoscopic closure and laparoscopic closure, and explore the effect and safety of acute perforation of the endoscopic closure technique. Methods: Analysis on the 40 therapeutic cases of laparoscopic repair and endoscopic closure treatments, respectively, to submucosal tumours (SMT) of the stomach removed through ESE/EFR. According to the double-sample t-test, the differences of operation time and medical expenses between the two closure methods were compared and analyzed. And used the chi-square test to compare the difference in terms of operational difficulty and effects. Results: Postoperative pathology of 76 therapeutic cases operated through ESE and EFR was diagnosed as mesenchymal tumor and 4 cases as leiomyoma, among which 34 cases were in fundus ventriculi, 30 in corpus ventriculi and 16 in antrum. Endoscopic closure is significantly lower than laparoscopic closure in operation time span (endoscopic closure VS laparoscopic repair 74.70±23.55min vs 178.35±38.98min, p < 0.001) , medical expenses (endoscopic closure VS laparoscopic repair 28463.55±8228.96rmb vs 61848.75±8812.12rmb, p < 0.001) and inpatient days (endoscopic closure VS laparoscopic repair 10.50±3.49days vs. 16.95±4.58days, P < 0.01), while there is no significant difference in terms of technical difficulty and effects (P > 0.05). Conclusion: With the training and technical progress of endoscopic closure, it is safe, effective and quick in recovery to have non-laparoscopic assisted surgery on gastric wall closure.