BACKGROUND Complications associated with stomas—including parastomal hernia(PSH),pro-lapse,mucocutaneous separation,and stoma retraction—provide considerable postoperative challenges for colostomy patients.Selecting...BACKGROUND Complications associated with stomas—including parastomal hernia(PSH),pro-lapse,mucocutaneous separation,and stoma retraction—provide considerable postoperative challenges for colostomy patients.Selecting between extraperi-toneal colostomy(EPC)and transperitoneal colostomy(TPC)pathways is there-fore essential for mitigating these complications.AIM To analyze the existing data regarding the efficacy of EPC compared to TPC in reducing stoma-related complications post-colostomy.METHODS PubMed,Google Scholar,EMBASE,MEDLINE,and the Cochrane Library were adopted to uncover pertinent papers in which EPC and TPC approaches were compared.We then conducted a meta-analysis using RevMan 5.4.1.RESULTS Both laparoscopic(Lap)and open approaches showed a reduced incidence of PSH in EPC relative to TPC(P<0.00001 and P=0.02 respectively).In addition,Lap EPC depicted a lesser incidence of prolapse,mucocutaneous separation,and stoma retraction(P=0.007,P=0.03,and P=0.01,respectively)compared to Lap TPC.However,EPC and TPC did not differ with respect to operation time,blood loss,edema,ischemia,necrosis,or infection after the LAP approach.CONCLUSION The extraperitoneal approach may provide benefits in minimizing some stoma-related problems such as PSH,pro-lapse,mucocutaneous separation,and stoma retraction after colostomy surgery.展开更多
Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic s...Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.展开更多
Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing ur...Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing urinary incontinence after RP.Our study aimed to analyze possible predictors of early postoperative(within 3 months)urinary continence(UC)outcomes following extraperitoneal single-site robot-assisted RP(ss-RARP)for localized PCa.Methods:We retrospectively reviewed data from 113 patients with localized PCa who were operated on by a highly experienced surgeon between September 2022 and December 2023.Patient characteristics(age,body mass index,prostate volume,prostate dimensions,preoperative and postoperative membranous urethral length,and percentage of membranous urethra removed)were analyzed using logistic regression to determine the independent factors contributing to short-term UC recovery after extraperitoneal ss-RARP.From the time of urinary catheter removal after surgery,the recovery of UC was followed up every month,and UC was defined as using≤1 safety pad daily,known as social continence.Results:The proportions of continent patients immediately after urinary catheter removal,1 month,and 3 months after extraperitoneal ss-RARP were 22%,49%,and 82%,respectively.The multivariate logistic regression analysis showed that the percentage of membranous urethra removed(p=0.016)and prostate volume(p=0.049)were associated with social UC recovery immediately after urinary catheter removal,and craniocaudal dimension of the prostate(p=0.042)and age(p=0.014)were associated with social UC recovery 1 month and 3 months after extraperitoneal ss-RARP,respectively.Conclusion:The percentage of membranous urethra removed,prostate volume,craniocaudal dimension of the prostate,and age are independent risk factors for social UC early after extraperitoneal ss-RARP.展开更多
Objective:This prospective randomized controlled study was conducted to evaluate the safety and efficacy of the Pringle hepatic hilar occlusion with a bulldog clamp in laparoscopic liver resection.Methods:From March 1...Objective:This prospective randomized controlled study was conducted to evaluate the safety and efficacy of the Pringle hepatic hilar occlusion with a bulldog clamp in laparoscopic liver resection.Methods:From March 1,2020 to July 31,2021,80 patients were enrolled,including 40 undergoing intraperitoneal Pringle maneuver(IPM)and 40 extraperitoneal Pringle maneuver(EPM).The observation indices included basic preoperative clinical characteristics and intraoperative and postoperative liver function indices.Results:There were no significant differences in the basic characteristics or types of hepatectomy,intraoperative blood loss,intraoperative blood transfusion,or hepatectomy time between the IPM and EPM groups.However,the blocking and operation time in the IPM group was shorter than that in the EPM group.There were no significant differences in alanine aminotransferase(ALT)or aspartate aminotransferase(AST)levels on the first day after surgery or in total bilirubin(TBIL)or albumin(ALB)levels on the first,third,or fifth days after surgery.However,C-reactive protein(CRP)levels on the first and third days,ALT and AST levels on the third and fifth days were lower,and hospital stay after surgery was shorter in the IPM group than in the EPM group.Conclusion:IPM using bulldog clamps is simple,safe,and effective.The inflammatory reaction is less severe,the degree of liver function injury is lower,and recovery is faster.展开更多
To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy(epR-spRP)and extraperitoneal robotic multiport radical prostatectomy(epR-mpRP)performed with the da Vinci Si Surgical System,compa...To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy(epR-spRP)and extraperitoneal robotic multiport radical prostatectomy(epR-mpRP)performed with the da Vinci Si Surgical System,comparison was performed between 30 single-port(SP group)and 26 multiport(MP group)cases.Comparisons included operative time,estimated blood loss(EBL),hospital stay,peritoneal violation,pain scores,scar satisfaction,continence,and erectile function.The median operation time and EBL were not different between the two groups.In the SP group,the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients(P<0.001).The median postoperative hospital stay in the SP group was shorter than that in the MP group(P<0.001).The rate of peritoneal damage in the SP group was less than that in the MP group(P=0.017).The pain score and overall need for pain medications in the SP group were lower than those in the MP group(P<0.001 and P=0.015,respectively).Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively(P=0.007).At 3 months,the cancer control,recovery of erectile function,and urinary continence rates were similar between the two groups.It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system.Therefore,epR-spRP can be a treatment option for localized prostate cancer.Although epR-spRP still has a learning curve,it has advantages for postoperative pain and self-assessed cosmesis.In the absence of the single-port robotic surgery platform,we can still provide minimally invasive surgery for patients.展开更多
Endoscopic extraperitoneal radical prostatectomy （EERPE） is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refin...Endoscopic extraperitoneal radical prostatectomy （EERPE） is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refined with the expansion of anatomical knowledge. The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure＇s established benefits in terms of potency, continence and oncological management. In this study, the technique and its evolution are presented in detail, along with an analysis of its clinical efficacy. We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy, and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.展开更多
AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperit...AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.展开更多
Background:In the treatment of colorectal cancer,laparoscopic surgery has seen a significant amount of success.Reducing the risk of postoperative complications and improving patients’quality of life can be accomplish...Background:In the treatment of colorectal cancer,laparoscopic surgery has seen a significant amount of success.Reducing the risk of postoperative complications and improving patients’quality of life can be accomplished by appropriately employing pelvic peritoneal repair and sigmoid colostomy when appropriate.Objective:To compare fusion closure of pelvic peritoneum combined with extraperitoneal colostomy with non-closure of pelvic peritoneum combined with intraperitoneal colostomy in patients with low rectal cancer who had permanent colostomy.Methods:Low rectal cancer patients admitted to Hengshui People’s Hospital for permanent colostomy were evaluated.The participants were divided into two groups:an observation and a control group.All 30 cases in the observation group underwent pelvic peritoneum closure and extraperitoneal colostomy,while the other 30 cases in the control group underwent intraperitoneal colostomy.The C-reactive protein(CRP)levels of the participants in both groups were evaluated for 6 months to 2 years(24 h before,24 h after,48 h after,96 h after surgery).Results:Comparing the colostomy operative time,time to first passage of flatus postoperatively,time to first defecation postoperatively,length of hospital stay,laboratory indicators,stoma-related complications,colostomy function,etc.,the colostomy operative time significantly differed between the two groups(P<0.05);the observation group did considerably better than the control group in terms of stoma-related complications and bowel movement control 6 months after surgery(P<0.05);and although serum CRP levels increased in both groups 48 h after surgery,the difference was significant(P<0.05).Conclusion:Extraperitoneal colostomy can improve the quality of life of patients with permanent stoma and reduce the occurrence of stoma-related complications.Thus,this technique is worthy of promotion in clinical practice.展开更多
Laparoscopic totally extraperitoneal (TEP) hernia repair is a well-accepted technique for inguinal hernia repair. Different types of mesh and fixation methods have been described. Recently, a novel, self-fixating mesh...Laparoscopic totally extraperitoneal (TEP) hernia repair is a well-accepted technique for inguinal hernia repair. Different types of mesh and fixation methods have been described. Recently, a novel, self-fixating mesh has been introduced and used successfully in open inguinal hernia repairs. We report the first initial experience using this mesh for TEP repairs.展开更多
Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparosc...Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparoscopic techniques(e.g.,transabdominal preperitoneal and totally extraperitoneal[TEP]repairs).1,2,3 Guidelines updated in 2018 and 2023 emphasize mesh-based repairs,providing recommendations to optimize outcomes and minimize complications.1,2 Laparoscopic hernia repair,particularly TEP,offers several advantages,such as reduced pain,quicker recovery,and improved cosmetic outcomes.展开更多
Objective Abdominal wall hernias,particularly midline primary and incisional types,represent a common and challenging surgical condition.The extended-view totally extraperitoneal(e-TEP)technique has recently been adap...Objective Abdominal wall hernias,particularly midline primary and incisional types,represent a common and challenging surgical condition.The extended-view totally extraperitoneal(e-TEP)technique has recently been adapted for ventral hernia repair,offering potential advantages over other approaches.This study aimed to evaluate the initial outcomes and institutional experience of the e-TEP technique for midline primary and incisional ventral hernia repair at a tertiary center in Vietnam.Methods This prospective descriptive study was conducted on 65 patients with midline primary or incisional ventral hernias who underwent e-TEP repair between June 2022 and August 2024.All procedures were performed by two experienced surgeons at the Department of General Surgery,Can Tho General Hospital,Vietnam.Follow-up continued until February 2025.Data were collected and analyzed on demographics,clinical characteristics,surgical details,postoperative outcomes,and recurrence.Results A total of 65 patients,with a mean age of 57.9±12.6 years,a mean BMI of 25.0±3.3 kg/m^(2),and 47(72.3%)female,were included.The types of hernias included primary hernias in 63.1%(41 patients)and incisional hernias in 36.9%(24 patients).Among the incisional hernias,3 cases were recurrences.The median defect area was 9 cm^(2)(range,1–50 cm2).A 15 cm×15 cm mesh was used in nearly all cases(98.5%).The mean operating time was 131.9±51.8 min,with no conversions to open repair or other procedures,and no intraoperative complications were observed.Nine patients(13%)experienced postoperative complications,with seroma being the most common(5 cases).Two patients sustained intestinal injuries that required reoperation,one developed a wound infection and one reported postoperative skin paresthesia.The mean visual analogue scale pain scores at postoperative 24 hours,48 hours,and at discharge were 4.3±1.3,3.0±1.5,and 1.0±0.4,respectively.The mean postoperative hospital stay was 4.52±2.24 d.Only one case of recurrence(1.5%)was observed,and no patient reported chronic pain during the mean follow-up period of 14.5±7.6 m.Conclusion The e-TEP technique for midline primary and incisional ventral hernia repair is a feasible and safe option when performed by experienced surgeons.It offers a low rate of complications,short hospital stay,and minimal recurrence rates.This technique can be considered a viable alternative for the management of midline ventral hernias,with promising short-term outcomes.展开更多
BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice be...BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice between intraperitoneal anastomosis(IA)and extraperitoneal anastomosis(EA)remains a subject of considerable debate.This study uses intraperitoneal isoperistaltic side-to-side anastomosis(IISSA)with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes.It is hypothesized that this technique may offer better short-term outcomes than EA.AIM To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.METHODS Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Surgical,postoperative,and pathological features of the IA and EA groups were observed before and after propensity score matching.Patients with right-sided and left-sided colon cancer were separated,each further divided into IA and EA groups(R-IA vs R-EA for right-sided,L-IA vs L-EA for left-sided),for stratified analysis of the aforementioned indicators.RESULTS After propensity score matching,63 pairs were matched in each group.In surgical characteristics,the IA group exhibited less blood loss and shorter incisions than the EA group.Regarding postoperative recovery,the IA group showed earlier recovery of gastrointestinal function.Pathologically,the IA group had greater lymph node clearance.Relative to the R-EA group,the R-IA group experienced reduced blood loss,shorter assisted incisions,earlier recovery of gastrointestinal functions and greater lymph node dissection.When compared to the L-EA group,the L-IA group demonstrated earlier postoperative anal exhaust and defecation,along with a reduced length of hospitalization.Regarding postoperative complications,no statistically significant differences were found between the groups either after matching or in the stratified analyses.CONCLUSION Compared to EA,IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.展开更多
Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic t...Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic technique.However,intracorporeal anastomosis(ICA)has emerged as a promising alternative because of its potential advantages.Recently,Wu et al provided compelling evidence supporting superiority of ICA over ECA,demonstrating reduced blood loss,smaller incisions,and faster postoperative recovery without increased complic-ations.Despite these benefits,ICA presents certain challenges such as longer operative times and technical difficulties.However,advances in minimally in-vasive surgery,including robot-assisted platforms,may facilitate broader adoption of ICA by addressing the technical limitations.Furthermore,meticulous surgical techniques and perioperative infection control strategies are essential for mitigating intra-abdominal infectious complications.Given the increasing adoption of ICA in minimally invasive right hemicolectomy,further studies,including multicenter randomized controlled trials,are necessary to confirm its oncological safety and establish standardized surgical protocols.Overall,ICA has the potential to become the preferred anastomotic approach in both laparoscopic and robotic colorectal surgeries.展开更多
Objective:To established a procedure for laparoscopic extraperitoneal ostomy after abdomino-perineal resection(APR)and study safety aspects and complications.Method:From July 2011 to July 2012,36 patients with low rec...Objective:To established a procedure for laparoscopic extraperitoneal ostomy after abdomino-perineal resection(APR)and study safety aspects and complications.Method:From July 2011 to July 2012,36 patients with low rectal cancer undergoing APR were included in the study and divided into extraperitoneal ostomy group(n=18)and intraperitoneal ostomy group(n=18).Short-and long-term complications were compared between the two groups.All patients were followed up and the median duration was 17 months(range:12-24).Results:The rates of short-term complication related to colostomies were comparable between the two groups,except the rate for stoma edema was higher in the extraperitoneal group(33.3%vs 0%;P=0.008).In the intraperitoneal ostomy group,two patients developed stoma prolapse,one had stoma stenosis,and two had parastomal hernia.In contrast,no long-term complications related to colostomies occurred in the extraperitoneal ostomy group.The rate of long-term complication was lower in the extraperitoneal ostomy group(0%vs 22.2%;P=0.036).Conclusion:The laparoscopic extraperitoneal ostomy is a relatively simple and safe procedure,with fewer long-term complications related to colostomy.However the follow-up period was not too long and needs to be extended.展开更多
The laparoscopic radical prostatectomy （LRP） is a developing technique for treatment of localizedprostate cancer, while the extraperitoneal approach has been highlighted recently.1 From May 2003 to April 2006, we pe...The laparoscopic radical prostatectomy （LRP） is a developing technique for treatment of localizedprostate cancer, while the extraperitoneal approach has been highlighted recently.1 From May 2003 to April 2006, we performed laparoscopic radical prostatectomy by transperitoneal or extraperitoneal approaches in 31 patients with localized prostate cancer. Some parameters of these patients are compared in this article.展开更多
BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little...BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.展开更多
Inflammatory myofibroblastic tumor(IMT) is an uncommon benign neoplasm with locally aggressive behavior but malignant change is rare.We report an unusual case of pelvic-abdominal inflammatory myofibroblastic tumor wit...Inflammatory myofibroblastic tumor(IMT) is an uncommon benign neoplasm with locally aggressive behavior but malignant change is rare.We report an unusual case of pelvic-abdominal inflammatory myofibroblastic tumor with malignant transformation in a 14-year-old boy presenting with abdominal pain and 9 kg body weight loss in one month.Computed tomography revealed a huge pelvi-abdominal mass(30 cm),possibly originating from the pelvic extraperitoneal space,protruding into the abdomen leading to upward displacement of the bowel loops,downward displacement of the urinary bladder,massive central necrosis,a well-enhanced peripheral solid component with prominent peritumoral vascularity.Subsequent examination confirmed the computed tomographic findings.Histopathologic examination revealed proliferative epitheloid and spindle cells,inflammatory cell infiltration and high mitotic counts.Immunohistochemistry was strongly positive for anaplastic lymphoma kinase and revealed a high proliferative index(ki-67 = 40%).DNA sequencing and electronic microscopy further confirmed the primitive fibroblastic cell phenotype of the tumor and a final diagnosis of inflammatory myofibroblastic tumor with malignant transformation was established.Rapid tumor recurrence was noted 20 d after radical tumor resection.To our knowledge,this is the largest documented case of IMT in a pediatric patient and the first report of IMT with malignant transformation originating from the pelvic extraperitoneal space.展开更多
Several techniques have been introduced to improve early postoperative continence. In this study, we evaluated the impact of bladder neck （vesicourethral anastomosis） suspension on the outcome of extraperitoneal end...Several techniques have been introduced to improve early postoperative continence. In this study, we evaluated the impact of bladder neck （vesicourethral anastomosis） suspension on the outcome of extraperitoneal endoscopic radical prostatectomy （EERPE）. In this research, a total of 180 patients underwent EERPE. Group 1 included patients who underwent nerve-sparing EERPE （nsEERPE） （n=45）, and Group 2 included patients who underwent nsEERPE with bladder neck suspension （BNS, n=45）. Groups 3 （n=45） and 4 （n=45） included patients who received EERPE and EERPE with BNS, respectively. Patients were randomly assigned to receive BNS with their nsEERPE or EERPE procedure. Perioperative parameters were recorded, and continence was evaluated by determining the number and weight of absorbent pads （pad weighing test） on the second day after catheter removal and by a questionnaire 3 months postoperatively. Two days after catheter removal, 11.1% of Group 1, 11.1% of Group 2, 4.4% of Group 3 and 8.9% of Group 4 were conti nent. The average urine loss was 80.4, 70.1, 325.0 and 291.3 g for the each of these groups, respectively. At 3 months, 76.5% of Group I and 81.3% of Group 2 were continent. The continence figures for Group 3 and 4 were 48.5% and 43.8%, respectively. Similar overall rates were observed in all groups. In conclusion, although there are controversial reports in the literature, early continence was never observed to be significantly higher in the BNS groups when compared with the non-BNS groups, regardless of the EERPE technique performed.展开更多
Background Pediatric kidney transplant(KT)using larger,deceased or living donor adult kidneys can be challenging in the pediatric population due to limited space in the retroperitoneum.Liver and native kidney(L/NK)mob...Background Pediatric kidney transplant(KT)using larger,deceased or living donor adult kidneys can be challenging in the pediatric population due to limited space in the retroperitoneum.Liver and native kidney(L/NK)mobilization techniques can be used in smaller and younger transplant recipients to aid in retroperitoneal placement of the renal allograft.Here,we compare the clinical outcomes of pediatric retroperitoneal KT with and without L/NK mobilization.Methods We retrospectively analyzed pediatric renal transplant recipients treated between January 2015 and May 2021.Donor and recipient demographics,intraoperative data,and recipient outcomes were included.Recipients were divided into two groups according to the surgical technique utilized:with L/NK mobilization(Group 1)and without L/NK mobilization(Group 2).Baseline variables were described using frequency distributions for categorical variables and means and standard errors for continuous variables.Tests of association with the likelihood of using L/NK mobilization were performed using standardχ2 tests,t tests,and the log-rank test.Results Forty-six pediatric recipients were evaluated and categorized into Group 1(n=26)and Group 2(n=20).Recipients in Group 1 were younger(6.7±0.8 years vs.15.3±0.7,P<0.001),shorter(109.5±3.7 vs.154.2±3.8 cm,P<0.001)and weighed less(21.4±2.0 vs.48.6±3.4 kg,P<0.001)than those in Group 2.Other baseline characteristics did not difer between Groups 1 and 2.One urologic complication was encountered in Group 2;no vascular or surgical complications were observed in either group.Additionally,no stents or drains were used in any of the patients.There were no cases of delayed graft function or graft primary nonfunction.The median follow-up of the study was 24.6 months post-transplant.Two patients developed death-censored graft failure(both in Group 2,P=0.22),and there was one death with a functioning graft(in Group 2,P=0.21).Conclusions Retroperitoneal liver/kidney mobilization is a feasible and safe technique that facilitates implantation of adult kidney allografts into pediatric transplant recipients with no increased risk of developing post-operative complications,graft loss,or mortality.展开更多
文摘BACKGROUND Complications associated with stomas—including parastomal hernia(PSH),pro-lapse,mucocutaneous separation,and stoma retraction—provide considerable postoperative challenges for colostomy patients.Selecting between extraperi-toneal colostomy(EPC)and transperitoneal colostomy(TPC)pathways is there-fore essential for mitigating these complications.AIM To analyze the existing data regarding the efficacy of EPC compared to TPC in reducing stoma-related complications post-colostomy.METHODS PubMed,Google Scholar,EMBASE,MEDLINE,and the Cochrane Library were adopted to uncover pertinent papers in which EPC and TPC approaches were compared.We then conducted a meta-analysis using RevMan 5.4.1.RESULTS Both laparoscopic(Lap)and open approaches showed a reduced incidence of PSH in EPC relative to TPC(P<0.00001 and P=0.02 respectively).In addition,Lap EPC depicted a lesser incidence of prolapse,mucocutaneous separation,and stoma retraction(P=0.007,P=0.03,and P=0.01,respectively)compared to Lap TPC.However,EPC and TPC did not differ with respect to operation time,blood loss,edema,ischemia,necrosis,or infection after the LAP approach.CONCLUSION The extraperitoneal approach may provide benefits in minimizing some stoma-related problems such as PSH,pro-lapse,mucocutaneous separation,and stoma retraction after colostomy surgery.
基金supported by the National Key R&D Program of China(No.2022YFC2702701)Shanghai Scientific and Technological Project(No.20Y11907600)Clinical Research Innovation Plan of Shanghai General Hospital(No.CTCCR-2021C17).
文摘Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.
文摘Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing urinary incontinence after RP.Our study aimed to analyze possible predictors of early postoperative(within 3 months)urinary continence(UC)outcomes following extraperitoneal single-site robot-assisted RP(ss-RARP)for localized PCa.Methods:We retrospectively reviewed data from 113 patients with localized PCa who were operated on by a highly experienced surgeon between September 2022 and December 2023.Patient characteristics(age,body mass index,prostate volume,prostate dimensions,preoperative and postoperative membranous urethral length,and percentage of membranous urethra removed)were analyzed using logistic regression to determine the independent factors contributing to short-term UC recovery after extraperitoneal ss-RARP.From the time of urinary catheter removal after surgery,the recovery of UC was followed up every month,and UC was defined as using≤1 safety pad daily,known as social continence.Results:The proportions of continent patients immediately after urinary catheter removal,1 month,and 3 months after extraperitoneal ss-RARP were 22%,49%,and 82%,respectively.The multivariate logistic regression analysis showed that the percentage of membranous urethra removed(p=0.016)and prostate volume(p=0.049)were associated with social UC recovery immediately after urinary catheter removal,and craniocaudal dimension of the prostate(p=0.042)and age(p=0.014)were associated with social UC recovery 1 month and 3 months after extraperitoneal ss-RARP,respectively.Conclusion:The percentage of membranous urethra removed,prostate volume,craniocaudal dimension of the prostate,and age are independent risk factors for social UC early after extraperitoneal ss-RARP.
基金supported by grants from Scientific Research Fund of Anhui Medical University(No.2021xkj034)Clinical Research Cultivation Program of the Second Affiliated Hospital of Anhui Medical University(No.2020LCYB18)Anhui Institute of Translational Medicine(No.2023zhyx-C84).
文摘Objective:This prospective randomized controlled study was conducted to evaluate the safety and efficacy of the Pringle hepatic hilar occlusion with a bulldog clamp in laparoscopic liver resection.Methods:From March 1,2020 to July 31,2021,80 patients were enrolled,including 40 undergoing intraperitoneal Pringle maneuver(IPM)and 40 extraperitoneal Pringle maneuver(EPM).The observation indices included basic preoperative clinical characteristics and intraoperative and postoperative liver function indices.Results:There were no significant differences in the basic characteristics or types of hepatectomy,intraoperative blood loss,intraoperative blood transfusion,or hepatectomy time between the IPM and EPM groups.However,the blocking and operation time in the IPM group was shorter than that in the EPM group.There were no significant differences in alanine aminotransferase(ALT)or aspartate aminotransferase(AST)levels on the first day after surgery or in total bilirubin(TBIL)or albumin(ALB)levels on the first,third,or fifth days after surgery.However,C-reactive protein(CRP)levels on the first and third days,ALT and AST levels on the third and fifth days were lower,and hospital stay after surgery was shorter in the IPM group than in the EPM group.Conclusion:IPM using bulldog clamps is simple,safe,and effective.The inflammatory reaction is less severe,the degree of liver function injury is lower,and recovery is faster.
基金This study was supported by the Medical Guidance Project of Shanghai Science and Technology Committee(No.19411967600 and No.17411972000).
文摘To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy(epR-spRP)and extraperitoneal robotic multiport radical prostatectomy(epR-mpRP)performed with the da Vinci Si Surgical System,comparison was performed between 30 single-port(SP group)and 26 multiport(MP group)cases.Comparisons included operative time,estimated blood loss(EBL),hospital stay,peritoneal violation,pain scores,scar satisfaction,continence,and erectile function.The median operation time and EBL were not different between the two groups.In the SP group,the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients(P<0.001).The median postoperative hospital stay in the SP group was shorter than that in the MP group(P<0.001).The rate of peritoneal damage in the SP group was less than that in the MP group(P=0.017).The pain score and overall need for pain medications in the SP group were lower than those in the MP group(P<0.001 and P=0.015,respectively).Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively(P=0.007).At 3 months,the cancer control,recovery of erectile function,and urinary continence rates were similar between the two groups.It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system.Therefore,epR-spRP can be a treatment option for localized prostate cancer.Although epR-spRP still has a learning curve,it has advantages for postoperative pain and self-assessed cosmesis.In the absence of the single-port robotic surgery platform,we can still provide minimally invasive surgery for patients.
文摘Endoscopic extraperitoneal radical prostatectomy （EERPE） is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refined with the expansion of anatomical knowledge. The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure＇s established benefits in terms of potency, continence and oncological management. In this study, the technique and its evolution are presented in detail, along with an analysis of its clinical efficacy. We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy, and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.
文摘AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.
基金the Medical Science Research Project of Hebei Province(20211322).
文摘Background:In the treatment of colorectal cancer,laparoscopic surgery has seen a significant amount of success.Reducing the risk of postoperative complications and improving patients’quality of life can be accomplished by appropriately employing pelvic peritoneal repair and sigmoid colostomy when appropriate.Objective:To compare fusion closure of pelvic peritoneum combined with extraperitoneal colostomy with non-closure of pelvic peritoneum combined with intraperitoneal colostomy in patients with low rectal cancer who had permanent colostomy.Methods:Low rectal cancer patients admitted to Hengshui People’s Hospital for permanent colostomy were evaluated.The participants were divided into two groups:an observation and a control group.All 30 cases in the observation group underwent pelvic peritoneum closure and extraperitoneal colostomy,while the other 30 cases in the control group underwent intraperitoneal colostomy.The C-reactive protein(CRP)levels of the participants in both groups were evaluated for 6 months to 2 years(24 h before,24 h after,48 h after,96 h after surgery).Results:Comparing the colostomy operative time,time to first passage of flatus postoperatively,time to first defecation postoperatively,length of hospital stay,laboratory indicators,stoma-related complications,colostomy function,etc.,the colostomy operative time significantly differed between the two groups(P<0.05);the observation group did considerably better than the control group in terms of stoma-related complications and bowel movement control 6 months after surgery(P<0.05);and although serum CRP levels increased in both groups 48 h after surgery,the difference was significant(P<0.05).Conclusion:Extraperitoneal colostomy can improve the quality of life of patients with permanent stoma and reduce the occurrence of stoma-related complications.Thus,this technique is worthy of promotion in clinical practice.
文摘Laparoscopic totally extraperitoneal (TEP) hernia repair is a well-accepted technique for inguinal hernia repair. Different types of mesh and fixation methods have been described. Recently, a novel, self-fixating mesh has been introduced and used successfully in open inguinal hernia repairs. We report the first initial experience using this mesh for TEP repairs.
文摘Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparoscopic techniques(e.g.,transabdominal preperitoneal and totally extraperitoneal[TEP]repairs).1,2,3 Guidelines updated in 2018 and 2023 emphasize mesh-based repairs,providing recommendations to optimize outcomes and minimize complications.1,2 Laparoscopic hernia repair,particularly TEP,offers several advantages,such as reduced pain,quicker recovery,and improved cosmetic outcomes.
文摘Objective Abdominal wall hernias,particularly midline primary and incisional types,represent a common and challenging surgical condition.The extended-view totally extraperitoneal(e-TEP)technique has recently been adapted for ventral hernia repair,offering potential advantages over other approaches.This study aimed to evaluate the initial outcomes and institutional experience of the e-TEP technique for midline primary and incisional ventral hernia repair at a tertiary center in Vietnam.Methods This prospective descriptive study was conducted on 65 patients with midline primary or incisional ventral hernias who underwent e-TEP repair between June 2022 and August 2024.All procedures were performed by two experienced surgeons at the Department of General Surgery,Can Tho General Hospital,Vietnam.Follow-up continued until February 2025.Data were collected and analyzed on demographics,clinical characteristics,surgical details,postoperative outcomes,and recurrence.Results A total of 65 patients,with a mean age of 57.9±12.6 years,a mean BMI of 25.0±3.3 kg/m^(2),and 47(72.3%)female,were included.The types of hernias included primary hernias in 63.1%(41 patients)and incisional hernias in 36.9%(24 patients).Among the incisional hernias,3 cases were recurrences.The median defect area was 9 cm^(2)(range,1–50 cm2).A 15 cm×15 cm mesh was used in nearly all cases(98.5%).The mean operating time was 131.9±51.8 min,with no conversions to open repair or other procedures,and no intraoperative complications were observed.Nine patients(13%)experienced postoperative complications,with seroma being the most common(5 cases).Two patients sustained intestinal injuries that required reoperation,one developed a wound infection and one reported postoperative skin paresthesia.The mean visual analogue scale pain scores at postoperative 24 hours,48 hours,and at discharge were 4.3±1.3,3.0±1.5,and 1.0±0.4,respectively.The mean postoperative hospital stay was 4.52±2.24 d.Only one case of recurrence(1.5%)was observed,and no patient reported chronic pain during the mean follow-up period of 14.5±7.6 m.Conclusion The e-TEP technique for midline primary and incisional ventral hernia repair is a feasible and safe option when performed by experienced surgeons.It offers a low rate of complications,short hospital stay,and minimal recurrence rates.This technique can be considered a viable alternative for the management of midline ventral hernias,with promising short-term outcomes.
基金Bethune Charitable Foundation Project,No.HZB-20190528-10Natural Science Foundation of Fujian Province,No.2020J011230.
文摘BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice between intraperitoneal anastomosis(IA)and extraperitoneal anastomosis(EA)remains a subject of considerable debate.This study uses intraperitoneal isoperistaltic side-to-side anastomosis(IISSA)with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes.It is hypothesized that this technique may offer better short-term outcomes than EA.AIM To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.METHODS Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Surgical,postoperative,and pathological features of the IA and EA groups were observed before and after propensity score matching.Patients with right-sided and left-sided colon cancer were separated,each further divided into IA and EA groups(R-IA vs R-EA for right-sided,L-IA vs L-EA for left-sided),for stratified analysis of the aforementioned indicators.RESULTS After propensity score matching,63 pairs were matched in each group.In surgical characteristics,the IA group exhibited less blood loss and shorter incisions than the EA group.Regarding postoperative recovery,the IA group showed earlier recovery of gastrointestinal function.Pathologically,the IA group had greater lymph node clearance.Relative to the R-EA group,the R-IA group experienced reduced blood loss,shorter assisted incisions,earlier recovery of gastrointestinal functions and greater lymph node dissection.When compared to the L-EA group,the L-IA group demonstrated earlier postoperative anal exhaust and defecation,along with a reduced length of hospitalization.Regarding postoperative complications,no statistically significant differences were found between the groups either after matching or in the stratified analyses.CONCLUSION Compared to EA,IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.
文摘Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic technique.However,intracorporeal anastomosis(ICA)has emerged as a promising alternative because of its potential advantages.Recently,Wu et al provided compelling evidence supporting superiority of ICA over ECA,demonstrating reduced blood loss,smaller incisions,and faster postoperative recovery without increased complic-ations.Despite these benefits,ICA presents certain challenges such as longer operative times and technical difficulties.However,advances in minimally in-vasive surgery,including robot-assisted platforms,may facilitate broader adoption of ICA by addressing the technical limitations.Furthermore,meticulous surgical techniques and perioperative infection control strategies are essential for mitigating intra-abdominal infectious complications.Given the increasing adoption of ICA in minimally invasive right hemicolectomy,further studies,including multicenter randomized controlled trials,are necessary to confirm its oncological safety and establish standardized surgical protocols.Overall,ICA has the potential to become the preferred anastomotic approach in both laparoscopic and robotic colorectal surgeries.
文摘Objective:To established a procedure for laparoscopic extraperitoneal ostomy after abdomino-perineal resection(APR)and study safety aspects and complications.Method:From July 2011 to July 2012,36 patients with low rectal cancer undergoing APR were included in the study and divided into extraperitoneal ostomy group(n=18)and intraperitoneal ostomy group(n=18).Short-and long-term complications were compared between the two groups.All patients were followed up and the median duration was 17 months(range:12-24).Results:The rates of short-term complication related to colostomies were comparable between the two groups,except the rate for stoma edema was higher in the extraperitoneal group(33.3%vs 0%;P=0.008).In the intraperitoneal ostomy group,two patients developed stoma prolapse,one had stoma stenosis,and two had parastomal hernia.In contrast,no long-term complications related to colostomies occurred in the extraperitoneal ostomy group.The rate of long-term complication was lower in the extraperitoneal ostomy group(0%vs 22.2%;P=0.036).Conclusion:The laparoscopic extraperitoneal ostomy is a relatively simple and safe procedure,with fewer long-term complications related to colostomy.However the follow-up period was not too long and needs to be extended.
文摘The laparoscopic radical prostatectomy （LRP） is a developing technique for treatment of localizedprostate cancer, while the extraperitoneal approach has been highlighted recently.1 From May 2003 to April 2006, we performed laparoscopic radical prostatectomy by transperitoneal or extraperitoneal approaches in 31 patients with localized prostate cancer. Some parameters of these patients are compared in this article.
文摘BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.
文摘Inflammatory myofibroblastic tumor(IMT) is an uncommon benign neoplasm with locally aggressive behavior but malignant change is rare.We report an unusual case of pelvic-abdominal inflammatory myofibroblastic tumor with malignant transformation in a 14-year-old boy presenting with abdominal pain and 9 kg body weight loss in one month.Computed tomography revealed a huge pelvi-abdominal mass(30 cm),possibly originating from the pelvic extraperitoneal space,protruding into the abdomen leading to upward displacement of the bowel loops,downward displacement of the urinary bladder,massive central necrosis,a well-enhanced peripheral solid component with prominent peritumoral vascularity.Subsequent examination confirmed the computed tomographic findings.Histopathologic examination revealed proliferative epitheloid and spindle cells,inflammatory cell infiltration and high mitotic counts.Immunohistochemistry was strongly positive for anaplastic lymphoma kinase and revealed a high proliferative index(ki-67 = 40%).DNA sequencing and electronic microscopy further confirmed the primitive fibroblastic cell phenotype of the tumor and a final diagnosis of inflammatory myofibroblastic tumor with malignant transformation was established.Rapid tumor recurrence was noted 20 d after radical tumor resection.To our knowledge,this is the largest documented case of IMT in a pediatric patient and the first report of IMT with malignant transformation originating from the pelvic extraperitoneal space.
文摘Several techniques have been introduced to improve early postoperative continence. In this study, we evaluated the impact of bladder neck （vesicourethral anastomosis） suspension on the outcome of extraperitoneal endoscopic radical prostatectomy （EERPE）. In this research, a total of 180 patients underwent EERPE. Group 1 included patients who underwent nerve-sparing EERPE （nsEERPE） （n=45）, and Group 2 included patients who underwent nsEERPE with bladder neck suspension （BNS, n=45）. Groups 3 （n=45） and 4 （n=45） included patients who received EERPE and EERPE with BNS, respectively. Patients were randomly assigned to receive BNS with their nsEERPE or EERPE procedure. Perioperative parameters were recorded, and continence was evaluated by determining the number and weight of absorbent pads （pad weighing test） on the second day after catheter removal and by a questionnaire 3 months postoperatively. Two days after catheter removal, 11.1% of Group 1, 11.1% of Group 2, 4.4% of Group 3 and 8.9% of Group 4 were conti nent. The average urine loss was 80.4, 70.1, 325.0 and 291.3 g for the each of these groups, respectively. At 3 months, 76.5% of Group I and 81.3% of Group 2 were continent. The continence figures for Group 3 and 4 were 48.5% and 43.8%, respectively. Similar overall rates were observed in all groups. In conclusion, although there are controversial reports in the literature, early continence was never observed to be significantly higher in the BNS groups when compared with the non-BNS groups, regardless of the EERPE technique performed.
文摘Background Pediatric kidney transplant(KT)using larger,deceased or living donor adult kidneys can be challenging in the pediatric population due to limited space in the retroperitoneum.Liver and native kidney(L/NK)mobilization techniques can be used in smaller and younger transplant recipients to aid in retroperitoneal placement of the renal allograft.Here,we compare the clinical outcomes of pediatric retroperitoneal KT with and without L/NK mobilization.Methods We retrospectively analyzed pediatric renal transplant recipients treated between January 2015 and May 2021.Donor and recipient demographics,intraoperative data,and recipient outcomes were included.Recipients were divided into two groups according to the surgical technique utilized:with L/NK mobilization(Group 1)and without L/NK mobilization(Group 2).Baseline variables were described using frequency distributions for categorical variables and means and standard errors for continuous variables.Tests of association with the likelihood of using L/NK mobilization were performed using standardχ2 tests,t tests,and the log-rank test.Results Forty-six pediatric recipients were evaluated and categorized into Group 1(n=26)and Group 2(n=20).Recipients in Group 1 were younger(6.7±0.8 years vs.15.3±0.7,P<0.001),shorter(109.5±3.7 vs.154.2±3.8 cm,P<0.001)and weighed less(21.4±2.0 vs.48.6±3.4 kg,P<0.001)than those in Group 2.Other baseline characteristics did not difer between Groups 1 and 2.One urologic complication was encountered in Group 2;no vascular or surgical complications were observed in either group.Additionally,no stents or drains were used in any of the patients.There were no cases of delayed graft function or graft primary nonfunction.The median follow-up of the study was 24.6 months post-transplant.Two patients developed death-censored graft failure(both in Group 2,P=0.22),and there was one death with a functioning graft(in Group 2,P=0.21).Conclusions Retroperitoneal liver/kidney mobilization is a feasible and safe technique that facilitates implantation of adult kidney allografts into pediatric transplant recipients with no increased risk of developing post-operative complications,graft loss,or mortality.
