A Systematic Review of Comparing Single-incision Versus Traditional Laparoscopic Right Hemicolectomy For Right Colon Diseases Background: Single-incision laparoscopic right hemicolectomy (SILS) has been promoted in clinic since 2008, but a systematic review of comparing SILS and traditional laparoscopic right hemicolectomy (TLS) with long-term follow-up is rare. Here, in this study, comparison of SILS and TLS with long-term follow-up was evaluated by a meta-analysis method. Methods: All studies about SILS and TLS for right hemicolectomy from 2010 to 2018 were searched from databases including Medline, Embase, Cochrane Library, and Wanfang. Operation index, recovery, and midterm follow-up data were evaluated by fixed-effects models, random-effects models, and Begg test. Results: We collected 22 studies with 2218 patients. SILS groups contained 1038 (46.7%) patients, and 1180 (53.3%) patients were observed in the TLS group. Patients’ baseline data were similar in the 2 groups. Compared with TLS, SILS had shorter operation duration [standardized mean difference (SMD): −0.35, 95% confidence interval (CI): −0.61 to −0.08, P<0.001, χ2=49.40], shorter hospitalization time (SMD: −0.27, 95% CI: −0.37 to −0.16, P<0.001, χ2=9.17), slightly less blood loss (SMD: −0.23, 95% CI: −0.36 to −0.10; P<0.001; χ2=5.36), and smaller incision length (SMD: −2.19, 95% CI: −3.66 to −0.71, P<0.001; χ2=316.1). No statistical differences were observed in other figures. Conclusion: SILS is more convenient and has better efficacy than TLS and could provide a promising surgical approach for right colon diseases.

Comparative Efficacy of 9 Major Drugs for Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: A Network Meta-Analysis Background: Postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most common complications after ERCP. The optimal drugs for reducing the risk of PEP are still unclear. This study aimed to compare the efficacy of 9 major drugs used worldwide for the prevention of PEP through a network meta-analysis. Methods: We conducted a systematic search of the literature up to October 2018 on PubMed, Embase, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov. Randomized controlled trials (RCTs) comparing allopurinol, diclofenac, gabexate (GAB), glyceryl trinitrate (GTN), indomethacin, nafamostat, octreotide, somatostatin, and ulinastatin for protection against PEP were included. Results: Eighty-six randomized controlled trials involving 25,246 patients were included in this network meta-analysis. Results indicated that diclofenac, GAB, GTN, indomethacin, somatostatin, and ulinastatin were more effective than placebo with odds ratios ranging between 0.48 (95% credible interval, 0.26-0.86) for GAB and 0.61 (0.39-0.94) for somatostatin. However, allopurinol, nafamostat, and octreotide showed similar efficacy as placebo in reducing the risk of PEP. No significant differences were found in the efficacy between diclofenac, GAB, GTN, indomethacin, somatostatin, and ulinastatin. In terms of prognosis, GAB may be the most effective treatment (surface under the cumulative ranking curve=70.6%) and the least effective was octreotide (surface under the cumulative ranking curve=28%). Conclusions: Although our analysis suggests that GAB may be the most effective drug in preventing PEP, the limitations of our study warrants more high-quality head-to-head trials of these clinical drugs in the future.

Coagulation System Disorders and Thrombosis Prophylaxis During Laparoscopic Fundoplications Background: The aim of this study was to assess and recommend the optimal deep vein thrombosis (DVT) prophylaxis regimen during and after laparoscopic fundoplication according to the blood coagulation disorders and the rate of DVT in 2 patient groups, receiving different DVT prophylaxis regimens. Materials and Methods: This was a prospective randomized, single-center clinical study. The study population, 121 patients, were divided into 2 groups: group I received low–molecular-weight heparin 12 hours before the operation; group II received low–molecular-weight heparin only 1 hour before the laparoscopic fundoplication. Both groups received intermittent pneumatic compression during the entire procedure. Bilateral Doppler ultrasound to exclude DVT was performed before the surgery. Venous phase computed tomographic images were acquired from the ankle to the iliac tubercles on the third postoperative day to determine the presence and location of DVT. Hypercoagulation state was assessed by measuring the prothrombin fragment F1+2 (F1+2), the thrombin-antithrombin complex (TAT), and tissue factor microparticles activity (MP-TF) in plasma. The hypocoagulation effect was evaluated by measuring plasma free tissue factor pathway inhibitor (fTFPI). Results: F1+2, TAT, and MP-TF indexes increased significantly, whereas fTFPI levels decreased significantly during and after laparoscopic fundoplication, when molecular-weight heparin was administered 12 hours before the operation. Computed tomography venography revealed peroneal vein thrombosis in 2 group I patients on the third postoperative day. Total postsurgical DVT frequency was 1.65%: 3.6% in group I, with no DVT in group II. Conclusion: Molecular-weight heparin and intraoperative intermittent pneumatic compression controls the hypercoagulation effect more efficiently when it is administered 1 hour before surgery: it causes significant reduction of F1+2, TAT, and MP-TF indexes and significant increases of fTFPI levels during and after laparoscopic fundoplication.

Comparison of the Effects of Midazolam/Fentanyl, Midazolam/Propofol, and Midazolam/Fentanyl/Propofol on Cognitive Function After Gastrointestinal Endoscopy Background: Drugs used for sedation/analgesia during gastrointestinal (GI) endoscopy, including midazolam, fentanyl, and propofol, result in short-term, reversible decline in cognitive function. This prospective cohort trial aimed to identify the sedative/analgesic regimen associated with the least impairment of cognition at the time of discharge. Methods: Patients undergoing elective GI endoscopy were included. Patients investigated at the Prince of Wales Hospital, Sydney, received midazolam/fentanyl (M/F), whereas patients investigated at the Prince of Wales Private Hospital, Sydney, received midazolam/fentanyl/propofol (M/F/P) or midazolam/propofol (M/P). Patients underwent a computerized neurocognitive test, the CogState Brief Battery, before sedation and at discharge. Results: Patients in the M/F group who received gastroscopy (n=22) were administered midazolam 3.36 mg (±0.79 mg) and fentanyl 61.36 μg (±16.77 μg), those who received colonoscopy (n=50) were administered midazolam 3.98 mg (±1.06 mg) and fentanyl 74.50 μg (±24.48 μg), and those who received gastroscopy/colonoscopy (n=28) were administered midazolam 4.82 mg (±1.41 mg) and fentanyl 94.64 μg (±24.35 μg). Patients in the M/F/P group who received colonoscopy (n=45) were administered midazolam 2.77 mg (±0.55 mg), fentanyl 45.11 μg (±25.78 μg), and propofol 148.64 mg (±57.65 mg), and those who received gastroscopy/colonoscopy (n=36) were administered midazolam 2.64 mg (±0.472 mg), fentanyl 35.28 μg (±19.16 μg), and propofol 168.06 mg (±60.75 mg). Nineteen patients in the M/P group who received gastroscopy (n=19) were administered midazolam 2.37 mg (±0.04 mg) and propofol 13.68 mg (±37.74 mg). Neurocognitive scores were significantly lower in the postprocedure test compared with baseline scores for detection, identification, and one card learning (P<0.001). Postprocedure detection test scores were significantly impaired in the M/F group compared with the M/F/P and M/P groups. Predictors of poorer neurocognitive function were midazolam dosage >3 mg (P<0.006) and fentanyl dosage >50 μg (P<0.009). Conclusion: The use of propofol in GI endoscopy allows for less exposure to midazolam and fentanyl and is associated with improved cognition at the time of discharge.

Feasibility and Safety of Endoscopic Thyroidectomy Via a Unilateral Axillobreast Approach for Unilateral Benign Thyroid Tumor in Vietnam The purpose of this research study was to assess the safety and surgical outcomes of endoscopic thyroidectomy applied via a unilateral axillobreast approach with CO2 insufflation to one-sided benign thyroid tumors in Vietnam. Only 1 patient of the 50 (2%) had a postoperative hematoma at the surgery site. Open surgical conversions did not occur. The duration of postoperative drainage was from 3 to 8 days, or 4.86±1.24 days on average. The length of stay in the hospital after surgery was 4 to 9 days, or 5.9±1.2 days on average. The postoperative pain in the first postoperative days was lower in intensity compared with open surgeries. The given method provided better results in terms of patient satisfaction with the cosmetic effect of the surgery compared with up-front surgery, minimally invasive video-assisted thyroidectomy, and endoscopic procedures via the breast approach, and 96% of patients were completely satisfied.

Patients Remain at High Risk of Gallstones Development Late (10 y) After Sleeve Gastrectomy? Background: Sleeve gastrectomy (SG) is an established bariatric procedure which produces substantial and rapid weight loss and hence can lead to an increase in gallstones development. Objectives: To demonstrate the early and late appearance of gallstones after SG. Materials and Methods: A prospective protocol was established in consecutive patients submitted to SG. Clinical and ultrasound evaluations were performed early (1 to 2 y) and late after surgery (over 6 y). Results: From 109 patients included, 13 (13.1%) had a previous and 10 (10.1%) had simultaneous cholecystectomy at the time of SG. Therefore, 86 patients were submitted to surveillance. Seven patients were unreachable, leaving 79 patients for late follow-up. Forty-five patients (57%) had alithiasic gallbladder late after surgery, whereas 34 patients (43%) showed appearance of gallstone. From them, 53% developed gallstones late after surgery (mean, 7.5 y). Among the group with early development of stones, 69% were symptomatic and in the latter group only 17%. Conclusions: Study with 92% of follow-up late after SG demonstrated a 43% development of gallstones: half earlier and half late after surgery. We emphasize the need for late control to detect the real appearance of gallstones after SG.

Effect of LncRNA MIAT on Prognosis of Hand-assisted Laparoscopic or Laparoscopic-assisted Colectomy for Colorectal Cancer Purpose: The current study aims to explore the effect of myocardial infarction associated transcript (MIAT) level on the long-term prognosis of hand-assisted laparoscopic colectomy (HALC) or laparoscopic-assisted colectomy (LAC) for colorectal cancer (CC). Materials and Methods: A total of 320 CC patients were included. Patients were randomized into HALC and LAC group. Results: MIAT level in CC tissue was upregulated, and had a significant positive association with its level in serum. MIAT levels in both CC tissue and serum were correlated with lymph node metastasis and histologic grading. Survival analysis showed that the overall survival rate in 3 years after operation was significantly lower in HALC-High MIAT group (P<0.05). When MIAT level is <10.9 in CC tissue or 8.7 in serum, 100% of patients who underwent HALC will be alive for >3 years. Conclusions: For patients with low MIAT level, both HALC and LAC are available, otherwise, LAC is more recommended.

Routine Colonoscopy After Acute Diverticulitis: is it Warranted? Purpose: Recent evidence suggests routine colonoscopy after acute diverticulitis is not necessary but remains debatable. The aim of this study was to investigate the incidence of follow-up colonoscopic finding of adenoma, advanced neoplastic lesion, and adenocarcinoma after diverticulitis. Materials and Methods: A retrospective review of all cases of acute diverticulitis admitted from November 2015 to April 2018 was performed. Data collected included demographics, computed tomography (CT) findings, and findings of the follow-up colonoscopy within 12 months. Results: A total of 368 patients were admitted for acute diverticulitis. A total of 366 patients underwent CT scan for diagnosis. Of whom, 185 patients (50.5%) had a follow-up colonoscopy; 115 (31.4%) did not have a follow-up colonoscopy, and the remaining have had a recent colonoscopy. The overall incidence of adenomas was 25.9% (n=48) and advanced colonic neoplasia 1.62% (n=3) in patients who underwent follow-up colonoscopy. Conclusions: The finding of advanced colonic neoplasia in follow-up colonoscopy after an acute episode of CT-proven diverticulitis is equivalent to, or less than, that of the population colorectal cancer screening program. Routine colonoscopy is not necessary unless there are other concerning symptoms/CT findings.

The “Off-Hour Effect” in Urgent Laparoscopic Cholecystectomy for Acute Cholecystitis Background: The observation that patients may have worse outcomes after urgent therapeutic interventions performed during off-hours compared with on-hours is termed the “off-hour effect.” This phenomenon has not been examined in urgent laparoscopic cholecystectomy (LC). Here we aimed to investigate the off-hour effect in urgent LC for acute cholecystitis. Patients and Methods: This study enrolled patients who underwent urgent LC for acute cholecystitis at our institution. On-hour LC was defined as a weekday operation starting between 9 AM and 9 PM; and off-hour LC as an operation on a weekend, or starting between 9 PM and 9 AM on a weekday. Patients were divided into on-hour and off-hour groups, and the operative outcomes of LC were compared between these groups. Results: The study included 371 patients, with 270 (72.8%) on-hour, and 101 (27.2%) off-hour operations. The 2 groups did not significantly differ in operation time, intraoperative blood loss, conversion rate to open surgery, incidence of postoperative complications, or duration of postoperative hospital stay. Discussion: Operative outcomes of urgent LC were comparable between the on-hour and off-hour groups, suggesting that there was no significant off-hour effect in urgent LC.

Endoscopic Ultrasound-guided Celiac Plexus Neurolysis to Alleviate Intractable Pain Caused by Advanced Pancreatic Cancer This study aimed to analyze the clinical safety and effectiveness of endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in alleviating intractable abdominal pain caused by advanced pancreatic cancer. A total of 58 patients with inoperable pancreatic cancer who underwent EUS-CPN from May 2015 to December 2017 were enrolled. Pain levels before and after EUS-CPN were assessed and compared using the Visual Analogue Scale. The preoperative Visual Analogue Scale score was 8.2±2.3, which decreased significantly to 3.6±1.5 at 2 days after EUS-CPN and to 2.2±0.8 after 1 month. The response rate was 79.3%. No patient experienced serious complications; 14 patients experienced mild, transient side effects (self-limiting diarrhea, reflex hypotension, and worsening of abdominal pain) that resolved within 48 hours. For pancreatic cancer patients, EUS-CPN can effectively control pain with minimal adverse effects.