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Background/aims: Recently, single-incision laparoscopic colectomy (SILC) for colorectal malignancy is rapidly becoming the central issue for explorers of minimally invasive surgery worldwide. The aim of this systematic review was to establish the safety and efficacy of SILC for colorectal malignancy when implemented by experienced surgeons., Methodology: PubMed, WHO international trial register and Embase were searched for publications concerning SILC and MLC from 2000 to 2013, with the last search on September 10, 2013. Only pure single-incision laparoscopic colonic surgery for malignant disease was included. Primary outcomes were the early postoperative complication profiles of SILC. Secondary outcomes were duration of operation time, blood loss, lymph node yields, conversion rate, distal margin of the resected tumor, and duration of hospital stay., Results: Eight studies involving 547 patients met the inclusion criteria. Compared with multiport laparoscopic colectomy (MLC), SILC has less postoperative complication and bleeding. The conversion, the median lymph node retrieval, proximal margin of the resected tumor and distal margin of the resected tumor for malignant disease achieved with SILC was acceptable. There was no significant reduction in length of hospital stay with SILC., Conclusion: SILC is a technically reliable and realistic approach with short-term results similar to those obtained with the MLC procedure.

Background/aims: Bariatric surgery has become the best option for the treatment for morbid obesity. It is not only a weight-reducing surgery but also a metabolic surgery. This study examined the short-term results undergoing LRYGB and LSG of bariatric surgery., Methodology: Studies and relevant literatures regarding the formation of LRYGB vs. LSG for morbid obesity or diabetes were searched through PubMed and Embase. The resolution of diabetes mellitus, resolution of hypertension and excess weight loss (EWL) in 12 months by LRYGB or LSG were pooled and compared using a meta-analysis. The odd ratios and mean differences were calculated with 95% confidence intervals to evaluate the influence of LRYGB., Results: Sixteen recent studies including 2758 patients in total were included in this meta-analysis. These studies demonstrated that compared with LSG, LRYGB had the better effect in resolving diabetes mellitus and excess weight loss at 12 months, had a similar effect in resolving hypertension (pooled OR of 2.46 (95% CI: 1.48-4.09, p<0.00001), pooled OR of 0.81 (95% CI: 0.57-1.16, p>0.005), pooled mean difference of 8.27 (95% CI: 6.89-9.66, p<0.00001), respectively)., Conclusions: In bariatric surgery, LRYGB is a more effective and reliable treatment for morbid obesity and for surgical treatment of poorly controlled T2DM. More large, prospective, controlled, randomized trials should be conducted to further compare the efficacy and safety of this approach.

Background/aims: The necessity of a defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer remains controversial. This meta-analysis evaluates the advantages of prophylactic stomas in patients undergoing low anterior resection and assesses postoperative outcomes of patients with or without a defunctioning stoma., Methodology: Studies and relevant literatures regarding the formation of defunctioning stomas after low anterior resection were searched through PubMed and Embase. The rates of anastomotic leakage and re-operation related to leakage with or without defunctioning stoma were pooled and compared using a meta-analysis. The risk ratios were calculated with 95% confidence intervals to evaluate the influence of defunctioning stomas., Results: Five recent studies including 878 patients in total were included in this meta-analysis. These studies demonstrated that defunctioning stomas significantly reduced the rate of postoperative anastomotic leakage and reoperation after low anterior resection, the pooled risk ratio was 0.34 (95% CI=0.22-0.53, p<0.00001) and 0.27 (95% CI=0.16-0.48, p<0.00001), respectively., Conclusions: Defunctioning stomas can be useful to minimize the rate of anastomotic leakage and re-operation related to leakage. Furthermore, anorectal function was not affected. However, the influence of a defunctioning stoma on long-term mortality and the quality of life in patients treated for rectal cancer is inconclusive.

Objective: To investigate the safety and feasibility of laparoscopic D2 gastrectomy for advanced gastric cancer., Methods: The clinical data of 210 cases of laparoscopic gastrectomy and 180 cases of open gastrectomy for radical (D2) gastrectomy from May 2007 to Dec 2010 were analyzed retrospectively., Results: A total of 206 cases underwent laparoscopic-assisted surgery with 4 conversions. Compared to the open group, the laparoscopic group was associated with less bleeding [(208±38) ml vs. (300±52) ml, P<0.05], quicker postoperative recovery of bowel function [(2.9±0.7) d vs. (3.9±1.8) d, P<0.05], shorter postoperative length of hospital stay[(12.8±6.2) d vs. (15.6±6.8) d, P<0.05], longer operative time [(258±42) min vs. (193±30) min, P<0.05]. The number of lymph node harvested was 20.5±1.9 in the laparoscopic group and 25.8±1.5 in the open group, and the postoperative complication rate was 8.1% (17/201) vs. 8.5% (15/180), and differences were not statistically significant (both P>0.05). The recurrence rate was 2.9% (6/210) and 2.8% (5/180), and the 3-year overall survival rate was 35.6% and 37.8%, the differences were not statistically significant (both P>0.05)., Conclusions: Laparoscopic radical gastrectomy for gastric cancer is safe and effective, which can reach the same range of lymph node dissection as open gastric cancer surgery and similar survival rate.

Background/aims: Single-incision laparoscopic colectomy (SILC) is rapidly becoming the focal point of attraction for early adopters of minimally invasive surgery worldwide. The aim of this study was to compare SILC with multiport laparoscopic colectomy (MLC) when implemented by experienced laparoscopic surgeons., Methodology: Studies and relevant literature regarding the formation of SILC vs. MLC were searched though PubMed and Embase. The volume of bleeding, the rates of conversion /adding trocars and morbidities by using single-incision laparoscopic surgery or multiport laparoscopic surgery were pooled and compared using a meta-analysis. The risk ratios and mean different were calculated with 95% confidence intervals to evaluate the influence of SILC., Results: Eleven recent studies including 800 patients in total were included in this meta-analysis. These studies demonstrated that compared to MLC, SILC has the advantage of less bleeding, higher rates of conversion and has similar morbidities. Pooled mean difference of -29.9 (95% CI: -47.05-(-12.74); p<0.001), a pooled RR of 2.04 (95% CI: 1.24-3.36; p<0.01) and a pooled RR of 0.94 (0.72-1.21; p>0.05), respectively., Conclusions: SILC is a technically realistic and reliable approach with short-term results similar to those obtained with the MLC procedure. More large, prospective, randomized, controlled trials should be conducted to further compare the safety and efficacy of this approach.