Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these p...Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these patients.Of late,various recurrence patterns have been observed;the most common of them being distant metastasis followed by the pancreatic bed and lymph node recurrence.Recurrence in the remnant pancreas is on the rise due to improved survival in patients who previously underwent surgery for pancreatic cancer.Total remnant pancreatectomy is an appealing option in resectable remnant pancreatic carcinoma without distant metastasis.It is an entity showing an increasing incidence and demanding further in-depth studies to elucidate the exact pathological mechanism and to establish appropriate management protocols.展开更多
Applying indocyanine green(ICG)fluorescence in surgery has created a new dimension of navigation surgery to advance in various disciplines.The research in this field is nascent and fragmented,necessitating academic ef...Applying indocyanine green(ICG)fluorescence in surgery has created a new dimension of navigation surgery to advance in various disciplines.The research in this field is nascent and fragmented,necessitating academic efforts to gain a comprehensive understanding.The present review aims to integrate diverse perspectives and recent advances in its application in gastrointestinal surgery.The relevant articles were selected by using the appropriate keyword search in PubMed.The angiography and cholangiography property of ICG fluorescence is helpful in various hepatobiliary disorders.In gastroesophageal and colorectal surgery,the lymphangiography and angiography property of ICG is applied to evaluate bowel vascularity and guide lymphadenectomy.The lack of objective parameters to assess ICG fluorescence has been the primary limitation when ICG is used to evaluate bowel perfusion.The optimum dose and timing of ICG administration need to be standardized in some new application areas in gastrointestinal surgery.Binding tumor-specific ligands with fluorophores can potentially widen the fluorescence application to detect primary and metastatic gastrointestinal tumors.The narrative review outlines prior contributions,limitations,and research opportunities for future studies across gastrointestinal sub-specialty.The findings of the present review would be helpful for scholars and practitioners to explore and progress in this exciting domain of gastrointestinal surgery.展开更多
Postcholecystectomy bile duct injury(BDI)remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs.Despite a decrease in the incidence of laparoscopic cholecys...Postcholecystectomy bile duct injury(BDI)remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs.Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI,the absolute number remains high as cholecystectomy is a commonly performed surgical procedure.Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent longterm results in most patients.As with many hepatobiliary disorders,a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery.Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy,laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive.While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management,most are retrospective analyses with small sample sizes.Also,long-term follow-up is avail-able only in a limited number of studies.The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches.The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture.Despite increasing use,lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture.High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.展开更多
文摘Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these patients.Of late,various recurrence patterns have been observed;the most common of them being distant metastasis followed by the pancreatic bed and lymph node recurrence.Recurrence in the remnant pancreas is on the rise due to improved survival in patients who previously underwent surgery for pancreatic cancer.Total remnant pancreatectomy is an appealing option in resectable remnant pancreatic carcinoma without distant metastasis.It is an entity showing an increasing incidence and demanding further in-depth studies to elucidate the exact pathological mechanism and to establish appropriate management protocols.
文摘Applying indocyanine green(ICG)fluorescence in surgery has created a new dimension of navigation surgery to advance in various disciplines.The research in this field is nascent and fragmented,necessitating academic efforts to gain a comprehensive understanding.The present review aims to integrate diverse perspectives and recent advances in its application in gastrointestinal surgery.The relevant articles were selected by using the appropriate keyword search in PubMed.The angiography and cholangiography property of ICG fluorescence is helpful in various hepatobiliary disorders.In gastroesophageal and colorectal surgery,the lymphangiography and angiography property of ICG is applied to evaluate bowel vascularity and guide lymphadenectomy.The lack of objective parameters to assess ICG fluorescence has been the primary limitation when ICG is used to evaluate bowel perfusion.The optimum dose and timing of ICG administration need to be standardized in some new application areas in gastrointestinal surgery.Binding tumor-specific ligands with fluorophores can potentially widen the fluorescence application to detect primary and metastatic gastrointestinal tumors.The narrative review outlines prior contributions,limitations,and research opportunities for future studies across gastrointestinal sub-specialty.The findings of the present review would be helpful for scholars and practitioners to explore and progress in this exciting domain of gastrointestinal surgery.
文摘Postcholecystectomy bile duct injury(BDI)remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs.Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI,the absolute number remains high as cholecystectomy is a commonly performed surgical procedure.Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent longterm results in most patients.As with many hepatobiliary disorders,a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery.Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy,laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive.While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management,most are retrospective analyses with small sample sizes.Also,long-term follow-up is avail-able only in a limited number of studies.The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches.The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture.Despite increasing use,lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture.High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.
