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
BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anast...BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anastomosis are two relatively mature anti-reflux procedures.A comparison of these two surgical procedures,tubular gastroesophageal anastomosis and double-channel anastomosis,has rarely been reported.Therefore,this study aimed to investigate the effects of these two reconstruction methods on the quality of life of patients with proximal gastric cancer after proximal gastrectomy.AIM To compare short-term clinical results of laparoscopic proximal gastrectomy with double-channel anastomosis vs tubular gastric anastomosis.METHODS Patients who underwent proximal gastrectomy at our hospital between January 2020 and January 2023 were enrolled in this retrospective cohort study.The patients were divided into an experimental group(double-channel anastomosis,33 cases)and a control group(tubular gastric anastomosis,30 cases).Baseline characteristics,surgical data,postoperative morbidities,and postoperative nutrition were recorded.RESULTS The differences in baseline data,surgical data,and postoperative complications(20.0%vs 21.2%)were not statistically significant between the two groups.There were no statistically significant differences in the levels of postoperative nutrition indicators between the two groups of patients during the preoperative period and at 3 months postoperatively.In addition,the levels of postoperative nutrition indicators in patients in the experimental group declined significantly less at 6 months and 12 months postoperatively compared with those of the control group(P<0.05).At 12 months postoperatively,the difference in anastomotic reflux esophagitis between the two groups was statistically significant(P<0.05)with the experimental group showing less reflux esophagitis.CONCLUSION Both double-channel anastomosis and tubular gastric anastomosis after proximal gastrectomy are safe and feasible.Double-channel anastomosis has a better anti-reflux effect and is more beneficial in improving the postoperative nutritional status.展开更多
BACKGROUND Magnetic compression anastomosis(MCA)offers a simple and reliable technique for inducing anastomoses at any point along the digestive tract.Evidence regarding whether the design of the MCA device influences...BACKGROUND Magnetic compression anastomosis(MCA)offers a simple and reliable technique for inducing anastomoses at any point along the digestive tract.Evidence regarding whether the design of the MCA device influences the anastomosis effect is lacking.AIM To investigate any difference in the side-to-side colonic anastomosis effect achieved with cylindrical vs circular ring magnets.METHODS We designed cylindrical and circular ring magnets suitable for side-to-side colonic anastomosis in rats.Thirty Sprague-Dawley rats were randomly divided into a cylindrical group,circular ring group,and cylindrical–circular ring group(n=10/group).Side-to-side colonic anastomosis was completed by transanal insertion of the magnets without incision of the colon.Operation time,perioperative complications,and magnet discharge time were recorded.Rats were euthanized 4 weeks postoperatively,and anastomotic specimens were obtained.The burst pressure and anastomotic diameter were measured sequentially,and anastomosis formation was observed by naked eye.Histological results were observed by light microscopy.RESULTS In all 30 rats,side-to-side colonic anastomosis was completed,for an operation success rate of 100%.No postoperative complications of bleeding and intestinal obstruction occurred,and the postoperative survival rate were 100%.The operation time,magnet discharge time,anastomotic bursting pressure,and anastomotic diameter did not differ significantly among the three designs(P>0.05).Healing was similar across the groups,with gross specimens showing good anastomotic healing and good mucosal continuity observed on histological analysis.CONCLUSION This study found no significant difference in the establishment of rat side-to-side colonic anastomosis with the use of cylindrical vs circular ring magnets.展开更多
BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in p...BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in patients undergoing this procedure.AIM To identify the most effective method for reducing reflux symptoms while preserving gastrointestinal integrity and nutritional status.METHODS A retrospective evaluation was conducted on 60 patients who underwent proximal gastrectomy between December 2020 and December 2023,divided equally into two groups based on the anastomosis technique used(forearm or posterior wall).GER symptoms were assessed using the GER disease ques-tionnaire(GerdQ)preoperatively and on the first postoperative day.Biochemical markers[diamine oxidase(DAO),D-lactic acid,and endotoxin(ETX)]and nutritional indicators[serum ferritin(SF),prealbumin(PA),and albumin(ALB)]were measured to evaluate gastrointestinal barrier function and nutritional status.RESULTS Both groups showed significant improvements in GerdQ scores and reflux symptom scores post-treatment,with the observation group exhibiting greater reductions.Biochemical markers indicated enhanced gastrointestinal barrier function post-treatment in both groups,with notable increases in DAO,D-lactic,and ETX levels.Nutritional status indicators also demonstrated significant changes,with reductions in SF,PA,and ALB levels,suggesting an impact of treatment on inflammatory and nutritional status.CONCLUSION The forearm anastomosis technique appears to be more effective in reducing GER symptoms and preserving gastrointestinal health in patients undergoing proximal gastrectomy for gastric cancer compared to the posterior wall anastomosis technique.These preliminary findings advocate for further research to confirm the benefits and potentially standardize Forearm Anastomosis in surgical practice for gastric cancer.展开更多
BACKGROUND At present,the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent,to explore the efficacy of laparoscopic jejunoileal side to side anastomosis ...BACKGROUND At present,the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent,to explore the efficacy of laparoscopic jejunoileal side to side anastomosis in the treatment of type 2 diabetes,the report is as follows.AIM To investigate the effect of jejunoileal side-to-side anastomosis on metabolic parameters in patients with type 2 diabetes mellitus(T2DM).METHODS We retrospectively analyzed the clinical data of 78 patients with T2DM who were treated via jejunoileal lateral anastomosis.Metabolic indicators were collected preoperatively,as well as at 3 and 6 months postoperative.The metabolic indicators analyzed included body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),2-hour blood glucose(PBG),glycated hemoglobin(HbA1c),fasting C-peptide,2-hour C-peptide(PCP),fasting insulin(Fins),2-hour insulin(Pins),insulin resistance index(HOMA-IR),βCellular function index(HOMA-β),alanine aminotransferase,aspartate aminotransferase,serum total cholesterol(TC),low-density lipoprotein cholesterol(L DL-C),triglycerides(TG),high-density lipoprotein,and uric acid(UA)levels.RESULTS SBP,DBP,PBG,HbA1c,LDL-C,and TG were all significantly lower 3 months postoperative vs preoperative values;body weight,BMI,SBP,DBP,FBG,PBG,HbA1c,TC,TG,UA,and HOMA-IR values were all significantly lower 6 months postoperative vs at 3 months;and PCP,Fins,Pins,and HOMA-βwere all significantly higher 6 months postoperative vs at 3 months(all P<0.05).CONCLUSION Side-to-side anastomosis of the jejunum and ileum can effectively treat T2DM and improve the metabolic index levels associated with it.展开更多
Objective Female sterilization is a common contraceptive method,but with changing family dynamics,an increasing number of women seek to restore fertility after tubal sterilization.Current clinical practice lacks effec...Objective Female sterilization is a common contraceptive method,but with changing family dynamics,an increasing number of women seek to restore fertility after tubal sterilization.Current clinical practice lacks effective tools for predicting pregnancy rates in this population after tubal anastomosis.This study aims to develop and internally validate a novel nomogram for predicting the pregnancy rate in women with tubal ligation after tubal anastomosis.Methods We developed a prediction model based on a training dataset of 208 patients with tubal ligation after undergoing tubal anastomosis between January 2012 and August 2020 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The follow-up period for all patients was one year postsurgery,during which pregnancy outcomes were recorded.The LASSO regression model was used to optimize feature selection for the pregnancy rate risk model.The performance of the nomogram was assessed for its calibration,discrimination,and clinical usefulness.Internal validation was assessed.Results Predictors included in the prediction nomogram were age,type of anastomosis,sterilization duration,time of conception,and anti-Mullerian hormone(AMH)levels.The model displayed good discrimination,with a C-index of 0.924(95%CI:0.876–0.971),and good calibration.A high C-index value of 0.879 was still reached in the interval validation.Decision curve analysis revealed that the pregnancy rate nomogram was clinically useful when intervention was selected at the pregnancy rate possibility threshold of 1%.Conclusion This novel pregnancy rate nomogram incorporating age,type of anastomosis,sterilization duration,time of conception,and AMH could be conveniently used to predict the pregnancy rate in women with tubal ligation after tubal anastomosis.展开更多
BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migr...BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migration near the esophagojejunal anastomosis(EJA),resulting in persistent drainage and mimicking EJAL after total gastrectomy.CASE SUMMARY A 64-year-old male underwent open total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma,with two silicone drains placed near the EJA.On postoperative day(POD)4,the patient developed signs of peritonitis and sepsis,necessitating surgical re-exploration abscess drainage,peritoneal lavage,and drain repositioning.A contrast swallow study on POD 18 revealed rapid filling of the abdominal drain without extraluminal contrast collection.Persistent drainage prompted an upper gastrointestinal endoscopy on POD 59,which revealed approximately 5 cm of the drain within the esophagus,with the perforation site located 2 cm distal to the intact EJA.The drain was repositioned under endoscopic guidance.A repeat contrast radiograph on POD 67 demonstrated no evidence of extraluminal contrast extravasation or filling of the abdominal drain.The patient was subsequently discharged without further incident.CONCLUSION Intraluminal drain migration is a rare complication following gastric surgery but should be considered when persistent drainage occurs.展开更多
BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic flu...BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic fluid accumulation in the abdominal cavity,it is particularly rare.Following laparoscopic total gastrectomy and Roux-en-Y anastomosis,the incidence of this condition is exceedingly low.CASE SUMMARY A 62-year-old male patient developed Petersen’s hernia following laparoscopic total gastrectomy(LTG)for gastric cancer,after Roux-en-Y anastomosis.Intestinal torsion and obstruction were experienced by the patient,along with a small amount of chylous ascites.Imaging studies and clinical assessment confirmed the diagnosis.Emergency surgery was performed promptly for the patient in the operating room.The twisted small intestine was reduced and the defect in Petersen’s space was repaired.The procedure was successful in the correction of the intestinal torsion and approximation of the hernia without the need for bowel resection.The patient’s condition significantly improved following the surgery.The ascites evolved from a milky white appearance to a pale yellow,with a substantial decrease in the triglyceride levels in the ascitic fluid,implying a favorable recovery trajectory.The patient was monitored closely and received appropriate care postoperatively,including nutritional support and fluid management.CONCLUSION This report illustrates the significance of recognizing Petersen’s hernia as a potential complication following gastrectomy for gastric cancer.It highlights the fundamental role of early surgical intervention in the effective management of such complications.The favorable outcome in this patient illustrates that prompt and appropriate surgical management can deter the necessity for more extensive procedures such as bowel resection.展开更多
In this article,we comment on an article by Wang et al published in the World Journal of Diabetes.Existing treatments with oral medications can partially mitigate the toxicity of elevated blood glucose levels in patie...In this article,we comment on an article by Wang et al published in the World Journal of Diabetes.Existing treatments with oral medications can partially mitigate the toxicity of elevated blood glucose levels in patients with type 2 diabetes mellitus.However,these patients often require lifelong,costly medications,and many struggle with poor compliance.To address the limitations of pharmacological treatments,laparoscopic jejunal-ileal lateral anastomosis has become increasingly common in clinical practice and generally yields favorable outcomes.This procedure stimulates the secretion of larger amounts of glucagon-like peptide-1 by intestinal L cells,which in turn promotes pancreatic islet cell proliferation,reduces insulin resistance,and effectively controls glucose and lipid metabolism disorders.Nonetheless,further research is needed to fully explore its indications,contraindications,the enhancement of patients'quality of life and patients’satisfaction with the subjective experience of treatment and long-term effects.展开更多
BACKGROUND Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis.AIM To identify potential risk factors for the development of ch...BACKGROUND Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis.AIM To identify potential risk factors for the development of chronic pouchitis.METHODS Predictors of chronic pouchitis were investigated through a systematic review and meta-analysis.A comprehensive search of the Medline,EMBASE,and PubMed databases was undertaken to identify relevant studies published up to October 2023.Meta-analytic procedures employed random-effects models for the combination of estimates,with the I^(2)statistic used to assess between-study heterogeneity.RESULTS Eleven studies with a total of 3722 patients,comprising 513 with chronic pouchitis and 3209 patients without,were included in the final analysis.Extraintestinal manifestation[odds ratio(OR)=2.11,95%confidence intervals(CI):1.53-2.91,P<0.001,I^(2)=0%],specifically primary sclerosing cholangitis(PSC)(OR=3.69,95%CI:1.40-9.21,P=0.01,I2=48%),and extensive colitis(OR=1.96,95%CI:1.23-3.11,P=0.00,I^(2)=31%)were associated with an increased risk of chronic pouchitis.Other factors,including gender,smoking status,family history of inflammatory bowel disease and ileal pouch anal anastomosis surgical indication were not significantly associated with chronic pouchitis.CONCLUSION Extraintestinal manifestations,PSC and extensive colitis are associated with the development of chronic pouchitis.These findings underscore the importance of comprehensive pre-operative assessment and tailored post operative management strategies.展开更多
In this editorial,I discuss the article by Wang et al,published in the World Journal of Diabetes,which explores jejunoileal side-to-side anastomosis as a novel surgical intervention for type 2 diabetes mellitus(T2DM)....In this editorial,I discuss the article by Wang et al,published in the World Journal of Diabetes,which explores jejunoileal side-to-side anastomosis as a novel surgical intervention for type 2 diabetes mellitus(T2DM).T2DM,often associated with obesity,remains a global health challenge,as sustained remission is difficult to achieve with conventional pharmacological therapy.Jejunoileal anastomosis offers a promising alternative,particularly for patients with normal or relatively high body mass index,and addresses the unique challenges posed by diverse patient populations.This procedure preserves gastric anatomy while simultaneously improving metabolic parameters,such as glycemic control,lipid profiles,and pancreaticβ-cell function.Unlike traditional metabolic surgeries that involve permanent anatomical alterations,this approach provides advantages such as reversibility,shorter operative times,and minimal nutritional complications,making it appealing to patients for whom conventional bariatric surgery is unsuitable.Advances in gut hormone physiology and incretin modulation support these findings.This innovative approach represents a potential paradigm shift in T2DM treatment,offering insights into the evolving role of surgical interventions in metabolic regulation.While early findings show promising diabetes remission rates and metabolic improvements at six months post-surgery,further studies with longer follow-up periods and broader patient cohorts are required.展开更多
BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestina...BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestinal(UGI)swallow studies to detect complications following OAGB has been questioned.AIM To evaluate the effectiveness and cost-efficiency of performing routine UGI studies on the first postoperative day(POD)after OAGB.METHODS A retrospective cohort analysis of a prospectively collected database was conducted to identify all consecutive patients who underwent OAGB between January 2019 and July 2022.Patient demographics,operative data,and postoperative complication rates were analyzed.Reports from all imaging studies were retrospectively reviewed,and complications were recorded.The institutional review board waived the requirement for informed consent.RESULTS A total of 385 patients were included.All patients had an iodine-based contrast swallow study on the first POD.Abnormal findings were observed in 4 patients(1%),none of which were correlated with postoperative complications.Two patients(0.5%)required reoperation due to complications although both had normal UGI study results.Sensitivity and positive predictive value of UGI studies for detecting complications were 0%,while specificity and negative predictive value were 99%and 98%,respectively.Based on hospital charges the overall cost of all the UGI swallow studies performed in our study was 95865 USD.CONCLUSION The study findings showed that performing routine UGI swallow studies on the first POD after laparoscopic OAGB is ineffective in detecting complications and is not cost effective.Normal UGI studies might mislead clinicians in the postoperative period and thus should be omitted in favor of close clinical monitoring.展开更多
BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-ter...BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-term efficacy of these two procedures is scarce.As such,a meta-analysis comparing OAGB and SG in terms of diabetes remission(DR)and percentage of excess weight loss(EWL)is warranted.AIM To compare OAGB and SG in terms of DR and EWL%in the medium term.METHODS A comprehensive literature search was conducted in PubMed/MEDLINE,Cochran Library,and Web of Science for relevant articles,from inception through April 2025,using the keywords“one-anastomosis gastric bypass”,“sleeve gastrectomy”,“mini-gastric bypass”,“diabetes remission”,“one-anastomosis”,and“excess weight loss”.Clinical trials,prospective,retrospective and case-control studies were included;cross-sectional studies,case reports,editorials,and opinions were excluded.The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used to assess the quality of included studies,and RevMan version 5.4 was used for data analyses.RESULTS A total of 1360 articles were identified,and 35 studies were retrieved of which 32 were included in the final analysis.Three full texts were excluded as they did not include data on DR or EWL%.OAGB achieved higher DR than SG at 1 year following surgery[odds ratio(OR)=1.77,95%confidence interval(CI):1.22-2.57,I^(2)=76%].However,DR rates were similar at 3 years and 5 years following surgery(OR=0.82,95%CI:0.61-1.10,I^(2)=23%and OR=0.92,95%CI:0.31-2.72,I^(2)=75%,respectively).OAGB showed higher EWL%at 1 year(OR=9.30,95%CI:6.45-12.15,I^(2)=91%),3 years(OR=10.02,95%CI:9.40-10.64,I^(2)=22%),and 5 years(OR=11.61,95%CI:3.74-19.48,I^(2)=97%).OAGB showed higher late complications than adjustable SG.The results were not different in sub-group analysis including only clinical trials,observational studies,and removing studies including super-obese patients and studies contributing most to heterogeneity.CONCLUSION In the medium term,DR rates were similar between OAGB and SG;however,OAGB showed higher EWL%than SG,and late complications were higher in OAGB.Clinical trials investigating the predictors of DR and EWL%are recommended.展开更多
Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedem...Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedema,typically in the limbs,to decompress blocked lymphatic drainage pathways.展开更多
Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced...Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced secretion of glucagon-like peptide-1.This surgical procedure alters the direction of nutrient flow,activates distal ileal L cells,and increases endogenous glucagon-like peptide-1 levels,supporting glucose homeostasis,enhancing insulin sensitivity,regulating body weight,and improving cardiovascular health.This structural adjustment transforms the gastrointestinal tract into an active endocrine regulatory organ,providing a pathway for metabolic improvement in patients with T2DM and other complex metabolic disorders.Although this procedure demonstrates significant metabolic improvements within 3-6 months after surgery,integrating hormone level measurements,metabolic marker analysis,and long-term follow-up has become crucial for exploring the complex mechanisms of T2DM in the field of metabolic surgery and T2DM management.Multidisciplinary collaboration involving support from endocrinology,nutrition,and rehabilitation teams before and after surgery is becoming increasingly vital in the long-term management of patients with T2DM.This collaboration optimizes surgical outcomes and enhances metabolic management.Side-to-side anastomosis shows potential in the multitarget metabolic management of T2DM,providing an additional intervention option for patients with T2DM and metabolic disorders.展开更多
BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques.However,research on its application for small bowel stoma reversal in patients with Crohn's disease(CD)is limited.T...BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques.However,research on its application for small bowel stoma reversal in patients with Crohn's disease(CD)is limited.Therefore,in this study,we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal(LIIR)and open ileostomy reversal(OIR).AIM To compare the safety,feasibility,bowel function recovery,and short-and longterm LIIR and OIR outcomes in patients with CD.METHODS This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution.The baseline data,postoperative recovery,and complication indicators were retrospectively analyzed.Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.RESULTS Notably,15 of the 45 patients in this study underwent OIR,and the remaining 30 received LIIR.Notably,no statistically significant differences were found between the two groups regarding clinical baseline characteristics,operation time,intraoperative hemorrhage,anastomotic site,enterolysis range,first postoperative flatus,postoperative complications,reoperation rate,or incidence of postoperative enteral nutrition intolerance.Compared with the OIR group,the LIIR group had a shorter postoperative hospital stay(P=0.045),lower incidence of enteral nutrition intolerance symptoms(P=0.019),and earlier postoperative total enteral nutrition initiation(P=0.033);however,it incurred higher total hospital costs(P=0.038).Furthermore,multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance(P<0.05).CONCLUSION Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible.Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.展开更多
In this editorial,we comment on an article by Liu et al.We focus specifically on the novel use of laparoscopic intracorporeal anastomosis(LIA)compared with open ileostomy reversal in patients with Crohn’s disease(CD)...In this editorial,we comment on an article by Liu et al.We focus specifically on the novel use of laparoscopic intracorporeal anastomosis(LIA)compared with open ileostomy reversal in patients with Crohn’s disease(CD),which is an innovative approach for improving postoperative outcomes and accelerating recovery in ileostomy reversal procedures.This study also highlights the limitations of the conventional open surgical technique,which is associated with higher rates of feeding intolerance,prolonged hospital stays,and delayed initiation of enteral nutrition.The chronic and recurrent nature of CD and the challenges posed by traditional surgical methods are issues addressed by LIA,which offers a minimally invasive approach that reduces surgical trauma,shortens recovery time,and improves tolerance to enteral nutrition,thereby enhancing postoperative outcomes.However,while LIA shows great promise,further prospective multicenter trials are needed to validate these findings and assess their broader application in other surgical scenarios.Overall,LIA represents a significant advancement in minimally invasive surgery for CD and has the potential to become the preferred standard approach for ileostomy reversal in patients requiring bowel reanastomosis.展开更多
Objective: To evaluate the clinical value of intrathoracic esophagogastric "layer-to-layer" anastomosis with esophageal mucosa extended varied in plane and to study the effective methods to prevent anastomot...Objective: To evaluate the clinical value of intrathoracic esophagogastric "layer-to-layer" anastomosis with esophageal mucosa extended varied in plane and to study the effective methods to prevent anastomotic leaking or stricture postoperatively. Methods: From May 1985 to December 2002, 2 240 esophageal and stomach cardia cancer patients treated by intrathoracic esophagogastric "layer-to-layer" anastomosis with esophageal mucosa extended varied in plane were retrospectively analyzed. Results: There was no anastomotic leaking and severe stricture in all above cases. Conclusion: Intrathoracic esophagogastric "layer-to-layer" anastomosis with esophageal mucosal extended varied in plane is an effective method to prevent anastomotic leaking and stricture postoperatively.展开更多
To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or per...To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or performing a stapled or hand-sewn anastomosis.Among the least studied is the configuration of the two stumps(i.e.,isoperistaltic or antiperistaltic)in the case of a side-to-side anastomosis.The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature.High-quality literature is scarce,with only three studies directly comparing the two alternatives,and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage,stenosis,or bleeding.However,there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis.Finally,existing data do not identify a certain anastomotic configuration(i.e.,isoperistaltic or antiperistaltic)as superior over the other.Thus,the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.展开更多
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.
基金Supported by the“521 Project”Funding Project Day of Lianyungang。
文摘BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anastomosis are two relatively mature anti-reflux procedures.A comparison of these two surgical procedures,tubular gastroesophageal anastomosis and double-channel anastomosis,has rarely been reported.Therefore,this study aimed to investigate the effects of these two reconstruction methods on the quality of life of patients with proximal gastric cancer after proximal gastrectomy.AIM To compare short-term clinical results of laparoscopic proximal gastrectomy with double-channel anastomosis vs tubular gastric anastomosis.METHODS Patients who underwent proximal gastrectomy at our hospital between January 2020 and January 2023 were enrolled in this retrospective cohort study.The patients were divided into an experimental group(double-channel anastomosis,33 cases)and a control group(tubular gastric anastomosis,30 cases).Baseline characteristics,surgical data,postoperative morbidities,and postoperative nutrition were recorded.RESULTS The differences in baseline data,surgical data,and postoperative complications(20.0%vs 21.2%)were not statistically significant between the two groups.There were no statistically significant differences in the levels of postoperative nutrition indicators between the two groups of patients during the preoperative period and at 3 months postoperatively.In addition,the levels of postoperative nutrition indicators in patients in the experimental group declined significantly less at 6 months and 12 months postoperatively compared with those of the control group(P<0.05).At 12 months postoperatively,the difference in anastomotic reflux esophagitis between the two groups was statistically significant(P<0.05)with the experimental group showing less reflux esophagitis.CONCLUSION Both double-channel anastomosis and tubular gastric anastomosis after proximal gastrectomy are safe and feasible.Double-channel anastomosis has a better anti-reflux effect and is more beneficial in improving the postoperative nutritional status.
基金Supported by the Key Research and Development Program of Shaanxi,No.2024SF-YBXM-447the Institutional Foundation of The First Affiliated Hospital of Xi’an Jiaotong University,No.2022MS-07the Fundamental Research Funds for the Central Universities,No.xzy022023068.
文摘BACKGROUND Magnetic compression anastomosis(MCA)offers a simple and reliable technique for inducing anastomoses at any point along the digestive tract.Evidence regarding whether the design of the MCA device influences the anastomosis effect is lacking.AIM To investigate any difference in the side-to-side colonic anastomosis effect achieved with cylindrical vs circular ring magnets.METHODS We designed cylindrical and circular ring magnets suitable for side-to-side colonic anastomosis in rats.Thirty Sprague-Dawley rats were randomly divided into a cylindrical group,circular ring group,and cylindrical–circular ring group(n=10/group).Side-to-side colonic anastomosis was completed by transanal insertion of the magnets without incision of the colon.Operation time,perioperative complications,and magnet discharge time were recorded.Rats were euthanized 4 weeks postoperatively,and anastomotic specimens were obtained.The burst pressure and anastomotic diameter were measured sequentially,and anastomosis formation was observed by naked eye.Histological results were observed by light microscopy.RESULTS In all 30 rats,side-to-side colonic anastomosis was completed,for an operation success rate of 100%.No postoperative complications of bleeding and intestinal obstruction occurred,and the postoperative survival rate were 100%.The operation time,magnet discharge time,anastomotic bursting pressure,and anastomotic diameter did not differ significantly among the three designs(P>0.05).Healing was similar across the groups,with gross specimens showing good anastomotic healing and good mucosal continuity observed on histological analysis.CONCLUSION This study found no significant difference in the establishment of rat side-to-side colonic anastomosis with the use of cylindrical vs circular ring magnets.
文摘BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in patients undergoing this procedure.AIM To identify the most effective method for reducing reflux symptoms while preserving gastrointestinal integrity and nutritional status.METHODS A retrospective evaluation was conducted on 60 patients who underwent proximal gastrectomy between December 2020 and December 2023,divided equally into two groups based on the anastomosis technique used(forearm or posterior wall).GER symptoms were assessed using the GER disease ques-tionnaire(GerdQ)preoperatively and on the first postoperative day.Biochemical markers[diamine oxidase(DAO),D-lactic acid,and endotoxin(ETX)]and nutritional indicators[serum ferritin(SF),prealbumin(PA),and albumin(ALB)]were measured to evaluate gastrointestinal barrier function and nutritional status.RESULTS Both groups showed significant improvements in GerdQ scores and reflux symptom scores post-treatment,with the observation group exhibiting greater reductions.Biochemical markers indicated enhanced gastrointestinal barrier function post-treatment in both groups,with notable increases in DAO,D-lactic,and ETX levels.Nutritional status indicators also demonstrated significant changes,with reductions in SF,PA,and ALB levels,suggesting an impact of treatment on inflammatory and nutritional status.CONCLUSION The forearm anastomosis technique appears to be more effective in reducing GER symptoms and preserving gastrointestinal health in patients undergoing proximal gastrectomy for gastric cancer compared to the posterior wall anastomosis technique.These preliminary findings advocate for further research to confirm the benefits and potentially standardize Forearm Anastomosis in surgical practice for gastric cancer.
文摘BACKGROUND At present,the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent,to explore the efficacy of laparoscopic jejunoileal side to side anastomosis in the treatment of type 2 diabetes,the report is as follows.AIM To investigate the effect of jejunoileal side-to-side anastomosis on metabolic parameters in patients with type 2 diabetes mellitus(T2DM).METHODS We retrospectively analyzed the clinical data of 78 patients with T2DM who were treated via jejunoileal lateral anastomosis.Metabolic indicators were collected preoperatively,as well as at 3 and 6 months postoperative.The metabolic indicators analyzed included body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),2-hour blood glucose(PBG),glycated hemoglobin(HbA1c),fasting C-peptide,2-hour C-peptide(PCP),fasting insulin(Fins),2-hour insulin(Pins),insulin resistance index(HOMA-IR),βCellular function index(HOMA-β),alanine aminotransferase,aspartate aminotransferase,serum total cholesterol(TC),low-density lipoprotein cholesterol(L DL-C),triglycerides(TG),high-density lipoprotein,and uric acid(UA)levels.RESULTS SBP,DBP,PBG,HbA1c,LDL-C,and TG were all significantly lower 3 months postoperative vs preoperative values;body weight,BMI,SBP,DBP,FBG,PBG,HbA1c,TC,TG,UA,and HOMA-IR values were all significantly lower 6 months postoperative vs at 3 months;and PCP,Fins,Pins,and HOMA-βwere all significantly higher 6 months postoperative vs at 3 months(all P<0.05).CONCLUSION Side-to-side anastomosis of the jejunum and ileum can effectively treat T2DM and improve the metabolic index levels associated with it.
基金supported by the Zhejiang Provincial Health Science and Technology Project Fund (2024KY227).
文摘Objective Female sterilization is a common contraceptive method,but with changing family dynamics,an increasing number of women seek to restore fertility after tubal sterilization.Current clinical practice lacks effective tools for predicting pregnancy rates in this population after tubal anastomosis.This study aims to develop and internally validate a novel nomogram for predicting the pregnancy rate in women with tubal ligation after tubal anastomosis.Methods We developed a prediction model based on a training dataset of 208 patients with tubal ligation after undergoing tubal anastomosis between January 2012 and August 2020 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The follow-up period for all patients was one year postsurgery,during which pregnancy outcomes were recorded.The LASSO regression model was used to optimize feature selection for the pregnancy rate risk model.The performance of the nomogram was assessed for its calibration,discrimination,and clinical usefulness.Internal validation was assessed.Results Predictors included in the prediction nomogram were age,type of anastomosis,sterilization duration,time of conception,and anti-Mullerian hormone(AMH)levels.The model displayed good discrimination,with a C-index of 0.924(95%CI:0.876–0.971),and good calibration.A high C-index value of 0.879 was still reached in the interval validation.Decision curve analysis revealed that the pregnancy rate nomogram was clinically useful when intervention was selected at the pregnancy rate possibility threshold of 1%.Conclusion This novel pregnancy rate nomogram incorporating age,type of anastomosis,sterilization duration,time of conception,and AMH could be conveniently used to predict the pregnancy rate in women with tubal ligation after tubal anastomosis.
文摘BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migration near the esophagojejunal anastomosis(EJA),resulting in persistent drainage and mimicking EJAL after total gastrectomy.CASE SUMMARY A 64-year-old male underwent open total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma,with two silicone drains placed near the EJA.On postoperative day(POD)4,the patient developed signs of peritonitis and sepsis,necessitating surgical re-exploration abscess drainage,peritoneal lavage,and drain repositioning.A contrast swallow study on POD 18 revealed rapid filling of the abdominal drain without extraluminal contrast collection.Persistent drainage prompted an upper gastrointestinal endoscopy on POD 59,which revealed approximately 5 cm of the drain within the esophagus,with the perforation site located 2 cm distal to the intact EJA.The drain was repositioned under endoscopic guidance.A repeat contrast radiograph on POD 67 demonstrated no evidence of extraluminal contrast extravasation or filling of the abdominal drain.The patient was subsequently discharged without further incident.CONCLUSION Intraluminal drain migration is a rare complication following gastric surgery but should be considered when persistent drainage occurs.
文摘BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic fluid accumulation in the abdominal cavity,it is particularly rare.Following laparoscopic total gastrectomy and Roux-en-Y anastomosis,the incidence of this condition is exceedingly low.CASE SUMMARY A 62-year-old male patient developed Petersen’s hernia following laparoscopic total gastrectomy(LTG)for gastric cancer,after Roux-en-Y anastomosis.Intestinal torsion and obstruction were experienced by the patient,along with a small amount of chylous ascites.Imaging studies and clinical assessment confirmed the diagnosis.Emergency surgery was performed promptly for the patient in the operating room.The twisted small intestine was reduced and the defect in Petersen’s space was repaired.The procedure was successful in the correction of the intestinal torsion and approximation of the hernia without the need for bowel resection.The patient’s condition significantly improved following the surgery.The ascites evolved from a milky white appearance to a pale yellow,with a substantial decrease in the triglyceride levels in the ascitic fluid,implying a favorable recovery trajectory.The patient was monitored closely and received appropriate care postoperatively,including nutritional support and fluid management.CONCLUSION This report illustrates the significance of recognizing Petersen’s hernia as a potential complication following gastrectomy for gastric cancer.It highlights the fundamental role of early surgical intervention in the effective management of such complications.The favorable outcome in this patient illustrates that prompt and appropriate surgical management can deter the necessity for more extensive procedures such as bowel resection.
文摘In this article,we comment on an article by Wang et al published in the World Journal of Diabetes.Existing treatments with oral medications can partially mitigate the toxicity of elevated blood glucose levels in patients with type 2 diabetes mellitus.However,these patients often require lifelong,costly medications,and many struggle with poor compliance.To address the limitations of pharmacological treatments,laparoscopic jejunal-ileal lateral anastomosis has become increasingly common in clinical practice and generally yields favorable outcomes.This procedure stimulates the secretion of larger amounts of glucagon-like peptide-1 by intestinal L cells,which in turn promotes pancreatic islet cell proliferation,reduces insulin resistance,and effectively controls glucose and lipid metabolism disorders.Nonetheless,further research is needed to fully explore its indications,contraindications,the enhancement of patients'quality of life and patients’satisfaction with the subjective experience of treatment and long-term effects.
文摘BACKGROUND Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis.AIM To identify potential risk factors for the development of chronic pouchitis.METHODS Predictors of chronic pouchitis were investigated through a systematic review and meta-analysis.A comprehensive search of the Medline,EMBASE,and PubMed databases was undertaken to identify relevant studies published up to October 2023.Meta-analytic procedures employed random-effects models for the combination of estimates,with the I^(2)statistic used to assess between-study heterogeneity.RESULTS Eleven studies with a total of 3722 patients,comprising 513 with chronic pouchitis and 3209 patients without,were included in the final analysis.Extraintestinal manifestation[odds ratio(OR)=2.11,95%confidence intervals(CI):1.53-2.91,P<0.001,I^(2)=0%],specifically primary sclerosing cholangitis(PSC)(OR=3.69,95%CI:1.40-9.21,P=0.01,I2=48%),and extensive colitis(OR=1.96,95%CI:1.23-3.11,P=0.00,I^(2)=31%)were associated with an increased risk of chronic pouchitis.Other factors,including gender,smoking status,family history of inflammatory bowel disease and ileal pouch anal anastomosis surgical indication were not significantly associated with chronic pouchitis.CONCLUSION Extraintestinal manifestations,PSC and extensive colitis are associated with the development of chronic pouchitis.These findings underscore the importance of comprehensive pre-operative assessment and tailored post operative management strategies.
文摘In this editorial,I discuss the article by Wang et al,published in the World Journal of Diabetes,which explores jejunoileal side-to-side anastomosis as a novel surgical intervention for type 2 diabetes mellitus(T2DM).T2DM,often associated with obesity,remains a global health challenge,as sustained remission is difficult to achieve with conventional pharmacological therapy.Jejunoileal anastomosis offers a promising alternative,particularly for patients with normal or relatively high body mass index,and addresses the unique challenges posed by diverse patient populations.This procedure preserves gastric anatomy while simultaneously improving metabolic parameters,such as glycemic control,lipid profiles,and pancreaticβ-cell function.Unlike traditional metabolic surgeries that involve permanent anatomical alterations,this approach provides advantages such as reversibility,shorter operative times,and minimal nutritional complications,making it appealing to patients for whom conventional bariatric surgery is unsuitable.Advances in gut hormone physiology and incretin modulation support these findings.This innovative approach represents a potential paradigm shift in T2DM treatment,offering insights into the evolving role of surgical interventions in metabolic regulation.While early findings show promising diabetes remission rates and metabolic improvements at six months post-surgery,further studies with longer follow-up periods and broader patient cohorts are required.
文摘BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestinal(UGI)swallow studies to detect complications following OAGB has been questioned.AIM To evaluate the effectiveness and cost-efficiency of performing routine UGI studies on the first postoperative day(POD)after OAGB.METHODS A retrospective cohort analysis of a prospectively collected database was conducted to identify all consecutive patients who underwent OAGB between January 2019 and July 2022.Patient demographics,operative data,and postoperative complication rates were analyzed.Reports from all imaging studies were retrospectively reviewed,and complications were recorded.The institutional review board waived the requirement for informed consent.RESULTS A total of 385 patients were included.All patients had an iodine-based contrast swallow study on the first POD.Abnormal findings were observed in 4 patients(1%),none of which were correlated with postoperative complications.Two patients(0.5%)required reoperation due to complications although both had normal UGI study results.Sensitivity and positive predictive value of UGI studies for detecting complications were 0%,while specificity and negative predictive value were 99%and 98%,respectively.Based on hospital charges the overall cost of all the UGI swallow studies performed in our study was 95865 USD.CONCLUSION The study findings showed that performing routine UGI swallow studies on the first POD after laparoscopic OAGB is ineffective in detecting complications and is not cost effective.Normal UGI studies might mislead clinicians in the postoperative period and thus should be omitted in favor of close clinical monitoring.
文摘BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-term efficacy of these two procedures is scarce.As such,a meta-analysis comparing OAGB and SG in terms of diabetes remission(DR)and percentage of excess weight loss(EWL)is warranted.AIM To compare OAGB and SG in terms of DR and EWL%in the medium term.METHODS A comprehensive literature search was conducted in PubMed/MEDLINE,Cochran Library,and Web of Science for relevant articles,from inception through April 2025,using the keywords“one-anastomosis gastric bypass”,“sleeve gastrectomy”,“mini-gastric bypass”,“diabetes remission”,“one-anastomosis”,and“excess weight loss”.Clinical trials,prospective,retrospective and case-control studies were included;cross-sectional studies,case reports,editorials,and opinions were excluded.The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used to assess the quality of included studies,and RevMan version 5.4 was used for data analyses.RESULTS A total of 1360 articles were identified,and 35 studies were retrieved of which 32 were included in the final analysis.Three full texts were excluded as they did not include data on DR or EWL%.OAGB achieved higher DR than SG at 1 year following surgery[odds ratio(OR)=1.77,95%confidence interval(CI):1.22-2.57,I^(2)=76%].However,DR rates were similar at 3 years and 5 years following surgery(OR=0.82,95%CI:0.61-1.10,I^(2)=23%and OR=0.92,95%CI:0.31-2.72,I^(2)=75%,respectively).OAGB showed higher EWL%at 1 year(OR=9.30,95%CI:6.45-12.15,I^(2)=91%),3 years(OR=10.02,95%CI:9.40-10.64,I^(2)=22%),and 5 years(OR=11.61,95%CI:3.74-19.48,I^(2)=97%).OAGB showed higher late complications than adjustable SG.The results were not different in sub-group analysis including only clinical trials,observational studies,and removing studies including super-obese patients and studies contributing most to heterogeneity.CONCLUSION In the medium term,DR rates were similar between OAGB and SG;however,OAGB showed higher EWL%than SG,and late complications were higher in OAGB.Clinical trials investigating the predictors of DR and EWL%are recommended.
基金the Ministry of Science and Technology of the People's Republic of China(2021ZD0201804,GW)the National Natural Science Foundation of China(82371416,HW).
文摘Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedema,typically in the limbs,to decompress blocked lymphatic drainage pathways.
基金Supported by the National Natural Science Foundation of China,No.82471616,No.82170418 and No.82271618Natural Science Foundation of Hubei Province,No.2022CFA015+2 种基金Central Guiding Local Science and Technology Development Project,No.2022BGE237Key Research and Development Program of Hubei Province,No.2022BCE001 and No.2023BCB139Hubei Provincial Health Commission Project,No.WJ2023M151。
文摘Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced secretion of glucagon-like peptide-1.This surgical procedure alters the direction of nutrient flow,activates distal ileal L cells,and increases endogenous glucagon-like peptide-1 levels,supporting glucose homeostasis,enhancing insulin sensitivity,regulating body weight,and improving cardiovascular health.This structural adjustment transforms the gastrointestinal tract into an active endocrine regulatory organ,providing a pathway for metabolic improvement in patients with T2DM and other complex metabolic disorders.Although this procedure demonstrates significant metabolic improvements within 3-6 months after surgery,integrating hormone level measurements,metabolic marker analysis,and long-term follow-up has become crucial for exploring the complex mechanisms of T2DM in the field of metabolic surgery and T2DM management.Multidisciplinary collaboration involving support from endocrinology,nutrition,and rehabilitation teams before and after surgery is becoming increasingly vital in the long-term management of patients with T2DM.This collaboration optimizes surgical outcomes and enhances metabolic management.Side-to-side anastomosis shows potential in the multitarget metabolic management of T2DM,providing an additional intervention option for patients with T2DM and metabolic disorders.
基金Supported by Chongqing Municipal Health Commission Medical Research Project,No.2023WSJK104.
文摘BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques.However,research on its application for small bowel stoma reversal in patients with Crohn's disease(CD)is limited.Therefore,in this study,we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal(LIIR)and open ileostomy reversal(OIR).AIM To compare the safety,feasibility,bowel function recovery,and short-and longterm LIIR and OIR outcomes in patients with CD.METHODS This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution.The baseline data,postoperative recovery,and complication indicators were retrospectively analyzed.Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.RESULTS Notably,15 of the 45 patients in this study underwent OIR,and the remaining 30 received LIIR.Notably,no statistically significant differences were found between the two groups regarding clinical baseline characteristics,operation time,intraoperative hemorrhage,anastomotic site,enterolysis range,first postoperative flatus,postoperative complications,reoperation rate,or incidence of postoperative enteral nutrition intolerance.Compared with the OIR group,the LIIR group had a shorter postoperative hospital stay(P=0.045),lower incidence of enteral nutrition intolerance symptoms(P=0.019),and earlier postoperative total enteral nutrition initiation(P=0.033);however,it incurred higher total hospital costs(P=0.038).Furthermore,multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance(P<0.05).CONCLUSION Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible.Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.
文摘In this editorial,we comment on an article by Liu et al.We focus specifically on the novel use of laparoscopic intracorporeal anastomosis(LIA)compared with open ileostomy reversal in patients with Crohn’s disease(CD),which is an innovative approach for improving postoperative outcomes and accelerating recovery in ileostomy reversal procedures.This study also highlights the limitations of the conventional open surgical technique,which is associated with higher rates of feeding intolerance,prolonged hospital stays,and delayed initiation of enteral nutrition.The chronic and recurrent nature of CD and the challenges posed by traditional surgical methods are issues addressed by LIA,which offers a minimally invasive approach that reduces surgical trauma,shortens recovery time,and improves tolerance to enteral nutrition,thereby enhancing postoperative outcomes.However,while LIA shows great promise,further prospective multicenter trials are needed to validate these findings and assess their broader application in other surgical scenarios.Overall,LIA represents a significant advancement in minimally invasive surgery for CD and has the potential to become the preferred standard approach for ileostomy reversal in patients requiring bowel reanastomosis.
文摘Objective: To evaluate the clinical value of intrathoracic esophagogastric "layer-to-layer" anastomosis with esophageal mucosa extended varied in plane and to study the effective methods to prevent anastomotic leaking or stricture postoperatively. Methods: From May 1985 to December 2002, 2 240 esophageal and stomach cardia cancer patients treated by intrathoracic esophagogastric "layer-to-layer" anastomosis with esophageal mucosa extended varied in plane were retrospectively analyzed. Results: There was no anastomotic leaking and severe stricture in all above cases. Conclusion: Intrathoracic esophagogastric "layer-to-layer" anastomosis with esophageal mucosal extended varied in plane is an effective method to prevent anastomotic leaking and stricture postoperatively.
文摘To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or performing a stapled or hand-sewn anastomosis.Among the least studied is the configuration of the two stumps(i.e.,isoperistaltic or antiperistaltic)in the case of a side-to-side anastomosis.The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature.High-quality literature is scarce,with only three studies directly comparing the two alternatives,and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage,stenosis,or bleeding.However,there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis.Finally,existing data do not identify a certain anastomotic configuration(i.e.,isoperistaltic or antiperistaltic)as superior over the other.Thus,the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.
