BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report ...BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplan-tation.The patient presented with a body mass index of 40.7 kg/m2 and a giant incisional hernia,compounded by extensive intraabdominal adhesions from mul-tiple previous surgeries.A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan.Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions,and the procedure was completed successfully using standard stapling techniques.Postoperative recovery was smooth,with significant weight loss achieved within the first month.CONCLUSION This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.展开更多
BACKGROUND Historically intraoperative drains were employed after pancreatic surgery but over the last decade,there has been debate over the routine usage of drains.AIM To assess the necessity of intra-abdominal drain...BACKGROUND Historically intraoperative drains were employed after pancreatic surgery but over the last decade,there has been debate over the routine usage of drains.AIM To assess the necessity of intra-abdominal drain placement,identify the most effective drain type,and determine the optimal timing for drain removal.METHODS A systematic review of electronic databases,including PubMed,MEDLINE,PubMed Central,and Google Scholar,was conducted using Medical Subject Headings and keywords until December 2023.From an initial pool of 1910 articles,48 were included after exclusion and screening.The primary outcomes analyzed were clinically relevant postoperative pancreatic fistula(CR-POPF),delayed gastric emptying(DGE),overall morbidity,and mortality.Subgroup analyses were performed for pancreaticoduodenectomy and distal pancreatectomy.RESULTS Routine use of drains is associated with a statistically significant increase in the risk of CR-POPF and DGE.Conversely,patients who did not have drains placed experienced a significant reduction in morbidity,readmission rates,and reoperations.No significant differences were observed between active and passive drain types.Early drain removal(<3 days)yielded favorable outcomes compared to delayed removal.CONCLUSION Analysis of randomized controlled trials and cohort studies did not demonstrate an advantage of routine drain placement following pancreatic resection,potentially contributing to increased morbidity and mortality.The decision to use drains should be left to the discretion of the operating surgeon.However,early drain removal can substantially reduce morbidity.展开更多
BACKGROUND Neurogenic tumors are rare but represent an important consideration in the differential diagnosis of abdominal mesenchymal tumors.Reports on their incidence,pathological features and clinical characteristic...BACKGROUND Neurogenic tumors are rare but represent an important consideration in the differential diagnosis of abdominal mesenchymal tumors.Reports on their incidence,pathological features and clinical characteristics are scarce.AIM To advance the overall knowledge on the histologic,immunohistochemical,clinical and radiologic characteristics of neurogenic tumors through this case series.METHODS An established database of a nationwide tertiary referral center,covering a 15-year period(2005 and 2020),was retrospectively re-evaluated.Diagnoses of neurogenic tumor cases were confirmed by two experts following review of the macroscopic,histological and immunohistochemical records along with findings from analysis of archived tissue sections for each included patient.Tissue microarrays were constructed for cases lacking necessary immunohistochemical studies.Clinical data and follow-up information were collected from the hospital records and the patients themselves,when available.RESULTS The study included 19 cases of intraabdominal neurogenic tumors,representing 12 women and 7 men, between 18 and 86 years of age (median: 51 years). Finalconfirmed diagnoses were 12 schwannomas, 2 diffuse submucosal neurofibromatoses,2 ganglioneuromas, 2 malignant peripheral sheath nerve tumors,and 1 mucosal Schwann cell hamartoma. Sizes of the tumors were variable, with amedian diameter of 4 cm;the two largest (> 10 cm) were schwannomas. Themajority of cases were asymptomatic at presentation, but the most frequentsymptom was abdominal pain. Gastrointestinal tract lesions were detected withendoscopy and extra-luminal lesions were detected with cross-sectional imaging.All cases were S100-positive and CD117-negative;most cases were negative fordesmin, epithelial membrane antigen, smooth muscle actin and CD34. In all but 5cases, the Ki67 proliferation index was ≤ 1%.CONCLUSION Re-evaluation of 19 cases of abdominal neurogenic tumors demonstrated considerablevariability in clinicopathologic characteristics depending on location,dimension and histological features.展开更多
BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in d...BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment.There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.CASE SUMMARY Here,we report a 16-year-old female patient with intestinal obstruction due to AC.She was treated with abdominal surgery three times.First,she underwent a laparotomy for peritonitis after trauma from a traffic accident.During the pro-cedure,pelvic empyema,severe intestinal adhesions,and damage to the serous layer of the rectum were found,but no significant intestinal rupture and perfo-ration were found.As a precaution,she underwent a prophylactic ileostomy after a flush in her abdomen.The second and third surgeries were for treatment of recurrent stoma obstruction.The patient’s condition was complicated for a long period,but after comprehensive treatment by our department,the patient was successfully discharged from the hospital and is currently recovering well.CONCLUSION Currently,abdominal contrast-enhanced computed tomography is the best imaging modality for pre-operative evaluation of AC,but most patients are diagnosed only after intrao-perative exploration.For the treatment of typical or severe ACs,the primary me-thod of removal and healing of ACs is complete removal of the abdominal fibrous membrane.Finding a breakthrough in the anatomy is the key to the success of the surgery.展开更多
文摘BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplan-tation.The patient presented with a body mass index of 40.7 kg/m2 and a giant incisional hernia,compounded by extensive intraabdominal adhesions from mul-tiple previous surgeries.A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan.Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions,and the procedure was completed successfully using standard stapling techniques.Postoperative recovery was smooth,with significant weight loss achieved within the first month.CONCLUSION This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.
文摘BACKGROUND Historically intraoperative drains were employed after pancreatic surgery but over the last decade,there has been debate over the routine usage of drains.AIM To assess the necessity of intra-abdominal drain placement,identify the most effective drain type,and determine the optimal timing for drain removal.METHODS A systematic review of electronic databases,including PubMed,MEDLINE,PubMed Central,and Google Scholar,was conducted using Medical Subject Headings and keywords until December 2023.From an initial pool of 1910 articles,48 were included after exclusion and screening.The primary outcomes analyzed were clinically relevant postoperative pancreatic fistula(CR-POPF),delayed gastric emptying(DGE),overall morbidity,and mortality.Subgroup analyses were performed for pancreaticoduodenectomy and distal pancreatectomy.RESULTS Routine use of drains is associated with a statistically significant increase in the risk of CR-POPF and DGE.Conversely,patients who did not have drains placed experienced a significant reduction in morbidity,readmission rates,and reoperations.No significant differences were observed between active and passive drain types.Early drain removal(<3 days)yielded favorable outcomes compared to delayed removal.CONCLUSION Analysis of randomized controlled trials and cohort studies did not demonstrate an advantage of routine drain placement following pancreatic resection,potentially contributing to increased morbidity and mortality.The decision to use drains should be left to the discretion of the operating surgeon.However,early drain removal can substantially reduce morbidity.
文摘BACKGROUND Neurogenic tumors are rare but represent an important consideration in the differential diagnosis of abdominal mesenchymal tumors.Reports on their incidence,pathological features and clinical characteristics are scarce.AIM To advance the overall knowledge on the histologic,immunohistochemical,clinical and radiologic characteristics of neurogenic tumors through this case series.METHODS An established database of a nationwide tertiary referral center,covering a 15-year period(2005 and 2020),was retrospectively re-evaluated.Diagnoses of neurogenic tumor cases were confirmed by two experts following review of the macroscopic,histological and immunohistochemical records along with findings from analysis of archived tissue sections for each included patient.Tissue microarrays were constructed for cases lacking necessary immunohistochemical studies.Clinical data and follow-up information were collected from the hospital records and the patients themselves,when available.RESULTS The study included 19 cases of intraabdominal neurogenic tumors,representing 12 women and 7 men, between 18 and 86 years of age (median: 51 years). Finalconfirmed diagnoses were 12 schwannomas, 2 diffuse submucosal neurofibromatoses,2 ganglioneuromas, 2 malignant peripheral sheath nerve tumors,and 1 mucosal Schwann cell hamartoma. Sizes of the tumors were variable, with amedian diameter of 4 cm;the two largest (> 10 cm) were schwannomas. Themajority of cases were asymptomatic at presentation, but the most frequentsymptom was abdominal pain. Gastrointestinal tract lesions were detected withendoscopy and extra-luminal lesions were detected with cross-sectional imaging.All cases were S100-positive and CD117-negative;most cases were negative fordesmin, epithelial membrane antigen, smooth muscle actin and CD34. In all but 5cases, the Ki67 proliferation index was ≤ 1%.CONCLUSION Re-evaluation of 19 cases of abdominal neurogenic tumors demonstrated considerablevariability in clinicopathologic characteristics depending on location,dimension and histological features.
基金Supported by Suqian Science and Technology Project Contract,No.S201910。
文摘BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment.There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.CASE SUMMARY Here,we report a 16-year-old female patient with intestinal obstruction due to AC.She was treated with abdominal surgery three times.First,she underwent a laparotomy for peritonitis after trauma from a traffic accident.During the pro-cedure,pelvic empyema,severe intestinal adhesions,and damage to the serous layer of the rectum were found,but no significant intestinal rupture and perfo-ration were found.As a precaution,she underwent a prophylactic ileostomy after a flush in her abdomen.The second and third surgeries were for treatment of recurrent stoma obstruction.The patient’s condition was complicated for a long period,but after comprehensive treatment by our department,the patient was successfully discharged from the hospital and is currently recovering well.CONCLUSION Currently,abdominal contrast-enhanced computed tomography is the best imaging modality for pre-operative evaluation of AC,but most patients are diagnosed only after intrao-perative exploration.For the treatment of typical or severe ACs,the primary me-thod of removal and healing of ACs is complete removal of the abdominal fibrous membrane.Finding a breakthrough in the anatomy is the key to the success of the surgery.
