BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumul...BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumulation of external appen-diceal mucus.They may present as an extra-appendiceal mass-like bulge,mucus or polypoid tissue at the appendiceal orifice,or even with abdominal dissem-ination.The surgical approach is usually appendectomy,ileocecal resection or right hemicolectomy.It is essential to raise awareness of LAMNs and choose an appropriate treatment.CASE SUMMARY A 68-year-old man underwent a routine physical examination at our hospital on May 17,2022.The patient had no symptoms of abdominal pain,bloating,or weight loss,and his tumour marker levels were normal.The faecal occult blood test was negative,and no abnormalities were identified on physical examination.Colonoscopy revealed a submucosal protrusion at the appendiceal orifice.During endoscopic ultrasound,uneven echoes were observed in the appendix cavity.A contrast-enhanced computed tomography scan of the abdomen revealed a nodular thickening at the base of the appendix,with a diameter of approximately 1 cm.When all the examination results were considered,we suspected the lesion to be an appendiceal mucinous tumour.Laparoscopic surgery was performed using the double purse-string suture method.Postoperative pathology suggested a low-grade mucinous cystadenoma of the appendix with no involvement of the margins.A repeat colonoscopy 18 months after surgery revealed no significant abnormality at the appendiceal orifice.A contrast-enhanced computed tomography scan of the abdomen suggested only postoperative changes.CONCLUSION This study describes a case of LAMN that was treated by resecting the mass at the appendiceal orifice via the double purse-string suture technique and provides new insights on the diagnosis and treatment of LAMNs.展开更多
BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing...BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing(EPSS)has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects.However,details regarding the efficacy of endoscopic pre-purse-string suture(P-EPSS)are unknown,especially that it offers several advantages over conventional EPSS(C-EPSS).AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations,and evaluate the efficacy of P-EPSS.METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS(n=63)or C-EPSS(n=117)between July 2014 and June 2020.The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size,location,and morphology,incidence of complete closure,intraoperative perforation,and delayed adverse events were evaluated.Data on the features and clinical course of cases with adverse events were collected for further analysis.RESULTS Patients with lesion size larger than 3 cm,lesions located at the fundus of stomach,or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure.The P-EPSS group showed a significantly higher proportion of intraoperative perforation(56%vs 17%)and a much shorter procedure time(9.06±6.14 min vs 14.84±7.25 min).Among adverse events,the incidence of delayed perforation(5%vs 4%;P=0.82)and delayed bleeding(3%vs 4%;P=0.96)did not differ significantly between the groups.Multivariate analysis revealed that lesions with incomplete closure[odds ratio(OR)=21.33;95%confidence interval(CI):5.45-83.45;P<0.01]or size greater than 3 cm(OR=3.14;95%CI:1.08-9.18;P=0.039)showed a statistical tendency to result in an increase in delayed adverse events.CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect.PEPSS could shorten the procedure and yield complete closure of mucosal defects.Rather than closure-type selection,incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.展开更多
BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(...BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.展开更多
AIM:To observe the clinical outcomes of 30-gauge(G)needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.METHODS:Eight patients with atonic pupils who underwent suture purse-string p...AIM:To observe the clinical outcomes of 30-gauge(G)needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.METHODS:Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed.Preoperative data and at least 6mo of postoperative data were collected from all the patients.RESULTS:The corrected distance visual acuity(CDVA)before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR,respectively(P=0.002).The pre-and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm(P=0.000),respectively.The corneal endothelial cell count was 2841±176/mm^(2) before and 2692±143/mm^(2) after surgery(P=0.000).No intraoperative or postoperative complications were reported.During the follow-up period of at least 6mo,all treated pupils were centered and generally or nearly round.Furthermore,the patients did not exhibit photophobia,glare,or diplopia.CONCLUSION:This technique is a simple and effective method for pupil reduction.展开更多
AIM： To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS： The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 an...AIM： To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS： The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed. The purse-string suture anoscope in the PPH kit was used on 15 patients （Group 1）, and the modified anoscope was used on 22 patients （Group 2）. Demographic characteristics of the patients, operation time, surgeon＇s performance, analgesic requirement, and complications were compared. RESULTS： Operation time was significantly longer in Group 1 （42.0 4- 8.4 min vs 27.7 4- 8.0 min, P = 0.039）. The surgeons reported their operative performance as significantly better in Group 2 （the results of the assessments were poor in ten, medium in four and good in one in Group 1, while good in all patients in Group 2, P 〈 0.001）. The need for haemostatic sutures was significantly higher in Group 1 （six cases） and was needed in two cases in Group 2 （P = 0.034）. CONCLUSION： Operation time decreased and the surgeon＇s satisfaction increased with use of the modified anoscope, and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.展开更多
BACKGROUND At present,prophylactic ileostomy is commonly used to protect distal intestinal anastomoses,particularly during the recovery period following colorectal surgery.However,after the ileum is returned to the ab...BACKGROUND At present,prophylactic ileostomy is commonly used to protect distal intestinal anastomoses,particularly during the recovery period following colorectal surgery.However,after the ileum is returned to the abdominal cavity,abdominal closure using traditional vertical interrupted suturing is associated with a higher incidence of wound infections.For patients undergoing ileostomy closure,selecting an appropriate suturing method for the skin incision at the stoma site is crucial for improving patient prognosis.AIM To investigate the impact of three different skin suturing methods at the ileostomy closure site on patient prognosis.METHODS Thirty patients who underwent ileostomy closure at the Affiliated Hospital of Qinghai University between January 2024 and October 2024 were selected based on inclusion and exclusion criteria.The patients were divided into three groups:The purse-string suture group,the cross-suture group,and the vertical interrupted suture group,with 10 cases in each group.The purse-string suture group,cross-suture group,and vertical interrupted suture group used purse-string,cross,and vertical interrupted suturing methods,respectively,for the skin incision at the ileostomy closure site.RESULTS There were no statistically significant differences among the three groups in terms of operative time,intraoperative blood loss,time to resume liquid diet,time to first bowel movement,postoperative hospital stay,hospitalization costs,or levels of white blood cell count,hemoglobin,and albumin on the third postoperative day(P>0.05).Nevertheless,significant differences(P<0.05)were observed in incision suture removal time,wound healing time,C-reactive protein levels on the third postoperative day,visual analog scale pain scores during the first three postoperative days,and the incidence of surgical site infection.Overall,the therapeutic outcomes of the pursestring suture group and the cross-suture group were superior to the vertical interrupted suture group.CONCLUSION Using purse-string or cross-suturing methods for skin incision at the ileostomy closure site can shorten wound healing and suture removal times,reduce surgical site infection incidence and postoperative inflammatory response,alleviate incision pain,and promote rapid postoperative recovery.展开更多
基金Supported by Jinhua City Science and Technology Plan Projects“Improve the Polarization of Cancer-related Fatigue:Clinical Efficacy Study”,No.2018-4-049.
文摘BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumulation of external appen-diceal mucus.They may present as an extra-appendiceal mass-like bulge,mucus or polypoid tissue at the appendiceal orifice,or even with abdominal dissem-ination.The surgical approach is usually appendectomy,ileocecal resection or right hemicolectomy.It is essential to raise awareness of LAMNs and choose an appropriate treatment.CASE SUMMARY A 68-year-old man underwent a routine physical examination at our hospital on May 17,2022.The patient had no symptoms of abdominal pain,bloating,or weight loss,and his tumour marker levels were normal.The faecal occult blood test was negative,and no abnormalities were identified on physical examination.Colonoscopy revealed a submucosal protrusion at the appendiceal orifice.During endoscopic ultrasound,uneven echoes were observed in the appendix cavity.A contrast-enhanced computed tomography scan of the abdomen revealed a nodular thickening at the base of the appendix,with a diameter of approximately 1 cm.When all the examination results were considered,we suspected the lesion to be an appendiceal mucinous tumour.Laparoscopic surgery was performed using the double purse-string suture method.Postoperative pathology suggested a low-grade mucinous cystadenoma of the appendix with no involvement of the margins.A repeat colonoscopy 18 months after surgery revealed no significant abnormality at the appendiceal orifice.A contrast-enhanced computed tomography scan of the abdomen suggested only postoperative changes.CONCLUSION This study describes a case of LAMN that was treated by resecting the mass at the appendiceal orifice via the double purse-string suture technique and provides new insights on the diagnosis and treatment of LAMNs.
基金the National Natural Science Foundation of China,No.82172737 and 82003277Shanghai Municipal Education Commission,No.16411950403 and 19411951605。
文摘BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing(EPSS)has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects.However,details regarding the efficacy of endoscopic pre-purse-string suture(P-EPSS)are unknown,especially that it offers several advantages over conventional EPSS(C-EPSS).AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations,and evaluate the efficacy of P-EPSS.METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS(n=63)or C-EPSS(n=117)between July 2014 and June 2020.The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size,location,and morphology,incidence of complete closure,intraoperative perforation,and delayed adverse events were evaluated.Data on the features and clinical course of cases with adverse events were collected for further analysis.RESULTS Patients with lesion size larger than 3 cm,lesions located at the fundus of stomach,or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure.The P-EPSS group showed a significantly higher proportion of intraoperative perforation(56%vs 17%)and a much shorter procedure time(9.06±6.14 min vs 14.84±7.25 min).Among adverse events,the incidence of delayed perforation(5%vs 4%;P=0.82)and delayed bleeding(3%vs 4%;P=0.96)did not differ significantly between the groups.Multivariate analysis revealed that lesions with incomplete closure[odds ratio(OR)=21.33;95%confidence interval(CI):5.45-83.45;P<0.01]or size greater than 3 cm(OR=3.14;95%CI:1.08-9.18;P=0.039)showed a statistical tendency to result in an increase in delayed adverse events.CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect.PEPSS could shorten the procedure and yield complete closure of mucosal defects.Rather than closure-type selection,incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.
基金This observational study was approved by the Ethics Committee of Renmin Hospital of Wuhan University.
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.
基金Supported by the Changzhou Science and Technology Bureau(No.CJ20239004).
文摘AIM:To observe the clinical outcomes of 30-gauge(G)needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.METHODS:Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed.Preoperative data and at least 6mo of postoperative data were collected from all the patients.RESULTS:The corrected distance visual acuity(CDVA)before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR,respectively(P=0.002).The pre-and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm(P=0.000),respectively.The corneal endothelial cell count was 2841±176/mm^(2) before and 2692±143/mm^(2) after surgery(P=0.000).No intraoperative or postoperative complications were reported.During the follow-up period of at least 6mo,all treated pupils were centered and generally or nearly round.Furthermore,the patients did not exhibit photophobia,glare,or diplopia.CONCLUSION:This technique is a simple and effective method for pupil reduction.
文摘AIM： To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS： The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed. The purse-string suture anoscope in the PPH kit was used on 15 patients （Group 1）, and the modified anoscope was used on 22 patients （Group 2）. Demographic characteristics of the patients, operation time, surgeon＇s performance, analgesic requirement, and complications were compared. RESULTS： Operation time was significantly longer in Group 1 （42.0 4- 8.4 min vs 27.7 4- 8.0 min, P = 0.039）. The surgeons reported their operative performance as significantly better in Group 2 （the results of the assessments were poor in ten, medium in four and good in one in Group 1, while good in all patients in Group 2, P 〈 0.001）. The need for haemostatic sutures was significantly higher in Group 1 （six cases） and was needed in two cases in Group 2 （P = 0.034）. CONCLUSION： Operation time decreased and the surgeon＇s satisfaction increased with use of the modified anoscope, and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.
文摘BACKGROUND At present,prophylactic ileostomy is commonly used to protect distal intestinal anastomoses,particularly during the recovery period following colorectal surgery.However,after the ileum is returned to the abdominal cavity,abdominal closure using traditional vertical interrupted suturing is associated with a higher incidence of wound infections.For patients undergoing ileostomy closure,selecting an appropriate suturing method for the skin incision at the stoma site is crucial for improving patient prognosis.AIM To investigate the impact of three different skin suturing methods at the ileostomy closure site on patient prognosis.METHODS Thirty patients who underwent ileostomy closure at the Affiliated Hospital of Qinghai University between January 2024 and October 2024 were selected based on inclusion and exclusion criteria.The patients were divided into three groups:The purse-string suture group,the cross-suture group,and the vertical interrupted suture group,with 10 cases in each group.The purse-string suture group,cross-suture group,and vertical interrupted suture group used purse-string,cross,and vertical interrupted suturing methods,respectively,for the skin incision at the ileostomy closure site.RESULTS There were no statistically significant differences among the three groups in terms of operative time,intraoperative blood loss,time to resume liquid diet,time to first bowel movement,postoperative hospital stay,hospitalization costs,or levels of white blood cell count,hemoglobin,and albumin on the third postoperative day(P>0.05).Nevertheless,significant differences(P<0.05)were observed in incision suture removal time,wound healing time,C-reactive protein levels on the third postoperative day,visual analog scale pain scores during the first three postoperative days,and the incidence of surgical site infection.Overall,the therapeutic outcomes of the pursestring suture group and the cross-suture group were superior to the vertical interrupted suture group.CONCLUSION Using purse-string or cross-suturing methods for skin incision at the ileostomy closure site can shorten wound healing and suture removal times,reduce surgical site infection incidence and postoperative inflammatory response,alleviate incision pain,and promote rapid postoperative recovery.
