1.The development history of enhanced recovery after surgery(ERAS)Enhanced recovery after surgery(ERAS)is a multimodal perioperative care approach that has evolved over the past 2 decades since its inception.In 1997,P...1.The development history of enhanced recovery after surgery(ERAS)Enhanced recovery after surgery(ERAS)is a multimodal perioperative care approach that has evolved over the past 2 decades since its inception.In 1997,Professor Henrik Kehlet,also known as the“father of ERAS”,from the University of Copenhagen in Denmark first proposed the ERAS concept and discovered its clinical feasibility and superiority,achieving remarkable results.ERAS was initially applied in colorectal surgery;subsequently,the concept gradually gained popularity and application worldwide.展开更多
BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To a...BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To analyses the effects of preoperative immunonutrition and standard oral nutrition supplements on colorectal surgery outcomes.METHODS This study employed a prospective single-center randomized double-blinded comparative approach and was conducted at Hospital Universiti Sains Malaysia between September 2023 and September 2024.In this study,the participants in the experimental group were supplied with a specialized oral supplement enriched with immune-modulating nutrients.Meanwhile,a conventional oral nutrition supplement was provided to the control group.The time to first flatus and the time to first bowel evacuation were the primary outcomes recorded.Incidence of nosocomial infections,surgical site infections,and the total length of hospital stay were considered secondary data.RESULTS This study involved 58 patients who were allocated into two groups.No dropouts were documented.The mean age of the participants was 61.20±12.96,and most were males(63.38%).All participants’baseline and surgical characteristics in both arms were also generally comparable.The participants in this study underwent colorectal surgery,where most had laparoscopic surgery(58%).Based on the results,no significant statistical differences were observed regarding the duration from the first flatus to the first bowel evacuation,the onset of a normal diet,and hospital stay between the experimental and control groups.Both groups also recorded 10(17.24%)infectious complications.CONCLUSION The findings indicated no notable variations in the primary and secondary endpoints despite the theoretical benefits of immune-modulating nutrients.Conclusively,routine preoperative immunonutrition may not provide additional advantages over standard nutrition in this demographic.展开更多
BACKGROUND Enhanced recovery after surgery(ERAS)programs provide recommendations for an optimized management of patients undergoing surgery.An ERAS program tailored on surgery for retroperitoneal sarcomas(RPS)may impr...BACKGROUND Enhanced recovery after surgery(ERAS)programs provide recommendations for an optimized management of patients undergoing surgery.An ERAS program tailored on surgery for retroperitoneal sarcomas(RPS)may improve patient outcomes and it has still not been established.AIM To determine how an ERAS program tailored to RPS surgery can be agreed upon,structured,and implemented.METHODS Twenty-five candidate items from existing ERAS programs,potentially relevant for RPS surgery,were identified via literature review and expert input.These were included in a questionnaire refined through cognitive interviews and pilot testing.Expert sarcoma surgeons rated each item’s relevance and feasibility on a 6-point scale.The survey was recirculated after one year.Intra-observer reproducibility,inter-observer concordance,and agreement with the modal value of the most experienced participants were analyzed.RESULTS Thirteen sarcoma surgeons from 6 centers participated in the survey.Although surgeons agreed on several items,their overall concordance was low.After recirculating the survey,the intraobserver reproducibility was low.Interestingly,the median concordance with the reference increased for relevance and decreased for feasibility.CONCLUSION Despite interest in ERAS for RPS,surgeon concordance on item relevance and feasibility remains low,underscoring the need for collaborative efforts toward a standardized,consensus-based protocol.展开更多
Laparoscopic and endoscopic cooperative surgery(LECS)is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors.Several modifications of LECS—including inverted LECS,non-...Laparoscopic and endoscopic cooperative surgery(LECS)is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors.Several modifications of LECS—including inverted LECS,non-exposed endoscopic wall-inversion surgery,and closed LECS have evolved over a period of time to address the earlier concerns about peritoneal contamination and tumor seeding.These innovations have led to the application of combined laparoendoscopic techniques to several gastrointestinal(GI)lesions such as the duodenum,colon,and rectum.This minireview explores the evolution,current applications,and future potential of laparoendoscopic surgery in GI diseases.展开更多
Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce...Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce. Aim: To test a novel AI commercially available tool for image analysis on a series of laparoscopic scenes. Methods: The research tools included OPENAI CHATGPT 4.0 with its corresponding image recognition plugin which was fed with a list of 100 laparoscopic selected snapshots from common surgical procedures. In order to score reliability of received responses from image-recognition bot, two corresponding scales were developed ranging from 0 - 5. The set of images was divided into two groups: unlabeled (Group A) and labeled (Group B), and according to the type of surgical procedure or image resolution. Results: AI was able to recognize correctly the context of surgical-related images in 97% of its reports. For the labeled surgical pictures, the image-processing bot scored 3.95/5 (79%), whilst for the unlabeled, it scored 2.905/5 (58.1%). Phases of the procedure were commented in detail, after all successful interpretations. With rates 4 - 5/5, the chatbot was able to talk in detail about the indications, contraindications, stages, instrumentation, complications and outcome rates of the operation discussed. Conclusion: Interaction between surgeon and chatbot appears to be an interesting frontend for further research by clinicians in parallel with evolution of its complex underlying infrastructure. In this early phase of using artificial intelligence for image recognition in surgery, no safe conclusions can be drawn by small cohorts with commercially available software. Further development of medically-oriented AI software and clinical world awareness are expected to bring fruitful information on the topic in the years to come.展开更多
Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics cl...Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics clinical CPSS conditions by taking two sequential surgical procedures.Step 1:A plastic rod was inserted into the left L5 intervertebral foramen to produce a steady compression on the dorsal root ganglion(DRG)and the spinal nerve,a common cause of low back pain(LBP).Step 2:The rod was removed after 7 days when rats exhibited mechanical and heat hypersensitivity in the ipsilateral hindpaw,followed by a full L5 laminectomy to mimic spine decompression surgery in LBP patients.The retention of the rod induced a prolonged LBP-like behavior but was quickly resolved after rod removal without laminectomy.However,rats that received laminectomy after rod removal developed heightened mechanical and heat sensitivity in the hindpaw,impaired gait,and reduced spontaneous exploration activity,indicating CPSS.Patch clamp recording revealed a significant augmentation in the intrinsic excitability of smalldiameter DRG neurons in CPSS rats.Administration of Dermorphin[D-Arg2,Lys4](1–4)amide(DALDA,5mg/kg,i.p.),a peripherally acting mu-opioid receptor(MOR)-preferred agonist,attenuated pain hypersensitivity,capsaicin-induced[Ca^(2+)]i rising and the increased intrinsic excitability of DRG neurons from CPSS rats.Our findings suggest that this new model,which mirrors the nature of CPSS developed in patients,may be useful for future studies of the underlying mechanisms.展开更多
AIM: To study the implementation of an enhanced recovery after surgery (ERAS) program at a large University Hospital from “pilot study” to “standard of care”.
BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing...BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.展开更多
Dear Editor,Descemet’s membrane detachment(DMD)is considered as a potential sight-threatening complication following various intraocular surgeries,particularly cataract surgery[1].The labile adhesion between the Desc...Dear Editor,Descemet’s membrane detachment(DMD)is considered as a potential sight-threatening complication following various intraocular surgeries,particularly cataract surgery[1].The labile adhesion between the Descemet’s membrane(DM)and the posterior corneal stromal layer can be easily separated with minimal mechanical force.Several risk factors have been associated with the development of DMD including old age,improper intraoperative operation,corneal ectatic disorders,and endothelial disorders and so on[1-4].展开更多
Computer assisted surgical planning allowed for a better selection of patients,evaluation of operative strategy, appropriate volumetric measurements,identification of anatomical risks, definition of tumour resection m...Computer assisted surgical planning allowed for a better selection of patients,evaluation of operative strategy, appropriate volumetric measurements,identification of anatomical risks, definition of tumour resection margins and choice of surgical approach in liver oncologic resections and living donor liver transplantations. Although preoperative computer surgical analysis has been widely used in daily clinical practice, intraoperative computer assisted solutions for risk analysis and navigation in liver surgery are not widely available or still under clinical evaluation. Computer science technology can efficiently assist modern surgeons during complex liver operations, mainly by providing image guidance with individualized 2 D images and 3 D models of the various anatomical and pathological structures of interest. Intraoperative computer assisted liver surgery is particularly useful in complex parenchyma-sparing hepatectomies, for intraoperative risk analysis and for the effective treatment of colorectal metastases after neoadjuvant therapy or when they are multiple. In laparoscopic liver surgery, intraoperative computer aid is definitively more important as, apart from a restricted field of view, there is also loss of the fine haptic feedback. Intraoperative computer assisted developments face challenges that prevent their application in daily clinical practice. There is a vast variety of studies regarding intraoperative computer assisted liver surgery but there are no clear objective measurements in order to compare them and select the most effective solutions. An overview of up-to-date intraoperative computer assisted solutions for liver surgery will be discussed.展开更多
Objective: This study aims to investigate the drainage effect and clinical outcomes of negative pressure chest drainage in patients after two-port thoracoscopic valve surgery, comparing the differences in postoperativ...Objective: This study aims to investigate the drainage effect and clinical outcomes of negative pressure chest drainage in patients after two-port thoracoscopic valve surgery, comparing the differences in postoperative pain, hospital stay, and other factors between the negative pressure group and the control group. Methods: This study is a prospective controlled trial that selected patients undergoing two-port thoracoscopic valve surgery at a certain hospital from January 2019 to December 2024. Patients were randomly assigned to the control group and the negative pressure group using a random number table method. The control group consisted of 30 patients (20 males, 10 females, mean age 42.03 ± 12.89 years), and the negative pressure group consisted of 35 patients (26 males, 9 females, mean age 41.84 ± 11.83 years). The control group received traditional chest drainage, while the negative pressure group received negative pressure chest drainage. Postoperative pain scores, hospital stay, drainage time, number of tube blockages, and incidences of pneumothorax or subcutaneous emphysema were recorded and statistically analyzed. Results: The negative pressure group had a significantly shorter postoperative drainage time compared to the control group (49.09 ± 11.99 hours vs. 79.10 ± 7.32 hours, P < 0.001). The postoperative pain score was lower in the negative pressure group (4.49 ± 1.27 vs. 7.03 ± 0.85, P < 0.001), and the hospital stay was significantly shorter (9.83 ± 1.69 days vs. 14.73 ± 2.32 days, P < 0.001). The incidence of pneumothorax or subcutaneous emphysema was significantly lower in the negative pressure group than in the control group (14.29% vs. 56.67%, P = 0.0003). Conclusion: The application of negative pressure chest drainage in patients after two-port thoracoscopic valve surgery can effectively reduce postoperative pain, shorten hospital stay, and lower the incidence of tube blockage and pneumothorax, demonstrating good clinical outcomes.展开更多
Bariatric and metabolic surgeries have gained extensive popularity and trust due to their documented efficacy and safety in managing not only obesity but also associated comorbidities such as diabetes mellitus, hypert...Bariatric and metabolic surgeries have gained extensive popularity and trust due to their documented efficacy and safety in managing not only obesity but also associated comorbidities such as diabetes mellitus, hypertension, dyslipidemia, sleep apnea, and joint pain. Traditionally, bariatric surgeries have been categorized into hypoabsorptive, restrictive, or hybrid approaches. However, these classifications inadequately reflect the complex anatomical and physiological alterations associated with modern surgical methodologies. This paper explores the evolution of metabolic surgeries, emphasizing the integration of physiological concepts into classic procedures to provide more tailored and effective treatment options for obesity and its comorbidities. Finally, the proposal for a new classification based on current metabolic concepts will facilitate communication among patients, doctors, and healthcare professionals. Additionally, it will enable a more didactic and standardized approach to data collection for conducting studies and publications.展开更多
The computer-assisted surgery (CAS)has significantly improved the accuracy, reliability and outcomes of traumatic,spinal,nerve surgery and many other operations with a less invasive way.The application of CAS for scap...The computer-assisted surgery (CAS)has significantly improved the accuracy, reliability and outcomes of traumatic,spinal,nerve surgery and many other operations with a less invasive way.The application of CAS for scaphoid fractures remains experimental.The related studies are scanty and most of them are cadaver researches.Some intrinsic defects from the registration procedure,scan and immobilization of limbs may inevitably result in deviations. Some deviations become more obvious with operations of small bones (such as scaphoid)although they are acceptable for spine and other orthopedic surgeries.We reviewed the current literatures on the applications of CAS for scaphoid operation and summarized technical principles,scan and registration methods,immobilization of limbs and their outcomes.On the basis of the data,we analyzed the limitations of this technique and envisioned its future development.展开更多
In this paper, we review some mathematical models in medical image processing. Due to the superiority in modeling and computation, variational methods have been proven to be powerful techniques, which have been extrem...In this paper, we review some mathematical models in medical image processing. Due to the superiority in modeling and computation, variational methods have been proven to be powerful techniques, which have been extremely popular and dramatically improved in the past two decades. On one hand, many models have been proposed for nearly all kinds of applications. On the other hand, a lot of models can be globally optimized and also many computation tools have been introduced. Under the variational framework, we focus on two basic problems in medical imaging： image restoration and segmentation, which are core components for kinds of specific tasks. For image restoration, we discuss some models on both additive and multiplicative noises. For image segmentation, we review some models on both whole image segmentation and specific target delineation, with the later being a key step in computer aided surgery. Additionally, we present some models on liver delineation and give their applications to living donor liver transplantation.展开更多
BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been est...BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been established.AIM To assess the efficacy and safety of combining intestinal stenting with laparoscopic surgery for the management of acute intestinal obstruction.METHODS Clinical data from 74 patients with colorectal cancer and acute intestinal obstruction,who were admitted to the emergency department of the authors’hospital between October 2023 and November 2024,were collected and analyzed.Patients were divided into two groups based on the surgical intervention:A control group(emergency open surgery,n=37)and a study group(intestinal stent implantation combined with laparoscopic surgery,n=37).Observation indicators included stent placement rate,obstruction relief rate,and stent-related complications.RESULTS Intestinal stent placement was 100%successful in the study group,all of whom experienced relief from obstruction while exhibiting a significantly lower rate of ostomy creation and a higher rate of primary anastomosis than in the control group,as well as less intraoperative blood loss,shorter time to flatus,and shorter hospital stay.The complication rate was 5.41%(2/37;bleeding and re-obstruction),with no statistically significant difference between the two groups in terms of operative duration or perioperative mortality.The overall complication rates were 5.41%(2/37)and 21.62%(8/37)in the intervention and control groups,respectively.Tumor recurrence and overall survival rates were 2.70%and 97.30%in the study group and 13.51%and 91.89%in the control group,respectively.CONCLUSION Intestinal stenting relieved acute obstructions,reduced the number of emergency surgeries,and supported laparoscopic procedures while improving primary anastomosis rates,minimizing ostomy occurrence,surgical trauma,and complications,and accelerating recovery.展开更多
Restoring the balance of gut microbiota has emerged as a critical strategy in treating intestinal disorders,with probiotics playing a pivotal role in maintaining bacterial equilibrium.Surgical preparations,trauma,and ...Restoring the balance of gut microbiota has emerged as a critical strategy in treating intestinal disorders,with probiotics playing a pivotal role in maintaining bacterial equilibrium.Surgical preparations,trauma,and digestive tract reconstruction associated with intestinal surgeries often disrupt the intestinal flora,prompting interest in the potential role of probiotics in postoperative recovery.Lan et al conducted a prospective randomized study on 60 patients with acute appendicitis,revealing that postoperative administration of Bacillus licheniformis capsules facilitated early resolution of inflammation and restoration of gastrointestinal motility,offering a novel therapeutic avenue for accelerated postoperative recovery.This editorial delves into the effects of perioperative probiotic supplementation on physical and intestinal recovery following surgery.Within the framework of enhanced recovery after surgery,the exploration of new probiotic supplementation strategies to mitigate surgical complications and reshape gut microbiota is particularly intriguing.展开更多
Acute rheumatic fever(ARF)and its sequela,rheumatic heart disease(RHD),remain major causes of morbidity and mortality in low-and middle-income countries,particularly in sub-Saharan Africa.In Cameroon,RHD accounts for ...Acute rheumatic fever(ARF)and its sequela,rheumatic heart disease(RHD),remain major causes of morbidity and mortality in low-and middle-income countries,particularly in sub-Saharan Africa.In Cameroon,RHD accounts for a considerable share of pediatric and adolescent heart disease.Severe valvular involvement often requires surgical intervention,but access to cardiac surgery is critically constrained.Since the 1980s,cardiac surgery in Cameroon has evolved from sporadic humanitarian missions to structured initiatives at the Douala and YaoundéGeneral Hospital and also the Shisong Cardiac Center.This article sheds light on the historical development and current state of cardiac surgery in Cameroon,emphasizing RHD as the leading surgical indication.It highlights both achievements and persistent gaps,and outlines perspectives for sustainability,including national training pathways,diaspora engagement,research and innovation,public-private partnerships,and South-South collaboration.Strengthening local capacity,securing sustainable financing mechanisms such as universal health coverage,and fostering regional cooperation are essential to build autonomous,resilient cardiac surgery programs in Cameroon.Addressing these priorities will be critical to improving access to timely surgical care and reducing preventable mortality from rheumatic heart disease.展开更多
Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma....Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma.However,the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored,particularly in non-Western populations.This study aims to explore patients’perceptions and preferences regarding laparoscopic incisions under ERAS,providing evidence to optimize incision planning and perioperative education.Methods A qualitative descriptive study was conducted at the Department of Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,between November 2022 and February 2023.The participants were adults(≥18 years)who underwent elective laparoscopic abdominal surgery under ERAS,excluding those with cognitive impairments,language barriers,or emergency procedures.Semi-structured interviews,covering physical function,social function,emotional function,self and others’acceptance,and confidence in the nature and treatment of the disease,were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons,nurses,and psychologists.The data were analyzed via the framework method to identify themes related to incision experiences.Results This qualitative study included 16 participants,8(50%)females and 6(37.5%)cancer patients,with a mean age of 41.5±12.2 years.Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location,size,and cosmetic appearance of the incision.They also voiced high expectations for preventing incision complications and sought information regarding postoperative care.There was notable variation in preferences regarding the choice of incision site before surgery.Participants with cancer focused on disease cure rather than aesthetics.Conclusion Personalized preoperative discussions,incision site selection,and postoperative education are critical for increasing patient satisfaction.Laparoscopic incisions under ERAS minimally impact psychological well-being,but location-specific discomfort and aesthetic preferences require attention.展开更多
BACKGROUND Gastrointestinal surgery has disadvantages such as long operation time,extended hospitalization time,and slow postoperative recovery.However,the promotion and clinical application of the enhanced recovery a...BACKGROUND Gastrointestinal surgery has disadvantages such as long operation time,extended hospitalization time,and slow postoperative recovery.However,the promotion and clinical application of the enhanced recovery after surgery(ERAS)concept have considerably shortened the hospitalization time of gastrointestinal surgery patients and reduced reactions to surgical stress and the risk of medical complications and readmission.ERAS breaks the conventional operating mode in the field of surgery but introduces great challenges in practice.AIM To explore the application of ERAS in perioperative patients within the field of gastrointestinal surgery,with a particular focus on investigating the awareness of ERAS among healthcare professionals and the barriers to its implementation.METHODS A retrospective study of medical records of perioperative patients in the gastrointestinal surgery ward of Ningbo No.2 Hospital from March 2020 to March 2022 was conducted.According to the different nursing modes adopted by patients during the perioperative period,patients were divided into the ERAS group and the control group.The postoperative outcomes of these groups such as the time to first ambulation,the time to first intake of food,and nursing satisfaction were compared.A self-developed questionnaire was used to assess the awareness of ERAS among healthcare professionals,along with a survey identifying barriers to its implementation.RESULTS Compared with the control group,the ERAS group demonstrated superior scores across various metrics,with the exception of the readmission rate due to complications within 1 month post-discharge(P<0.05).Statistically significant differences were observed between the two groups in terms of educational background,years of service,and prior training in ERAS(P<0.05).CONCLUSION ERAS significantly reduces the time to first ambulation and first food intake for patients undergoing gastrointestinal surgery.Furthermore,the awareness of ERAS among healthcare professionals correlates with their educational background,years of experience,and prior training.ERAS plays a crucial role in expediting patient recovery,improving nursing satisfaction,and optimizing healthcare resources.展开更多
AIM: To quantitatively investigate the retinal vascular diameter changes, analyzing the early and long-term effects on the retinal circulation, with 6-month follow-up. METHODS: Patients underwent horizontal strabismus...AIM: To quantitatively investigate the retinal vascular diameter changes, analyzing the early and long-term effects on the retinal circulation, with 6-month follow-up. METHODS: Patients underwent horizontal strabismus surger y were enrolled prospectively. Retinal vessel diameters on color fundus photographs were assessed before and 1, 7 d, 6 mo after surgery, using a computerassisted quantitative assessment software. To evaluate the retinal vascular caliber changes, retinal vascular diameters were calculated by means of the Parr–Hubbard formula as the central retinal arteriolar equivalent(CRAE) and central retinal venular equivalent(CRVE). The arteriovenous ratio(AVR) was calculated as CRAE divided by CRVE. RESULTS: A total of 154 eyes of 104 consecutive patients were included. Compared with the data before surgery(121.55±24.67), the mean CRAE(131.18±28.29) significantly increased 1 d af ter surger y(P=0.003), but went back to baseline level at 7 d(118.89±30.35, P=0.15), and 6 mo(123.22±15.32, P=0.60), so did the AVR(P<0.001, P=0.08, P=0.07). As for the mean CRVE, there was no significant difference between those four time points(172.43±33.25, 175.57±36.98, 174.03±40.18, 174.86±20.46, P=1.00). CONCLUSION: Strabismus surgery on both lateral and media rectus muscles, or single media rectus muscle may increase retinal blood flow during the early postoperative period, but would return to normal later. The number of transected anterior ciliary arteries rather might be the main cause of retinal hemodynamic changes early after strabismus surgery.展开更多
文摘1.The development history of enhanced recovery after surgery(ERAS)Enhanced recovery after surgery(ERAS)is a multimodal perioperative care approach that has evolved over the past 2 decades since its inception.In 1997,Professor Henrik Kehlet,also known as the“father of ERAS”,from the University of Copenhagen in Denmark first proposed the ERAS concept and discovered its clinical feasibility and superiority,achieving remarkable results.ERAS was initially applied in colorectal surgery;subsequently,the concept gradually gained popularity and application worldwide.
基金Supported by Universiti Sains Malaysia,Short-Term Grant,No.R501-LR-RND002-0000000342-0000.
文摘BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To analyses the effects of preoperative immunonutrition and standard oral nutrition supplements on colorectal surgery outcomes.METHODS This study employed a prospective single-center randomized double-blinded comparative approach and was conducted at Hospital Universiti Sains Malaysia between September 2023 and September 2024.In this study,the participants in the experimental group were supplied with a specialized oral supplement enriched with immune-modulating nutrients.Meanwhile,a conventional oral nutrition supplement was provided to the control group.The time to first flatus and the time to first bowel evacuation were the primary outcomes recorded.Incidence of nosocomial infections,surgical site infections,and the total length of hospital stay were considered secondary data.RESULTS This study involved 58 patients who were allocated into two groups.No dropouts were documented.The mean age of the participants was 61.20±12.96,and most were males(63.38%).All participants’baseline and surgical characteristics in both arms were also generally comparable.The participants in this study underwent colorectal surgery,where most had laparoscopic surgery(58%).Based on the results,no significant statistical differences were observed regarding the duration from the first flatus to the first bowel evacuation,the onset of a normal diet,and hospital stay between the experimental and control groups.Both groups also recorded 10(17.24%)infectious complications.CONCLUSION The findings indicated no notable variations in the primary and secondary endpoints despite the theoretical benefits of immune-modulating nutrients.Conclusively,routine preoperative immunonutrition may not provide additional advantages over standard nutrition in this demographic.
文摘BACKGROUND Enhanced recovery after surgery(ERAS)programs provide recommendations for an optimized management of patients undergoing surgery.An ERAS program tailored on surgery for retroperitoneal sarcomas(RPS)may improve patient outcomes and it has still not been established.AIM To determine how an ERAS program tailored to RPS surgery can be agreed upon,structured,and implemented.METHODS Twenty-five candidate items from existing ERAS programs,potentially relevant for RPS surgery,were identified via literature review and expert input.These were included in a questionnaire refined through cognitive interviews and pilot testing.Expert sarcoma surgeons rated each item’s relevance and feasibility on a 6-point scale.The survey was recirculated after one year.Intra-observer reproducibility,inter-observer concordance,and agreement with the modal value of the most experienced participants were analyzed.RESULTS Thirteen sarcoma surgeons from 6 centers participated in the survey.Although surgeons agreed on several items,their overall concordance was low.After recirculating the survey,the intraobserver reproducibility was low.Interestingly,the median concordance with the reference increased for relevance and decreased for feasibility.CONCLUSION Despite interest in ERAS for RPS,surgeon concordance on item relevance and feasibility remains low,underscoring the need for collaborative efforts toward a standardized,consensus-based protocol.
文摘Laparoscopic and endoscopic cooperative surgery(LECS)is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors.Several modifications of LECS—including inverted LECS,non-exposed endoscopic wall-inversion surgery,and closed LECS have evolved over a period of time to address the earlier concerns about peritoneal contamination and tumor seeding.These innovations have led to the application of combined laparoendoscopic techniques to several gastrointestinal(GI)lesions such as the duodenum,colon,and rectum.This minireview explores the evolution,current applications,and future potential of laparoendoscopic surgery in GI diseases.
文摘Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce. Aim: To test a novel AI commercially available tool for image analysis on a series of laparoscopic scenes. Methods: The research tools included OPENAI CHATGPT 4.0 with its corresponding image recognition plugin which was fed with a list of 100 laparoscopic selected snapshots from common surgical procedures. In order to score reliability of received responses from image-recognition bot, two corresponding scales were developed ranging from 0 - 5. The set of images was divided into two groups: unlabeled (Group A) and labeled (Group B), and according to the type of surgical procedure or image resolution. Results: AI was able to recognize correctly the context of surgical-related images in 97% of its reports. For the labeled surgical pictures, the image-processing bot scored 3.95/5 (79%), whilst for the unlabeled, it scored 2.905/5 (58.1%). Phases of the procedure were commented in detail, after all successful interpretations. With rates 4 - 5/5, the chatbot was able to talk in detail about the indications, contraindications, stages, instrumentation, complications and outcome rates of the operation discussed. Conclusion: Interaction between surgeon and chatbot appears to be an interesting frontend for further research by clinicians in parallel with evolution of its complex underlying infrastructure. In this early phase of using artificial intelligence for image recognition in surgery, no safe conclusions can be drawn by small cohorts with commercially available software. Further development of medically-oriented AI software and clinical world awareness are expected to bring fruitful information on the topic in the years to come.
基金supported by the Neurosurgery Pain Research Institute at Johns Hopkins University and by the Lehner Family Foundation.
文摘Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics clinical CPSS conditions by taking two sequential surgical procedures.Step 1:A plastic rod was inserted into the left L5 intervertebral foramen to produce a steady compression on the dorsal root ganglion(DRG)and the spinal nerve,a common cause of low back pain(LBP).Step 2:The rod was removed after 7 days when rats exhibited mechanical and heat hypersensitivity in the ipsilateral hindpaw,followed by a full L5 laminectomy to mimic spine decompression surgery in LBP patients.The retention of the rod induced a prolonged LBP-like behavior but was quickly resolved after rod removal without laminectomy.However,rats that received laminectomy after rod removal developed heightened mechanical and heat sensitivity in the hindpaw,impaired gait,and reduced spontaneous exploration activity,indicating CPSS.Patch clamp recording revealed a significant augmentation in the intrinsic excitability of smalldiameter DRG neurons in CPSS rats.Administration of Dermorphin[D-Arg2,Lys4](1–4)amide(DALDA,5mg/kg,i.p.),a peripherally acting mu-opioid receptor(MOR)-preferred agonist,attenuated pain hypersensitivity,capsaicin-induced[Ca^(2+)]i rising and the increased intrinsic excitability of DRG neurons from CPSS rats.Our findings suggest that this new model,which mirrors the nature of CPSS developed in patients,may be useful for future studies of the underlying mechanisms.
文摘AIM: To study the implementation of an enhanced recovery after surgery (ERAS) program at a large University Hospital from “pilot study” to “standard of care”.
文摘BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.
基金Supported by the Natural Science Foundation of Fujian Province(No.2024J011318No.2024J011321)Fuzhou Science and Technology Program(No.2023-S-005).
文摘Dear Editor,Descemet’s membrane detachment(DMD)is considered as a potential sight-threatening complication following various intraocular surgeries,particularly cataract surgery[1].The labile adhesion between the Descemet’s membrane(DM)and the posterior corneal stromal layer can be easily separated with minimal mechanical force.Several risk factors have been associated with the development of DMD including old age,improper intraoperative operation,corneal ectatic disorders,and endothelial disorders and so on[1-4].
文摘Computer assisted surgical planning allowed for a better selection of patients,evaluation of operative strategy, appropriate volumetric measurements,identification of anatomical risks, definition of tumour resection margins and choice of surgical approach in liver oncologic resections and living donor liver transplantations. Although preoperative computer surgical analysis has been widely used in daily clinical practice, intraoperative computer assisted solutions for risk analysis and navigation in liver surgery are not widely available or still under clinical evaluation. Computer science technology can efficiently assist modern surgeons during complex liver operations, mainly by providing image guidance with individualized 2 D images and 3 D models of the various anatomical and pathological structures of interest. Intraoperative computer assisted liver surgery is particularly useful in complex parenchyma-sparing hepatectomies, for intraoperative risk analysis and for the effective treatment of colorectal metastases after neoadjuvant therapy or when they are multiple. In laparoscopic liver surgery, intraoperative computer aid is definitively more important as, apart from a restricted field of view, there is also loss of the fine haptic feedback. Intraoperative computer assisted developments face challenges that prevent their application in daily clinical practice. There is a vast variety of studies regarding intraoperative computer assisted liver surgery but there are no clear objective measurements in order to compare them and select the most effective solutions. An overview of up-to-date intraoperative computer assisted solutions for liver surgery will be discussed.
文摘Objective: This study aims to investigate the drainage effect and clinical outcomes of negative pressure chest drainage in patients after two-port thoracoscopic valve surgery, comparing the differences in postoperative pain, hospital stay, and other factors between the negative pressure group and the control group. Methods: This study is a prospective controlled trial that selected patients undergoing two-port thoracoscopic valve surgery at a certain hospital from January 2019 to December 2024. Patients were randomly assigned to the control group and the negative pressure group using a random number table method. The control group consisted of 30 patients (20 males, 10 females, mean age 42.03 ± 12.89 years), and the negative pressure group consisted of 35 patients (26 males, 9 females, mean age 41.84 ± 11.83 years). The control group received traditional chest drainage, while the negative pressure group received negative pressure chest drainage. Postoperative pain scores, hospital stay, drainage time, number of tube blockages, and incidences of pneumothorax or subcutaneous emphysema were recorded and statistically analyzed. Results: The negative pressure group had a significantly shorter postoperative drainage time compared to the control group (49.09 ± 11.99 hours vs. 79.10 ± 7.32 hours, P < 0.001). The postoperative pain score was lower in the negative pressure group (4.49 ± 1.27 vs. 7.03 ± 0.85, P < 0.001), and the hospital stay was significantly shorter (9.83 ± 1.69 days vs. 14.73 ± 2.32 days, P < 0.001). The incidence of pneumothorax or subcutaneous emphysema was significantly lower in the negative pressure group than in the control group (14.29% vs. 56.67%, P = 0.0003). Conclusion: The application of negative pressure chest drainage in patients after two-port thoracoscopic valve surgery can effectively reduce postoperative pain, shorten hospital stay, and lower the incidence of tube blockage and pneumothorax, demonstrating good clinical outcomes.
文摘Bariatric and metabolic surgeries have gained extensive popularity and trust due to their documented efficacy and safety in managing not only obesity but also associated comorbidities such as diabetes mellitus, hypertension, dyslipidemia, sleep apnea, and joint pain. Traditionally, bariatric surgeries have been categorized into hypoabsorptive, restrictive, or hybrid approaches. However, these classifications inadequately reflect the complex anatomical and physiological alterations associated with modern surgical methodologies. This paper explores the evolution of metabolic surgeries, emphasizing the integration of physiological concepts into classic procedures to provide more tailored and effective treatment options for obesity and its comorbidities. Finally, the proposal for a new classification based on current metabolic concepts will facilitate communication among patients, doctors, and healthcare professionals. Additionally, it will enable a more didactic and standardized approach to data collection for conducting studies and publications.
基金the National Natural Science Foundation of China(No.51675036)the Innovation and Development Project of Intelligent Manufacturing Technique from Beijing Municipal Science and Technology Commission(No.Z161100001516012).
文摘The computer-assisted surgery (CAS)has significantly improved the accuracy, reliability and outcomes of traumatic,spinal,nerve surgery and many other operations with a less invasive way.The application of CAS for scaphoid fractures remains experimental.The related studies are scanty and most of them are cadaver researches.Some intrinsic defects from the registration procedure,scan and immobilization of limbs may inevitably result in deviations. Some deviations become more obvious with operations of small bones (such as scaphoid)although they are acceptable for spine and other orthopedic surgeries.We reviewed the current literatures on the applications of CAS for scaphoid operation and summarized technical principles,scan and registration methods,immobilization of limbs and their outcomes.On the basis of the data,we analyzed the limitations of this technique and envisioned its future development.
基金Supported by the National Natural Science Foundation of China (11101365)a National Science and Technology Project during the twelfth five-year plan of China (2012BAI10B04)
文摘In this paper, we review some mathematical models in medical image processing. Due to the superiority in modeling and computation, variational methods have been proven to be powerful techniques, which have been extremely popular and dramatically improved in the past two decades. On one hand, many models have been proposed for nearly all kinds of applications. On the other hand, a lot of models can be globally optimized and also many computation tools have been introduced. Under the variational framework, we focus on two basic problems in medical imaging： image restoration and segmentation, which are core components for kinds of specific tasks. For image restoration, we discuss some models on both additive and multiplicative noises. For image segmentation, we review some models on both whole image segmentation and specific target delineation, with the later being a key step in computer aided surgery. Additionally, we present some models on liver delineation and give their applications to living donor liver transplantation.
文摘BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been established.AIM To assess the efficacy and safety of combining intestinal stenting with laparoscopic surgery for the management of acute intestinal obstruction.METHODS Clinical data from 74 patients with colorectal cancer and acute intestinal obstruction,who were admitted to the emergency department of the authors’hospital between October 2023 and November 2024,were collected and analyzed.Patients were divided into two groups based on the surgical intervention:A control group(emergency open surgery,n=37)and a study group(intestinal stent implantation combined with laparoscopic surgery,n=37).Observation indicators included stent placement rate,obstruction relief rate,and stent-related complications.RESULTS Intestinal stent placement was 100%successful in the study group,all of whom experienced relief from obstruction while exhibiting a significantly lower rate of ostomy creation and a higher rate of primary anastomosis than in the control group,as well as less intraoperative blood loss,shorter time to flatus,and shorter hospital stay.The complication rate was 5.41%(2/37;bleeding and re-obstruction),with no statistically significant difference between the two groups in terms of operative duration or perioperative mortality.The overall complication rates were 5.41%(2/37)and 21.62%(8/37)in the intervention and control groups,respectively.Tumor recurrence and overall survival rates were 2.70%and 97.30%in the study group and 13.51%and 91.89%in the control group,respectively.CONCLUSION Intestinal stenting relieved acute obstructions,reduced the number of emergency surgeries,and supported laparoscopic procedures while improving primary anastomosis rates,minimizing ostomy occurrence,surgical trauma,and complications,and accelerating recovery.
文摘Restoring the balance of gut microbiota has emerged as a critical strategy in treating intestinal disorders,with probiotics playing a pivotal role in maintaining bacterial equilibrium.Surgical preparations,trauma,and digestive tract reconstruction associated with intestinal surgeries often disrupt the intestinal flora,prompting interest in the potential role of probiotics in postoperative recovery.Lan et al conducted a prospective randomized study on 60 patients with acute appendicitis,revealing that postoperative administration of Bacillus licheniformis capsules facilitated early resolution of inflammation and restoration of gastrointestinal motility,offering a novel therapeutic avenue for accelerated postoperative recovery.This editorial delves into the effects of perioperative probiotic supplementation on physical and intestinal recovery following surgery.Within the framework of enhanced recovery after surgery,the exploration of new probiotic supplementation strategies to mitigate surgical complications and reshape gut microbiota is particularly intriguing.
文摘Acute rheumatic fever(ARF)and its sequela,rheumatic heart disease(RHD),remain major causes of morbidity and mortality in low-and middle-income countries,particularly in sub-Saharan Africa.In Cameroon,RHD accounts for a considerable share of pediatric and adolescent heart disease.Severe valvular involvement often requires surgical intervention,but access to cardiac surgery is critically constrained.Since the 1980s,cardiac surgery in Cameroon has evolved from sporadic humanitarian missions to structured initiatives at the Douala and YaoundéGeneral Hospital and also the Shisong Cardiac Center.This article sheds light on the historical development and current state of cardiac surgery in Cameroon,emphasizing RHD as the leading surgical indication.It highlights both achievements and persistent gaps,and outlines perspectives for sustainability,including national training pathways,diaspora engagement,research and innovation,public-private partnerships,and South-South collaboration.Strengthening local capacity,securing sustainable financing mechanisms such as universal health coverage,and fostering regional cooperation are essential to build autonomous,resilient cardiac surgery programs in Cameroon.Addressing these priorities will be critical to improving access to timely surgical care and reducing preventable mortality from rheumatic heart disease.
基金supported by the Applied Research Grant Program of the Academy of Social Sciences of Zhejiang University(No.2020XZA108)Medical Science and Technology Project of Zhejiang Province(No.2023KY798)Key Project in the Agricultural and Social Development Sector of the Science and Technology Bureau of Hangzhou(No.20231203A09).
文摘Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma.However,the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored,particularly in non-Western populations.This study aims to explore patients’perceptions and preferences regarding laparoscopic incisions under ERAS,providing evidence to optimize incision planning and perioperative education.Methods A qualitative descriptive study was conducted at the Department of Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,between November 2022 and February 2023.The participants were adults(≥18 years)who underwent elective laparoscopic abdominal surgery under ERAS,excluding those with cognitive impairments,language barriers,or emergency procedures.Semi-structured interviews,covering physical function,social function,emotional function,self and others’acceptance,and confidence in the nature and treatment of the disease,were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons,nurses,and psychologists.The data were analyzed via the framework method to identify themes related to incision experiences.Results This qualitative study included 16 participants,8(50%)females and 6(37.5%)cancer patients,with a mean age of 41.5±12.2 years.Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location,size,and cosmetic appearance of the incision.They also voiced high expectations for preventing incision complications and sought information regarding postoperative care.There was notable variation in preferences regarding the choice of incision site before surgery.Participants with cancer focused on disease cure rather than aesthetics.Conclusion Personalized preoperative discussions,incision site selection,and postoperative education are critical for increasing patient satisfaction.Laparoscopic incisions under ERAS minimally impact psychological well-being,but location-specific discomfort and aesthetic preferences require attention.
基金Supported by Zhejiang Province Medical and Health Science and Technology Project,No.2025KY1381。
文摘BACKGROUND Gastrointestinal surgery has disadvantages such as long operation time,extended hospitalization time,and slow postoperative recovery.However,the promotion and clinical application of the enhanced recovery after surgery(ERAS)concept have considerably shortened the hospitalization time of gastrointestinal surgery patients and reduced reactions to surgical stress and the risk of medical complications and readmission.ERAS breaks the conventional operating mode in the field of surgery but introduces great challenges in practice.AIM To explore the application of ERAS in perioperative patients within the field of gastrointestinal surgery,with a particular focus on investigating the awareness of ERAS among healthcare professionals and the barriers to its implementation.METHODS A retrospective study of medical records of perioperative patients in the gastrointestinal surgery ward of Ningbo No.2 Hospital from March 2020 to March 2022 was conducted.According to the different nursing modes adopted by patients during the perioperative period,patients were divided into the ERAS group and the control group.The postoperative outcomes of these groups such as the time to first ambulation,the time to first intake of food,and nursing satisfaction were compared.A self-developed questionnaire was used to assess the awareness of ERAS among healthcare professionals,along with a survey identifying barriers to its implementation.RESULTS Compared with the control group,the ERAS group demonstrated superior scores across various metrics,with the exception of the readmission rate due to complications within 1 month post-discharge(P<0.05).Statistically significant differences were observed between the two groups in terms of educational background,years of service,and prior training in ERAS(P<0.05).CONCLUSION ERAS significantly reduces the time to first ambulation and first food intake for patients undergoing gastrointestinal surgery.Furthermore,the awareness of ERAS among healthcare professionals correlates with their educational background,years of experience,and prior training.ERAS plays a crucial role in expediting patient recovery,improving nursing satisfaction,and optimizing healthcare resources.
基金Supported by the Project for Collaboration Between Basis and Clinic of Capital Medical University(No.14JL04)。
文摘AIM: To quantitatively investigate the retinal vascular diameter changes, analyzing the early and long-term effects on the retinal circulation, with 6-month follow-up. METHODS: Patients underwent horizontal strabismus surger y were enrolled prospectively. Retinal vessel diameters on color fundus photographs were assessed before and 1, 7 d, 6 mo after surgery, using a computerassisted quantitative assessment software. To evaluate the retinal vascular caliber changes, retinal vascular diameters were calculated by means of the Parr–Hubbard formula as the central retinal arteriolar equivalent(CRAE) and central retinal venular equivalent(CRVE). The arteriovenous ratio(AVR) was calculated as CRAE divided by CRVE. RESULTS: A total of 154 eyes of 104 consecutive patients were included. Compared with the data before surgery(121.55±24.67), the mean CRAE(131.18±28.29) significantly increased 1 d af ter surger y(P=0.003), but went back to baseline level at 7 d(118.89±30.35, P=0.15), and 6 mo(123.22±15.32, P=0.60), so did the AVR(P<0.001, P=0.08, P=0.07). As for the mean CRVE, there was no significant difference between those four time points(172.43±33.25, 175.57±36.98, 174.03±40.18, 174.86±20.46, P=1.00). CONCLUSION: Strabismus surgery on both lateral and media rectus muscles, or single media rectus muscle may increase retinal blood flow during the early postoperative period, but would return to normal later. The number of transected anterior ciliary arteries rather might be the main cause of retinal hemodynamic changes early after strabismus surgery.
