Journal of Gastrointestinal Surgery最新文献

Background: The management of foreign body ingestion in the adult population varies widely given the lack of evidence-based guidelines. The purpose of this study was to identify risk factors associated with the need for operative intervention in these cases.

Methods: This was a retrospective cohort study between July 2015-January 2021. All adult patients (age ≥18 years) presenting after foreign body ingestion were included. We collected and analyzed demographics and clinical outcomes data. Multivariable regression was utilized to identify foreign body characteristics associated with operative interventions.

Results: A total of 303 patient encounters were included. Ingested foreign bodies were classified as sharp/pointed (64.7%), blunt (40.6%), magnetic (8.3%), or corrosive/battery (5.0%). Forty percent underwent endoscopic interventions, including esophagogastroduodenoscopy (35.3%), and colonoscopy (4.6%). Twelve (4.0%) patients underwent an operative intervention secondary to perforation or failure to progress. Patients with perforation or failure to progress had longer median foreign body lengths compared to patients without these complications (11.5cm vs. 3.0cm, p<0.001). On multivariate regression analysis, foreign body length was significantly associated with the need for operative intervention (odds ratio [OR]: 1.67 for each centimeter increment, p<0.001). The ingestion of sharp/pointed objects was associated with a lower risk of operative intervention (OR: 0.20, p=0.04).

Conclusion: Adult patients who present after foreign body ingestion can often be managed conservatively. The length of ingested objects appears to be more associated with the need for operative intervention rather than the shape. Early endoscopic removal of high-risk foreign bodies should be considered when feasible.

Background: Few studies have developed artificial intelligence systems for automatic recognition of the anatomy of the stomach, a dynamic organ capable of expansion and contraction. This study aimed to create a three-dimensional simulation to assist gastric cancer surgery by combining artificial intelligence models to visualize the positional relationships among the stomach, surrounding organs, and blood vessels.

Methods: We developed a deep learning-based model using an artificial intelligence system to segment abdominal organs and detect blood vessels, including mid-artery level structures from contrast-enhanced computed tomography images. Surgical structures including the stomach, pancreas, and arteries were extracted using a blood vessel detection model. Two surgeons and two radiologists evaluated 51 three-dimensional images for structural detection confidence using a five-point scale and compared them to standard computed tomography images.

Results: A retrospective analysis of 51 cases of preoperative patients with gastric cancer demonstrated that artificial intelligence-generated images provided clear visualization of the spatial relationships between blood vessels and organs. Structures, including the left hepatic-left-gastric artery, common duct and its branches, and the short gastric artery distinct from the splenic artery, were clearly identified. These findings were useful for surgical planning. The reliability score for detecting blood vessels was significantly higher (P < 0.05) for the artificial intelligence images compared to the computed tomography images, with good agreement among the evaluators.

Conclusion: Automatic organ recognition systems are promising, valuable tools for gastric cancer surgery, improving preoperative planning and potentially reducing operative time and complications.

Background: Single-port mediastinoscopic radical esophagectomy represents the least invasive form of esophagectomy that avoids thoracotomy or thoracoscopy. However, conventional double-instrument approaches are constrained by a narrow operative field, often leading to limited mediastinal lymph node dissection and a risk of recurrent laryngeal nerve (RLN) injury. Although the introduction of continuous intraoperative nerve integrity monitoring (NIM) has markedly reduced the incidence of RLN palsy, the adequacy of lymphadenectomy remains a major concern. To address this limitation, we introduced a triple-instrument cervical approach to enhance operative visibility and precision.

Methods: Between May 2020 and April 2025, 48 consecutive patients with thoracic esophageal cancer underwent single-port mediastinoscopic radical esophagectomy with continuous NIM at our institution. Among them, 26 received a triple-instrument cervical approach, while 22 underwent a conventional double-instrument approach. Clinicopathological characteristics and perioperative outcomes were compared between the two groups.

Results: Triple-instrument access significantly increased the number of mediastinal lymph nodes retrieved (median 22 [IQR 7-46] vs 16 [IQR 2-42], P = 0.048), without significant differences in blood loss (median 123 vs 63mL, P = 0.266), RLN palsy (7.7% vs 4.5%, P = 0.881), or hospital stay (median 14 days in both groups, P = 0.883). Multivariate analysis identified the triple-instrument technique as an independent predictor of high lymph node yield (odds ratio = 5.55, 95% CI 1.19-25.8, P = 0.029).

Conclusion: The triple-instrument cervical approach represents a technically feasible and oncologically sound refinement of single-port mediastinoscopic esophagectomy. By combining continuous NIM and improved ergonomics, this technique enhances mediastinal lymphadenectomy without increasing morbidity.

Background: The RefluxStop procedure, shown to effectively eliminate gastroesophageal reflux disease (GERD) symptoms in clinical trial, has been offered at our clinic since 2020. Promising short-term outcomes in initial cohorts have been published; we now present outcomes for 100 patients with follow-up of at least 1 year.

Methods: A retrospective cohort study was performed with the first 100 patients to reach 12-month postoperative follow-up. The primary endpoint was symptom resolution, quantified using the GERD Health-Related Quality of Life (GERD-HRQL) score; secondary effectiveness endpoints included patient satisfaction and proton pump inhibitor (PPI) use. Safety data were reported as surgical complications up to 90 days and device- or surgery-related complications during the 12-month follow-up.

Results: At baseline, 53% of the patients had hiatal hernia of ≥4cm, 66% had ineffective esophageal motility, and 46% reported preoperative dysphagia. Median (IQR) GERD-HRQL score (0-75 points) decreased by 97.6% from 42.5 (29-50) preoperatively to 1.0 (0-5) at 12 months (p<0.001). PPI use decreased from 94.8% at baseline to 5.2% at 12 months. Two cases of early device penetration to the stomach occurred, attributable to surgical technique with unduly tight pouch closure; no intervention was required. Two patients (2%) required revision surgery for hiatal repair, both had hernia >7cm at baseline.

Conclusion: In this cohort of 100 severe sufferers, the RefluxStop procedure resulted in excellent 12-month outcomes with median 97.6% improvement in total GERD-HRQL score, resolving GERD symptoms to a high level of satisfaction, even in clinically complex patient groups.