World Journal of Gastrointestinal Surgery最新文献

Background: Early postoperative anastomosis-related complications are frequently associated with technical defects during the anastomotic procedure. Few studies focused on intraoperative anastomotic complications in esophagojejunostomy with circular stapler.

Aim: To explore whether endoscopic examination could reduce the occurrence of early postoperative anastomotic complications.

Methods: Clinical data from 160 patients with gastric cancer who underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler at Nanchong Central Hospital from January 2020 to December 2023 were retrospectively analyzed. Based on whether intraoperative endoscopic examination (IEE) was performed, patients were divided into the IEE group and the non-IEE (NIEE) group.

Results: All patients successfully underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler. In the IEE group, 7 (8.8%) patients were found to have anastomotic defects: 3 (3.8%) air leaks, 2 (2.5%) bleeding, 1 (1.3%) stricture and 1 (1.3%) full-thickness tearing. Three patients with anastomotic discontinuities were subsequently treated with additional suturing. One anastomotic bleeding was managed with laparoscopic suturing, and another was treated with endoscopic clips. One patient had anastomotic stricture, which was corrected intraoperatively. One patient experienced full-thickness tearing caused by the circular stapler, necessitating a redo anastomosis. These anastomotic defects were repaired intraoperatively, and no postoperative anastomotic complications occurred. 6 (7.5%) patients with postoperative anastomotic complications were observed in the NIEE group. The NIEE group had a significantly higher incidence of postoperative anastomosis-related complications compared to the IEE group (7.5% vs 0%; P = 0.029).

Conclusion: Routine IEE significantly reduces early anastomotic complications by enabling immediate detection and repair of technical defects in esophagojejunostomy with circular stapler.

Colonic anastomotic leakage (AL) remains the most severe complication of colorectal surgery, significantly increasing morbidity, mortality, and healthcare burdens. The ideal solution - complete AL prevention without a defunctioning stoma - has long eluded surgeons and patients. Hu et al proposed total enteric flow diversion using a modified ileostomy tube with an inflatable balloon, demonstrating its efficacy in completely preventing AL in porcine models. This innovation echoes the ancient legend of Yu the Great, a Chinese hero renowned for taming the Yellow River's catastrophic floods. Unlike his father, who failed by merely building embankments to block water, Yu succeeded by dredging channels to redirect floods seaward. This paradigm of "diversion over obstruction" applies equally to AL prevention. Beyond Hu et al's balloon technique, alternatives like the C-seal, the SafeHeal Colovac+ anastomosis protection device and Tong et al's biodegradable stent-based diverting techniques show promise in clinical trials. Key challenges remain: Diversion efficiency, device migration risks, and patient tolerance. We must accelerate such like breakthroughs in non-stoma diversion strategies to transform AL management.

Background: A literature review revealed that intraductal papillary mucinous neoplasm of the biliary tract (IPMN-B) cases with characteristic clinical, imaging, endoscopic, and pathological features are exceedingly rare. Herein, we present a case of typical IPMN-B with malignant transformation that required 4 years for a definitive diagnosis, to enhance the understanding of this disease entity.

Case summary: A 67-year-old male patient was referred to our hospital due to abdominal pain and jaundice. Four years before this admission, a cystic lesion and left hepatolithiasis were incidentally discovered. Laboratory tests revealed mild increases in serum white blood cell count, total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase. Tumour marker levels were within normal limits. Imaging findings demonstrated an enlargement of the cystic tumour from 41 mm to 63 mm, along with the development of numerous enhancing papillary nodules within it, which showed hyperenhancement during the arterial phase. Duodenoscopy revealed an enlarged major duodenal papilla with a fish-mouth appearance and dilated orifice, exuding translucent jelly-like mucus. Endoscopic retrograde cholangiography demonstrated multiple cloudy, irregular filling defects within the dilated extrahepatic bile duct. Following the diagnosis of IPMN-B, left hepatectomy was performed. Postoperative histopathological examination and immunohistochemistry confirmed IPMN-B with high-grade intraepithelial neoplasia and associated invasive carcinoma.

Conclusion: Heightened vigilance and recognition of IPMN-B are essential when "hepatic cysts" or "biliary stones" are incidentally detected.

Background: Gastric cancer is a major global health issue, especially in East Asia. Radical gastrectomy, the primary treatment, often leads to complications like malnutrition and infection, impairing recovery. Traditional Chinese medicine may offer benefits in regulating gastrointestinal function and immunity. This study investigated the effects of a modified Pingwei Baohe decoction (MPBD) on postoperative immune function and nutritional status in gastric cancer patients.

Aim: To explore the influence of MPBD on the postoperative immune function and nutritional status of patients with gastric cancer.

Methods: A total of 55 gastric cancer patients who underwent radical proximal gastrectomy in Hebei Provincial People's Hospital and The Fourth Hospital of Hebei Medical University from June 2023 to June 2025 were selected as the research objects and divided into the observation group (28 cases, receiving chemotherapy plus MPBD) and the control group (27 cases, receiving chemotherapy alone) at a ratio of 1:1 according to the random number table method. Inflammatory indicators, immune function, nutritional status, and gastrointestinal function recovery time were compared before and 28 days after intervention.

Results: After 28 days, the observation group showed significantly lower levels of inflammatory markers (IL-6, IL-4, IL-2, IL-17A, IFN-γ, TNF-α, IL-10), neutrophil-to-lymphocyte ratio (NLR), and proportion of CONUT score > 2, alongside significantly higher levels of CD3⁺, CD4⁺, CD4⁺/CD8⁺ ratio, absolute lymphocyte count (ALC), lymphocyte percentage (LYM%), and TNF-α/IL-4 ratio compared to the control group (P < 0.05). In both groups, post-intervention levels of the aforementioned inflammatory markers, NLR, and proportion of CONUT score > 2 were significantly lower than baseline, while the immune parameters (CD3⁺, CD4⁺, CD4⁺/CD8⁺ ratio, ALC, LYM%, TNF-α/IL-4 ratio) were significantly higher (P < 0.05). Additionally, gastrointestinal function recovery times (first flatus, bowel sounds recovery, abdominal distension relief) in the observation group were significantly shorter than in the control group (P < 0.05).

Conclusion: MPBD significantly enhances postoperative immune function, mitigates inflammatory responses, improves nutritional status, and accelerates gastrointestinal function recovery in gastric cancer patients.

Background: Laparoscopic fenestration is a common treatment for hepatic cysts, but postoperative recurrence and complications remain concerns.

Aim: To evaluate suturing the liver's round ligament to the cyst wall after laparoscopic fenestration for hepatic cysts.

Methods: This retrospective case series study involved patients who underwent the novel surgical technique at the Second People's Hospital of Changzhou, affiliated with Nanjing Medical University, between December 2022 and March 2024. The perioperative indicators observed included operative duration, intraoperative blood loss, the occurrence of bile leakage or hemorrhage within the drainage fluid, and the duration of hospital confinement.

Results: Fifteen patients were included. The surgeries were successfully completed laparoscopically, with a mean operative duration of 75.0 ± 15.4 minutes and minimal intraoperative blood loss. No major complications, such as significant bleeding, bile leakage, or intra-abdominal infections, were reported. The follow-up period, ranging from 3 months to 12 months, revealed a cure rate of 40.0% and a total efficacy rate of 100%, with no cases deemed ineffective.

Conclusion: Suturing the free pedicled round ligament to the cyst wall after laparoscopic fenestration is feasible and effective, with promising cure rates.

Background: Postoperative recurrence is common in Crohn's disease (CD), with endoscopic lesions in a majority of patients by 12 months after surgery. Ileocolonoscopy is the reference standard but is invasive and poorly suited to frequent surveillance. Intestinal ultrasound (IUS) - including small intestine contrast ultrasound and contrast enhanced ultrasound - is a repeatable, noninvasive alternative.

Aim: To summarize the evidence on the diagnostic accuracy and prognostic value of IUS for detecting postoperative recurrence in CD.

Methods: We systematically searched PubMed and EMBASE through June 2025 for original English-language studies evaluating IUS against clinical or endoscopic outcomes in postoperative CD. This scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline. After screening 259 unique records, 41 full texts were assessed and 20 studies were included.

Results: Bowel wall thickness thresholds of ≥ 5 mm at the neo-terminal ileum predict endoscopic recurrence with sensitivities 81%-94% and specificities 86%-100%; lower cutoffs at the anastomosis (≥ 3-3.5 mm) also carry risk (data from singlecenter cohorts). Dualsite assessment (neo-terminal ileum + ileocolonic anastomosis) improves performance. Adding Doppler hyperemia or mesenteric lymphadenopathy increases accuracy; combining bowel wall thickness ≥ 3 mm with fecal calprotectin ≥ 50 μg/g yields high specificity (approximately 93%-100%) with a negative predictive value of nearly 95% when both are negative. Contrast enhanced ultrasound-based composite scores reach approximately 98% diagnostic accuracy in prospective cohorts. Small intestine contrast ultrasound shows similarly strong early diagnostic performance - for example, an area under the receiver operating characteristic curve up to 0.95 when using ileocolonic anastomosis wall thickness ≥ 3 mm to 3.5 mm plus lesion length, with 82%-94% sensitivity and > 90% specificity reported even within 7 days post-resection. Overall, IUS shows moderate agreement with endoscopy (κ approximately 0.5-0.8) and stronger prognostic value when performed within 12 months post-surgery.

Conclusion: IUS can be integrated into postoperative surveillance algorithms - particularly within the first year - and can reduce routine endoscopy in selected patients. Research priorities include standardized thresholds and composite scoring, consensus training/competency, and multicenter validation including artificial intelligenceassisted interpretation.

Background: The gut-vascular barrier (GVB) is critical for maintaining intestinal homeostasis, but its involvement in intestinal obstruction (IO) remains unclear.

Aim: To investigate GVB disruption in patients with IO and its association with perioperative infection, organ injury, and clinical prognosis.

Methods: Intestinal tissues from surgical patients with IO (IO group) and without obstruction (control group) were analyzed for PV1, a biomarker of GVB disruption. In the IO group, PV1 expression correlated with clinical data. Patients were further stratified into PV1-high and PV1-low subgroups, and clinical parameters were compared.

Results: PV1 expression was significantly elevated in the IO group. In the IO group, PV1 levels were positively correlated with perioperative infection markers, liver and kidney injury indices, and adverse prognostic indicators, including prolonged hospitalization, antibiotic use, fever duration, and postoperative complications. Several of these outcomes were significantly worse in the PV1-high subgroup than in the PV1-low subgroup, although severe postoperative complications and mortality did not differ.

Conclusion: Our findings demonstrate that IO induces GVB damage, and the extent of impairment is closely associated with infection, organ injury, and adverse clinical outcomes in surgical patients, suggesting a pathogenic role for GVB disruption in IO.

Background: Patients with postoperative severe acute pancreatitis (SAP) in the intensive care unit (ICU) face complex challenges arising from physiological and microenvironmental imbalances, psychological stress, and the interaction of multiple environmental factors. Traditional nursing models inadequately address this integrated microenvironment, highlighting the need for microenvironment theory-based nursing interventions to optimize outcomes.

Aim: To evaluate the impact of a microenvironment theory-based nursing intervention model on the prognosis of patients with postoperative SAP in the ICU.

Methods: Between January 2022 and December 2024, 106 patients with SAP who were admitted to ICU of the Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital) were randomly assigned to two groups: (1) A control group (n = 53, routine care); and (2) An observation group (n = 53, routine care plus microenvironment theory-based nursing). Postoperative recovery, psychological distress, disease severity, and complication rates were compared between groups.

Results: The observation group had significantly shorter postoperative flatus, defecation, and hospital stay compared with the control group (P < 0.05). The Hamilton Depression Rating Scale (17-item) and Hamilton Anxiety Rating Scale (14-item) scores in the observation group were significantly lower than those in the control group (P < 0.05). The observation group had a lower Acute Physiology and Chronic Health Evaluation II score (P < 0.05) compared with the control group. The postoperative complication rates were 5.66% (3/53) and 18.87% (10/53) in the observation group and control group, respectively (P < 0.05).

Conclusion: In patients with SAP, the microenvironment theory-based nursing intervention model facilitated postoperative recovery, alleviated depression and anxiety, reduced disease severity, and decreased postoperative complications.

Background: Enhanced recovery after surgery (ERAS) guidelines have been established for multiple types of adult surgeries. However, ERAS guidelines tailored to pediatric surgeries remain to be developed.

Aim: To evaluate the clinical outcomes of ERAS protocols in pediatric laparoscopic Meckel's diverticulum resection.

Methods: This retrospective cohort study analyzed 78 consecutive pediatric cases treated between January 2017 and March 2025. Patients were divided into: Traditional care group (n = 38): January 2017-December 2020; ERAS protocol group (n = 40): January 2021-March 2025. We compared perioperative outcomes, including clinical recovery parameters and laboratory markers, to assess protocol efficacy.

Results: All procedures were completed laparoscopically by the same surgical team without conversion. Baseline characteristics, including demographics, diverticulum location, and intraoperative parameters (operative time, blood loss), were comparable between groups (all P > 0.05). The ERAS protocol demonstrated significantly shorter postoperative length of stay (7.55 ± 1.52 days vs 10.40 ± 3.59 days, P < 0.001) while complication rates were numerically lower in the ERAS group (17.50% vs 13.16%, P = 0.595). Additional benefits of ERAS implementation included: Reduced intravenous fluid requirements (5.00 mL/kg/hour vs 8.00 mL/kg/hour), accelerated gastrointestinal recovery (first flatus: 2.00 days vs 3.00 days), lower pain scores (P < 0.001), earlier total enteral nutrition achievement (5.00 days vs 6.50 days) and shorter intravenous therapy duration (6.00 days vs 8.00 days; all P < 0.001). ERAS patients also showed reduced drainage utilization (P < 0.05) and improved inflammatory marker profiles postoperatively [neutrophils: (5.98 ± 2.02) × 10⁹/L vs (8.01 ± 3.98) × 10⁹/L]; median C-reactive protein: 13.6 mg/L 7 vs 19.63 mg/L). Glycemic control was superior in the ERAS group despite higher induction levels (both P < 0.05). Parental satisfaction (92.50% vs 86.84%) and 30-day readmission rates (2.50% vs 2.63%) showed no significant differences.

Conclusion: ERAS protocols safely optimize recovery in children undergoing laparoscopic Meckel's diverticulum resection, significantly reducing length of stay while improving pain management and overall clinical outcomes. These findings support the adoption of ERAS in pediatric intestinal surgery.