World Journal of Gastrointestinal Surgery最新文献

Emerging evidence underscores the critical role of intestinal microbiota in postoperative recovery and long-term outcomes of gastrointestinal procedures. In this editorial, we comment on the retrospective study by Niu et al, which highlights the beneficial impact of dietary fiber supplementation on gut microbiota restoration following endoscopic mucosa resection. The findings highlight the potential of fiber supplementation to modulate gut microbiota and support recovery following endoscopic mucosa resection. Nonetheless, we also emphasize the need for prospective, randomized studies to delineate the optimal type, dose, and duration of fiber supplementation. This research represents a significant step toward evidence-based nutritional interventions in minimally invasive gastrointestinal surgery and underscores the importance of microbiota-targeted therapies in personalized postoperative care.

This letter discusses the findings of Pang et al retrospective study on omental patch repair as a balanced treatment for gastric ulcer perforation. We acknowledge its clinical value while highlighting a critical limitation: Conventional mechanical closure often results in fibrotic scarring and functional impairment across the mucosal, muscular, and neurovascular layers. To address this, we propose the innovative concept of "multi-layer repair" and present a proof-of-concept three-dimensional bioprinted functional biopatch. This patch features a multilayer structure: An inner layer laden with gastric mucosal organoids and an outer layer containing primary gastric muscle cells, both integrated onto a wet-adhesive electrospun membrane. Preliminary animal studies have yielded encouraging results, supporting its potential to promote functional restoration beyond mechanical sealing.

Background: Postoperative nutritional management of gastric cancer (GC) remains a problem that needs to be solved in clinical treatment.

Aim: To develop an early graded nutrition management plan and evaluate its impact on feeding tolerance, nutritional status, and prognosis.

Methods: In total, 142 patients who underwent laparoscopic radical gastrectomy at Jiujiang University Affiliated Hospital between August 2021 and August 2022 were included in this study. Based on postoperative nutritional management and feeding, the patients were divided into observation and control groups. The general information questionnaire, Visual Analog Scale, and Pittsburgh Sleep Quality Index were used to evaluate pain and sleep of patients, respectively. Independent sample t-test and χ ² test were used to analyze differences between groups.

Results: The feeding intolerance rates in the control and observation groups were 13.2% and 4.1%, respectively. Hospitalization time and first defecation times in the observation group were shorter than those in the control group. Hemoglobin, prealbumin, transferrin, and immunological indices in the observation group were significantly higher than those in the control group 7 days after surgery, whereas calcitonin levels were significantly lower than those in the control group (P < 0.05). In general, the nutritional status of the observation group was better than that of the control group, and pain and sleep quality scores improved.

Conclusion: Compared with the conventional postoperative feeding, early stepwise nutritional management can significantly enhance the nutritional status of patients with GC after surgery, improve their feeding tolerance, and reduce postoperative complications.

Background: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is a common complication of the procedure. The effective prevention of post-ERCP pancreatitis (PEP) remains a key focus of clinical research.

Aim: To develop a prediction model for PEP based on multidimensional clinical indicators and evaluate its clinical application value.

Methods: We retrospectively analyzed 183 patients with biliary tract diseases who underwent ERCP at Xuzhou Medical University from January 2020 to June 2023, divided into non-PEP (n = 159) and PEP (n = 24) groups based on PEP development. Baseline and intraoperative data were compared, and PEP-related factors examined via univariate and multivariate logistic regression. Using R, 70% of patients were assigned to training and 30% to testing sets for PEP prediction model development. Model accuracy was evaluated using a calibration curve and receiver operating characteristic (ROC) area under the curve (AUC).

Results: Age, total cholesterol level, history of pancreatitis, pancreatic ductography, bleeding, and intubation time differed significantly between the two groups when baseline data and intraoperative conditions were compared (P < 0.05). Multifactorial logistic regression analysis demonstrated that age [odds ratio (OR) = 0.192, 95% confidence interval (CI): 0.053-0.698], total cholesterol (OR = 0.324, 95%CI: 0.152-0.694), history of pancreatitis (OR = 6.159, 95%CI: 1.770-21.434), pancreatography (OR = 3.726, 95%CI: 1.028-13.507), and bleeding (OR = 3.059, 95%CI: 1.001-9.349) were independently associated with acute pancreatitis after ERCP. The predictive probabilities from the calibration curves had mean errors of 0.021 and 0.030, with ROC AUCs of 0.840 and 0.797 in the training and test sets, respectively.

Conclusion: Age, total cholesterol, pancreatitis history, pancreatic ductography, and bleeding influence the risk of acute PEP. A model incorporating these factors may aid early detection and intervention.

Background: With an aging society, older patients undergoing cholecystectomy often have multiple chronic diseases and require long-term multi-medication. Medication complexity significantly increases the risk of medication errors and adverse reactions, and effective nursing interventions are urgently required to ensure medication safety.

Aim: To investigate the efficacy of evidence-based nursing practices in mitigating polypharmacy risks among Suzhou Municipal Hospital Road Front Yard Area, thereby providing clinical guidance.

Methods: The sixty older patients who underwent cholecystectomy between September 2024 and September 2025 treated with polypharmacy were enrolled. Using random number tables, hey were divided into study and control groups (n = 30 each), who received routine medication nursing and evidence-based nursing, respectively. Pre-intervention and post-intervention comparisons were made between groups for medication knowledge, competence, and adherence scores. The incidences of duplicate medications, missed doses, self-discontinuation, unauthorized alterations, schedule changes, and adverse reaction rates assessed potential medication risks.

Results: Both the study and control groups showed significant increases in medication knowledge, management competence, and adherence scores after intervention (all P < 0.05). The study group had higher post-intervention scores (medication knowledge: 87.29 ± 5.09 vs 70.62 ± 5.38; medication management competence: 63.22 ± 3.11 vs 56.19 ± 4.08; medication adherence: 7.13 ± 1.04 vs 6.05 ± 1.03, all P < 0.05). The incidence of duplicate medication, missed doses, self-discontinuation, unauthorized dose alterations, and schedule modifications decreased in both groups post-intervention (all P < 0.05), with lower rates in the study group (duplicate medication: 13.33% vs 30.0%; missed doses: 10.0% vs 26.67%; all P < 0.05). The study group had a lower adverse reaction rate (3.33% vs 26.67%, P < 0.05) and more patients with potential medication hazard level 0 (83.33% vs 53.33%), while fewer patients had level 2 and 3 hazards (3.33% vs 16.67% and 0% vs 10.00%, respectively; all P < 0.05).

Conclusion: Evidence-based nursing for polypharmacy risks in older adults undergoing cholecystectomy can enhance medication awareness, improve management and adherence, reduce adverse behaviors, and lower adverse reactions and hazard levels.

Background: Pediatric short bowel syndrome (SBS) poses management challenges, and teduglutide is a potential therapy. However, comprehensive data on its pediatric safety are lacking.

Aim: To evaluate the impact of teduglutide on infection and gastrointestinal adverse events in pediatric SBS patients via systematic review and meta-analysis.

Methods: Following PRISMA 2009 guidelines and PROSPERO registration, we searched PubMed, Web of Science, and EMBASE for randomized controlled trials (RCTs) (pediatric SBS patients ≤ 18 years; teduglutide vs placebo/standard care). Two reviewers screened studies, extracted data, and assessed bias (ROB2). Meta-analyses used RevMan 5.4 (Mantel-Haenszel method, random-effects if I ² ≠ 0). Trial sequential analysis and GRADE were applied.

Results: Three RCTs involving 115 pediatric patients were included. Pooled analysis revealed no statistically significant differences between the teduglutide and control groups for the primary outcome of infection events [RR = 0.83; (95%CI: 0.44-1.56); P = 0.57; I ² = 0%; 2 studies, n = 55]. Similarly, no significant differences were found for secondary outcomes: Upper respiratory tract infection [RR = 0.68; (95%CI: 0.32-1.47); P = 0.33; I ² = 0%], catheter site infection [RR = 1.86; (95%CI: 0.23-14.78); P = 0.56; I ² = 0%], vomiting [RR = 1.35; (95%CI: 0.10-18.23); P = 0.82; I ² = 72%], abdominal pain [RR = 2.47; (95%CI: 0.50-12.16); P = 0.27; I ² = 0%], nausea [RR = 1.31; (95%CI: 0.24-7.22); P = 0.75; I ² = 0%], diarrhea [RR = 1.02; (95%CI: 0.23-4.43); P = 0.98; I ² = 0%], and abdominal distension [RR = 1.49; (95%CI: 0.18-12.35); P = 0.71; I ² = 0%]. The overall certainty of evidence assessed by GRADE was moderate.

Conclusion: Teduglutide does not increase infection or gastrointestinal adverse event risk in pediatric SBS, but small sample sizes limit conclusions. Larger studies are needed.

Background: Functional gastrointestinal disorders (FGIDs) are common gastrointestinal conditions that significantly impair patient quality of life. Current clinical treatment methods are relatively limited, making the search for more effective therapeutic strategies critically important. Latent myofascial trigger points (MTrPs) injection, as an emerging minimally invasive treatment method, has shown potential in alleviating muscle pain and improving function, but its application in FGIDs remains insufficiently validated.

Aim: To assess improvements in gastrointestinal symptom severity, quality of life indices, and treatment-related adverse events between the two therapeutic approaches.

Methods: This single-blind randomized controlled study recruited 60 FGIDs patients from Qilu Hospital of Shandong University, randomly divided into an injection group (TI group) and an oral medication group (PO group) at a 1:1 ratio. The TI group received abdominal wall latent MTrPs injection therapy, while the PO group received oral symptomatic medication treatment. Primary outcome measures were gastrointestinal symptom severity scores (Gastrointestinal Symptom Rating Scale, Irritable Bowel Syndrome Severity Scoring System scales) at 2 weeks and 4 weeks after treatment completion. Secondary outcome measures included Gastrointestinal Quality of Life Index scores. Both groups underwent rigorous follow-up and assessment.

Results: The TI group is anticipated to significantly outperform the PO group in gastrointestinal symptom relief and quality of life improvement. TI group patients are expected to show a notable decrease in symptom scores, increased quality of life index, and higher clinical effectiveness rate. Additionally, the TI group is projected to have a low adverse event rate and good safety profile.

Conclusion: Latent MTrPs injection therapy may represent an effective and safe new method for treating FGIDs. Compared to traditional oral medication treatment, this method demonstrates significant advantages in improving patient symptoms and quality of life.

Perioperative morbidity of esophagectomy significantly affects the surgical outcome, like any major gastrointestinal procedure. Despite introduction of minimally invasive esophagectomy, the morbidity is still close to 30%-40%. The common complications following esophagectomy are pulmonary infections, cardiac events, anastomotic leakage, bleeding, chylous leak, and recurrent laryngeal nerve palsy which in turn lead to longer hospital stay, increased treatment cost and poor quality of life. A nomographic model comprising preoperative (patient, disease and treatment related) and intraoperative factors in combination with Artificial Intelligence may accurately identify the patients at higher risk of morbidity. This will aid in optimizing the modifiable risk factors preoperatively, and closely monitor these patients post operatively for early identification of complications and to initiate early corrective measures to improve the surgical outcome.

The clinicians remain uncertain about the ideal timing for loop ileostomy reversal following rectal resection surgery. The common practice of waiting 8-12 weeks to protect from anastomotic complication, especially in patients who receive neoadjuvant chemoradiotherapy, would expose patients to dehydration, electrolyte disturbances, stoma related complications, and reduced quality of life. Randomized controlled trials have studied early reversal of ileostomy, with results ranging from improved outcomes in selected patients to increased morbidity when applied indiscriminately. Meta-analyses have also yielded heterogeneous findings, reflecting the need for careful patient selection. The study by Özcan and Düzgün used retrospective methods to show that patients who underwent early closure experienced similar complication rates to those who had late closure, but early closure were associated with better quality of life. Taken together, current evidence suggests that reversal within 2-4 weeks may be safe and beneficial in meticulously selected patients with an intact anastomosis and an uneventful postoperative course. Their study provides practical data supporting early closure. It is limited, however, by being retrospective with a short follow-up period, which may leave important concerns unaddressed. Multicenter randomized trials are required to help establish safe standardized criteria for early closure and long-term safety.

Background: Colorectal cancer (CRC) is a common malignant tumor of the digestive system that poses a serious threat to human health. During the perioperative period, patients with CRC are prone to nutritional risks and malnutrition. Compared with traditional nutritional support, immunostimulatory nutrients, including glutamine (Gln), have attracted increasing attention. Although many previous studies have reported that perioperative Gln supplementation can improve short-term clinical outcomes in patients with CRC, some studies have not demonstrated a benefit. Resolution of Gln supplementation value thus requires further exploration.

Aim: To clarify the influence of perioperative Gln-enhanced nutritional support on postoperative outcomes including nutritional status, immune function, inflammation levels, morbidity due to complications, and length of hospital stay (LOS).

Methods: A comprehensive literature search was conducted (inception to June 2025). PubMed, EMBASE, Web of Science, Cochrane Library, China Biomedical Database, CNKI, VIP, and the Wanfang Electronic Database were searched. This meta-analysis ultimately included 27 studies with a total of 1643 patients; 827 patients received perioperative Gln treatment and 816 received conventional nutritional therapy. A random-effects model was used to pool relative risks (RR) and mean differences (MD) with 95% confidence intervals (CI).

Results: Pooled analysis showed that Gln intervention reduced morbidity associated with postoperative infectious complications (RR = 0.36; 95%CI: 0.24-0.54) and non-infectious complications (RR = 0.32; 95%CI: 0.19-0.55) and shortened the LOS by 2.31 days (MD = -2.31; 95%CI: -3.21 to -1.41) in CRC patients. Gln supplementation also increased serum albumin, prealbumin, peripheral blood lymphocyte count, and nitrogen balance levels and improved humoral and cellular immune function. We also found that postoperative tumor necrosis factor-α and C-reactive protein levels were lower in Gln-supplemented patients. By contrast, Gln supplementation did not improve CD8⁺ and CD4⁺/CD8⁺ levels.

Conclusion: Gln supplementation effectively improved short-term clinical outcomes in patients with CRC.