World Journal of Gastrointestinal Surgery最新文献

Background: Pancreatic duct stones often develop in the late stage of chronic pancreatitis. However, for complex pancreatic duct stones or stones in the pancreatic body and tail, endoscopic treatment is often ineffective and ultimately requires surgical intervention.

Case summary: A young man who had been smoking for 10 years and drinking alcohol for 5 years had a history of abdominal pain for 8 years and diarrhea for 2 years. The patient was diagnosed with "chronic pancreatitis combined with pancreatic duct stones" in other hospitals and underwent several endoscopic treatments, but the abdominal pain still recurred. The patient presented to our hospital one week after another episode of abdominal pain. Our team arranged for computed tomography and magnetic resonance imaging examinations, which revealed a markedly atrophic pancreas and a dilated pancreatic duct, and a large number of stones. Our team convened a multidisciplinary consultation to discuss treatment options and reviewed extensive literature. Ultimately, based on the literature and consultation advice, we implemented a novel, previously unreported surgical procedure. The surgical approach we proposed combines the Beger procedure and the Frey procedure, involving complete pancreatic head resection with duodenal preservation, full-length longitudinal incision of the pancreatic duct in the body and tail, and side-to-side pancreaticojejunostomy. Postoperative follow-up revealed a favorable prognosis.

Conclusion: The main contribution of this case is the development of a modified surgical procedure for chronic pancreatitis complicated by complex pancreatic duct stones. For chronic pancreatitis complicated by stones that respond poorly to pharmacotherapy or endoscopic treatment, surgery is a worthy early treatment option. Early surgical intervention can effectively drain pancreatic juice, delay pancreatic atrophy, and protect pancreatic function. Our proposed modified procedure can more thoroughly remove stones and reduce the recurrence rate of stones and pain. Although we successfully treated a patient with this procedure for the first time, its efficacy and safety in a human population are currently lacking validation.

The compelling study by Liu et al delivers a critical verdict: The primary tumor site is not merely an anatomical detail, but a fundamental prognostic imperative in the surgical management of colorectal liver metastases. Their analysis of 178 patients definitively establishes right-sided colonic origin as an independent harbinger of aggressive disease, characterized by significantly higher recurrence rates and inferior survival outcomes compared to left-sided and rectal cancers. This biological dichotomy is further elucidated by the strong association of right-sided tumors with an adverse prognostic profile, including rampant lymph node metastasis, elevated D-dimer (reflecting a pro-thrombotic, pro-metastatic state), hypoalbuminemia, and resistance to neoadjuvant therapy. These findings necessitate an immediate paradigm shift in clinical practice. We can no longer treat colorectal cancer as a monolith. Preoperative risk stratification, surgical decision-making, and adjuvant therapy plans must be tailored according to the primary tumor location. For patients with right-sided primaries, these data suggest a more aggressive multimodal approach and vigilant, personalized surveillance to improve upon the discouraging outcomes this study clearly exposes.

Background: The choice between Billroth II and Roux-en-Y reconstruction after radical gastrectomy for gastric cancer (GC) affects the occurrence of reflux and the quality of life (QoL) in patients.

Aim: To investigate the QoL and reflux oesophagitis incidence in patients who underwent Billroth II or Roux-en-Y gastrointestinal reconstruction after radical gastrectomy for GC.

Methods: One hundred patients with GC who underwent radical resection at our hospital between January 2023 and December 2024 were enrolled. The patients were divided into two groups based on the postoperative gastrointestinal reconstruction technique: The Billroth II group and the Roux-en-Y group, comprising 50 patients each. The incidence of gastroesophageal reflux within two weeks postoperatively was compared between the groups, including 24-hour reflux episodes, frequency of reflux episodes lasting > 5 minutes, and maximum reflux duration. The reflux symptom scores were measured. Nutritional indicators, including serum albumin (ALB), prealbumin (PA), and haemoglobin (Hb), were assessed 4 and 8 weeks postoperatively. The QoL was evaluated using the QLQ-C30 questionnaire. The incidence of reflux oesophagitis was monitored at 3 months of follow-up.

Results: No significant differences were observed between the groups in terms of baseline clinical characteristics (P > 0.05). At 2 weeks postoperatively, the Roux-en-Y group exhibited significantly lower 24-hour reflux episodes, episodes lasting > 5 minutes, and maximum reflux duration than the Billroth II group (P < 0.05). The Roux-en-Y group exhibited significantly lower reflux symptom scores, including epigastric burning, acid regurgitation, upper abdominal distension, and upper abdominal pain, than the Billroth II group (P < 0.05). No significant differences were observed in the peripheral blood ALB, PA, or Hb levels at 4 and 8 weeks postoperatively between the two groups (P > 0.05). The QLQ-C30 scores at 4 and 8 weeks postoperatively were significantly higher in the Roux-en-Y group than in the Billroth II group (P < 0.05). At the 3-month postoperative follow-up, the incidence of reflux oesophagitis was 4.0% in the Roux-en-Y group, significantly lower than the 16.0% observed in the Billroth II group (P < 0.05).

Conclusion: Among patients with GC undergoing gastrointestinal reconstruction, Roux-en-Y procedures resulted in fewer cases of gastroesophageal reflux and milder symptoms than Billroth II procedures. Nutritional status was comparable postoperatively between the two reconstruction techniques. However, the former significantly affects the patients' QoL less favourably and exhibits a lower incidence of reflux oesophagitis, demonstrating considerable clinical significance.

Background: Bile duct metastasis from gastric cancer is a very rare secondary cancer, which can cause biliary obstruction.

Case summary: A 42-year-old male presented with right upper abdominal discomfort and jaundice after a total gastrectomy for poorly differentiated gastric adenocarcinoma. He underwent comprehensive laboratory tests and imaging examinations, and ultimately endoscopic retrograde cholangiopancreatography with choledochoscopy was performed. Stenoses were identified in the common hepatic duct and the common bile duct. Under choledochoscopic guidance, biopsy was taken from the bile duct tissue at the stenotic site. Then, a plastic stent was placed across the stenosis. Pathological examination with immunohistochemical staining confirmed poorly differentiated adenocarcinoma of the common bile duct. Following the procedure, the patient's liver function gradually improved, and his abdominal discomfort was also relieved.

Conclusion: This case indicates the possibility of bile duct metastasis from gastric cancer and highlights the necessity of endoscopic retrograde cholangiopancreatography combined with choledochoscopy in patients with suspicious malignant biliary obstruction.

Background: Surgery for Hirschsprung's disease (HD) generally results in a satisfactory outcome, but some patients continue to have bowel dysfunction. There are very few studies in the literature that compare the early and late clinical outcomes.

Aim: To evaluate changes in anorectal function and clinical outcome with age in patients who underwent Duhamel operation (DO) for HD.

Methods: Twenty-eight patients who had previously undergone DO to treat HD were invited to an outpatient clinic upon reaching adulthood to participate in follow-ups. The patients' clinical data from the early and mid-term follow-ups were evaluated retrospectively based upon the hospital records and datasets from previous studies. The functional outcome tests in adulthood included anorectal manometry, rectoanal inhibitory reflex, maximum anal resting pressure, and a questionnaire.

Results: Among the patients that reached adulthood and underwent early and mid-term evaluations, only 10 responded to the invitation and attended. That study population was comprised of 8 males and 2 females, ranging in age from 19 years to 25 years, with an average of 21.57 years. The anorectal inhibitory reflex was abnormal in 6 of the patients (66.7%). While the rate of patients who were deemed clinically "good" at the early postoperative evaluation was 53%, that rate reached to 90% in the adult evaluation.

Conclusion: Improvement correlated with age, while other anorectal manometric parameters were unchanged. Long-term adult follow-up is essential for objectively evaluating surgical outcomes and overall success.

Background: Post-colonoscopy colorectal cancer (PCCRC) remains an important issue in endoscopic examination. This study investigates the clinical features of PCCRC and possible correlation factors.

Aim: To explore clinical features of PCCRC and correlation factors.

Methods: A retrospective cohort analysis enrolled patients diagnosed with colorectal cancer (CRC) via colonoscopy at West China Hospital, Sichuan University, between January 1, 2022, and December 30, 2024. Demographic data, tumor characteristics, endoscopic findings, and miss records were extracted from electronic medical records and telephone follow-ups. An exploratory analysis was performed to identify causes of missed diagnosis during endoscopy.

Results: Among 5411 colonoscopies in 2047 CRC patients, 66 prior examinations (27 colonoscopies in 17 non-PCCRC patients; 39 colonoscopies in 25 PCCRC patients) failed to establish diagnosis. The overall miss rate was 1.2%, with a PCCRC rate of 0.7%. Compared to the non-PCCRC group, advanced age was significantly associated with PCCRC (P = 0.006). The most common location that occurred PCCRC was sigmoid colon. PCCRC cases had higher rate of prior CRC surgery (41.0%). For endoscopists, PCCRC cases with CRC surgery increased the risk of judgement error. Insertion time demonstrated a positive correlation with missed diagnosis risk, whereas withdrawal time exhibited a negative correlation.

Conclusion: The incidence of PCCRC remains significant. Beyond tumor characteristics, endoscopist proficiency and procedural factors critically impact detection accuracy.

Background: Interleukin-8 (IL-8), a pro-inflammatory chemokine, is implicated in angiogenesis, tumor growth, and metastasis. However, its diagnostic and prognostic significance in colorectal cancer remains unclear.

Aim: To evaluate the diagnostic utility of serum IL-8 in patients with newly diagnosed colon adenocarcinoma.

Methods: In this prospective case-control study, 44 treatment-naïve patients with colon adenocarcinoma and 44 age-matched healthy controls were enrolled. Preoperative serum IL-8 levels were measured by enzyme-linked immunosorbent assay. Statistical analyses included univariate and multivariate models, odds ratios, and receiver operating characteristic (ROC) curve analysis.

Results: Serum IL-8 levels were significantly higher in patients than in controls (P = 0.005). ROC curve analysis yielded an area under the curve of 0.68, with both sensitivity and specificity of 63.6% at a cut-off value of 42.3 ng/L. Multivariate analysis confirmed IL-8 as an independent predictor (odds ratio = 1.050), with each 1 ng/L increase conferring a 5% higher risk. No significant associations were observed with tumor stage, location, or histopathological features.

Conclusion: IL-8 may serve as a diagnostic biomarker in colon adenocarcinoma, and its potential prognostic role warrants validation in larger, multicenter cohorts.

Background: Chronic calculous cholecystitis (CCC), caused by persistent gallstone-induced inflammation, can lead to development of small cell neuroendocrine carcinoma (SCNEC) of the gallbladder through chronic irritation, cellular damage, and repair. This report describes a rare case of advanced SCNEC of the gallbladder potentially induced by CCC and highlights its clinical features and treatment challenges.

Case summary: A 64-year-old woman with a history of CCC presented with persistent right upper quadrant pain. Imaging revealed a mass in the gallbladder and hepatic hilum. The patient underwent radical cholecystectomy and hepatic resection. Histopathological examination confirmed SCNEC with synaptophysin and CD56 positivity and Ki-67 of 80%. Due to severe hepatic dysfunction (total bilirubin ≥ 300 μmol/L, albumin ≤ 25 g/L), chemotherapy was contraindicated. The patient's condition deteriorated rapidly, and she died 2 months postoperatively.

Conclusion: Early detection and surgical intervention are critical for improving outcomes in gallbladder SCNEC associated with chronic inflammation.

Background: Laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric surgery owing to its effective weight loss and low complication rates. Nonetheless, some patients experience weight regain or insufficient weight loss due to residual gastric dilation, the factors of which remain unclear.

Aim: To evaluate changes in residual gastric volume after LSG using three-dimensional computed tomography reconstruction and to investigate the factors contributing to gastric dilation.

Methods: This retrospective study included 50 patients who underwent LSG. Preoperative clinical and laboratory data were obtained. The residual gastric volume was measured using three-dimensional computed tomography reconstruction at 1 month and 3 months postoperatively. The total sleeve volume, tube volume, antral volume, and tube-to-antral volume ratio were also assessed. Resected gastric volume and staple line length were measured during surgery. Weight metrics and laboratory indices were recorded at 1 month, 3 months, 6 months, and 12 months postoperatively. The Eating Behavior After Bariatric Surgery Questionnaire and Gastroesophageal Reflux Disease Questionnaire (GERD-Q) were used to assess the dietary behavior of patients after LSG. Correlation between the degree of residual gastric dilation and percent total weight loss (%TWL) at 12 months postoperatively was analyzed. Univariate and multivariate correlation analyses were conducted to identify risk factors for residual gastric dilation after LSG.

Results: The 50 included patients had a mean preoperative body mass index of 42.27 ± 7.19 kg/m² and average %TWL of 34% ± 7% at 1 year after LSG. At 1 month after LSG, the mean tube volume, antral volume, and total sleeve volume were 45.93 ± 16.75 mL, 115.85 ± 44.92 mL, and 161.77 ± 55.37 mL, respectively. At 3 months after LSG, the residual gastric volume showed statistically significant dilation (average dilation degree: 13.50% ± 17.35%). %TWL at 1 year significantly correlated with residual gastric dilation (P < 0.05). Univariate and multivariate linear regression analyses revealed that preoperative type 2 diabetes, residual gastric volume at 1 month after LSG, and GERD-Q scores were independent risk factors influencing the degree of residual gastric dilation.

Conclusion: In conclusion, residual gastric dilation after LSG significantly affected the efficacy of weight loss. Preoperative type 2 diabetes, residual gastric volume at 1 month after LSG, and GERD-Q scores were independent risk factors affecting the degree of residual gastric dilation.

Background: Patients with gastric cancer (GC) often experience complex pain, including a neuropathic component, which may influence their response to perioperative interventions.

Aim: To identify neuropathic pain (NP) components in patients with GC and evaluate the clinical efficacy of perioperative psychological interventions.

Methods: The study comprised 100 patients with GC who underwent surgical treatment at Jiujiang No. 1 People's Hospital between April 2022 and April 2025. Using randomized number tables, the participants were allocated into either an observation (n = 50) or control (n = 50) group. The control group received conventional perioperative pain management, while the observation group received additional perioperative psychological interventions. Between-group differences were compared in terms of pain intensity, pain characteristics, anxiety and depression levels, postoperative analgesic consumption, early postoperative recovery, and recovery quality.

Results: On postoperative day 7, both groups exhibited higher Numeric Rating Scale scores for resting and activity pain than that demonstrated on preoperative day 1 (P < 0.05), while Hospital Anxiety and Depression Scale (HADS)-Anxiety and HADS-Depression scores were also lower (P < 0.05). Regarding the primary outcomes, patients in the observation group exhibited lower Numeric Rating Scale scores for resting and activity-related pain and a lower NP-positivity rate than those in the control group (P < 0.05). For the secondary outcomes, patients in the observation group had fewer effective presses for intravenous patient-controlled analgesia, lower morphine equivalents, earlier time to first ambulation, earlier time to first flatus, shorter hospital stays, and higher Quality of Recovery-15 scores compared with the control group (P < 0.05). Moreover, their HADS-Anxiety and HADS-Depression scores were also lower than those in the control group (P < 0.05). Stratified regression analysis revealed significant main effects of group assignment and NP status (P < 0.05), with a significant interaction term between group assignment and NP status (P < 0.05).

Conclusion: Effective identification of the NP component in the patients' pain, coupled with perioperative psychological interventions, significantly reduced pain intensity and NP-positivity rates. This approach improved anxiety and depressive symptoms, decreased postoperative analgesic use, accelerated early recovery, and enhanced quality of recovery.