World Journal of Gastrointestinal Surgery最新文献

Background: Acute gastrointestinal injury (AGI) is common in intensive care unit (ICU) and worsens the prognosis of critically ill patients. The four-point grading system proposed by the European Society of Intensive Care Medicine is subjective and lacks specificity. Therefore, a more objective method is required to evaluate and determine the grade of gastrointestinal dysfunction in this patient population. Digital continuous monitoring of bowel sounds and some biomarkers can change in gastrointestinal injuries. We aimed to develop a model of AGI using continuous monitoring of bowel sounds and biomarkers.

Aim: To develop a model to discriminate AGI by monitoring bowel sounds and biomarker indicators.

Methods: We conducted a prospective observational study with 75 patients in an ICU of a tertiary-care hospital to create a diagnostic model for AGI. We recorded their bowel sounds, assessed AGI grading, collected clinical data, and measured biomarkers. We evaluated the model using misjudgment probability and leave-one-out cross-validation.

Results: Mean bowel sound rate and citrulline level are independent risk factors for AGI. Gastrin was identified as a risk factor for the severity of AGI. Other factors that correlated with AGI include mean bowel sound rate, amplitude, interval time, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, platelet count, total protein level, blood gas potential of hydrogen (pH), and bicarbonate (HCO₃ ^-) level. Two discriminant models were constructed with a misclassification probability of < 0.1. Leave-one-out cross-validation correctly classified 69.8% of the cases.

Conclusion: Our AGI diagnostic model represents a potentially effective approach for clinical AGI grading and holds promise as an objective diagnostic standard for AGI.

Background: Laparoscopic anatomical liver resection has become more challenging because some subsegmental Glissonean pedicles are hard to dissect. Here, we introduce how to dissect every (sub) segmental Glissonean pedicle from the first porta hepatis and perform standardized (sub) segmentectomy [from segment 1 (S1) to S8].

Aim: To summarize our methods of laparoscopic anatomical segmental and subsegmental liver resection.

Methods: The Glisson sheath and liver capsule were separated along the Laennec membrane. The Glissonean pedicle could be isolated and transected with little or no parenchymal damage through this extra-Glissonean dissection approach. The basin of the (sub) segment was determined by the ischemia demarcation line or indocyanine green staining. The hepatic vein or intersegmental vein was also used to guide the plane of parenchymal transection.

Results: All segmental or subsegmental pedicles or even the pedicle of the cone unit could be dissected along the Laennec membrane using our novel technique through the first porta hepatis. The dorsal branches of S8, the branches of S4a and the paracaval portion branches (b/c vein) of the caudate lobe were the most difficult to dissect.

Conclusion: The novel techniques of liver segmental and subsegmental pedicle anatomy is feasible for laparoscopic liver resection and can help accurately guide (sub) segmentectomy from S1 to S8.

In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Surgery. It investigates the potential mechanism of alcohol use disorder (AUD) following weight loss and its future prospects. We are particularly interested in this issue. According to existing research, the occurrence of AUD is closely linked to social factors, and the prevalence of AUD varies across different regions. However, there are limited studies on bariatric surgery and postoperative AUD in the Asian population, leaving ample room for further research in this area. Additionally, we believe that postoperative follow-up and dietary management are crucial. A multi-system integrated approach to management is the future direction for treating obesity.

Background: Anastomotic leakage (AL) is a significant complication of rectal cancer surgery, particularly in patients undergoing neoadjuvant chemoradiotherapy. This study aimed to evaluate the onset and prognostic factors influencing AL in these patients and provide insights for better postoperative management.

Aim: To explore AL incidence in patients who underwent neoadjuvant radiotherapy for rectal cancer and evaluate influencing factors and prognosis.

Methods: We retrospectively analyzed data of patients with rectal cancer who underwent neoadjuvant chemoradiotherapy post-radical surgery admitted to our hospital from January 2020 to January 2023. Postoperative AL was recorded in all patients. Among 63 patients with AL initially enrolled, 2 were lost to follow-up; thus, 61 patients were included in the incident group. Another 59 patients without AL were included in the non-incident group. Clinical characteristics of both groups were analyzed to identify factors affecting postoperative AL and determine prognosis.

Results: Multivariate analysis revealed that sex, operative time, bleeding, pelvic radiation injury, and intraoperative blood transfusion were independent risk factors for postoperative AL (P < 0.05). The Swiss Institute for Experimental Cancer Research (ISREC) grades for patients with postoperative AL were mainly A (49.18%) and B (40.98%), and most leakages occurred in the posterior wall (65.57%). Clinical manifestations included anal sacrococaudal pain (29.51%), anal pus (26.23%), and other symptoms. Invasive interventions were performed < 2 times in 80.33% of patients. Poor prognoses were mainly associated with chronic pressacral sinus formation (24.59%), anastomotic stenosis (29.51%), and long-term stoma (19.67%). Multivariate analysis revealed distance from the anal margin and ISREC grade as independent risk factors for poor prognosis following AL (P < 0.05).

Conclusion: Sex, operative time, bleeding loss, pelvic radiation damage, and intraoperative blood transfusion are independent risk factors for AL and the distance between tumor and ISREC grade potentially affect prognosis.

Background: Mucosal adenocarcinoma of the descending duodenum is a very rare gastrointestinal tumor. Due to its low incidence, it has rarely been the focus of clinical and pathological studies. The clinical manifestations of these tumors are usually nonspecific, and they are easily misdiagnosed or missed. Pathological diagnosis is the gold standard for diagnosis, but due to the small number of cases, the relevant pathological characteristics and diagnostic criteria are not completely clear. The purpose of this study was to deepen the understanding of the diagnosis and treatment of this disease and to provide a clinical guidance.

Case summary: A 61-year-old woman who was hospitalized with recurrent abdominal pain for more than 20 days. The patient developed epigastric pain with no obvious cause more than 20 days prior, mainly left epigastric pain and middle epigastric pain, and presented persistent dull pain without nausea or vomiting, fever or chills. The patient was treated at a local hospital, gastroscopy revealed a new lesion in the circum-intestinal cavity in the descending part of the duodenum, and pathological biopsy revealed mucous adenocarcinoma in the descending part of the duodenum. Currently, for further diagnosis and treatment, the patient is admitted to our hospital for surgical treatment for "malignant tumor of the duodenum" in the outpatient department.

Conclusion: Mucosal adenocarcinoma of the descending duodenum has a high misdiagnosis rate and missed diagnosis rate, clinical manifestations lack specificity, and pathological diagnosis is the main basis for diagnosis.

Background: Gastric cancer is the leading cause of cancer-related deaths worldwide. Early gastric cancer (EGC) is often associated with the risk of lymph node metastasis, which influences treatment decisions. Despite the use of enhanced computed tomography, the prediction of lymph node involvement remains challenging.

Aim: To investigate the risk factors for lymph node metastasis and invasion depth in patients with EGC.

Methods: In total, 210 patients with pathologically diagnosed EGC were included in this study. Univariate and multivariate statistical analyses were used to predict risk factors for lymph node metastasis and invasion depth in patients with EGC.

Results: Among the 210 patients, 27 (12.9%) had lymph node metastases. Of the 117 patients with submucosal gastric cancer, 24 (20.5%) had lymph node metastases. Both univariate and multivariate analyses indicated that the depth of invasion in EGC was a risk factor for lymph node metastasis in these patients. Additionally, pathological type was identified as a risk factor for cancer cell invasion in patients with EGC.

Conclusion: EGC invasion depth, not tumor type, size, age, sex, or location, predicts lymph node spread. Tumor type, not size, age, sex, or location, predicts cancer cell invasion.

Background: The 5-year survival rate of patients with advanced gastric cancer remains extremely low (< 15%), whereas the 5-year survival rate of patients with early gastric cancer (EGC) is > 90%. Consequently, strengthening the screening of patients with EGC and precancerous lesions (PCLs) is essential.

Aim: To identify the value of serum pepsinogen ratio (PGR) screening for EGC and PCLs in the Shengli Oilfield Central Hospital.

Methods: We first selected 385 patients with gastric lesions in the Youcheng area, determining benign lesions, PCLs, and EGC in 135, 123, and 127 cases, respectively, based on endoscopy and case diagnosis. The positive rates of pepsinogen I, pepsinogen II and Helicobacter pylori (H. pylori) in the three groups were detected, and the PGR was calculated. Subsequently, we plotted receiver operating characteristic curves to analyze the screening value of PGR and H. pylori-positive rates for PCLs and EGC.

Results: PGR expression demonstrated a decreasing trend in patients with benign lesions, PCLs, and EGC successively according to the detection results, whereas the H. pylori-positive rate was notably increased in patients with PCLs and EGC compared to those with benign lesions. The area under the curves (AUCs) of PGR, H. pylori, and their combination in differentiating patients with benign lesions from those with PCLs were 0.611, 0.582, and 0.689, respectively; PGR, H. pylori, and their combination had an AUC of 0.618, 0.502, and 0.618 in distinguishing PCL patients from EGC patients, respectively; the AUCs of PGR, H. pylori, and their combination in discriminating patients with benign lesions from those with EGC were 0.708, 0.581, and 0.750, respectively.

Conclusion: PGR has great screening potential for patients with EGC and PCLs in the Youcheng area, and the screening efficiency is further improved by combining the H. pylori-positive rate.

Background: Laparoscopic cholecystectomy is considered the gold standard for the treatment of patients with gallstones. However, bile duct injury is one of the most serious complications of this surgery, with an incidence rate of 0.3%-0.7%. Variations in anatomical structures are one of the main reasons for such injuries.

Case summary: We report a 26-year-old male patient who presented with repeated upper abdominal pain for 1 year. Ultrasound examination and blood tests indicated gallstones accompanied by chronic cholecystitis. The patient underwent laparoscopic cholecystectomy. During the surgery, a communicating bile duct connecting the gallbladder neck and the right hepatic duct was discovered and injured. Meticulous dissection identified it as a communicating accessory hepatic duct, which was then definitively ligated. Postoperatively, the patient recovered well, magnetic resonance imaging and magnetic resonance cholangiopancreatography showed no intrahepatic or extrahepatic bile duct strictures. The pathology report showed chronic cholecystitis with gallstones.

Conclusion: Carefully manage communicating accessory bile ducts in cholecystectomy using cholangiography or meticulous separation, followed by ligation is effective.

This article is a comment on the article by Jia et al, aiming at establishing a predictive model to predict the occurrence of preoperative gastric retention in endoscopic retrograde cholangiopancreatography preparation. We share our perspectives on this predictive model. First, further differentiation in predicting the severity of gastric retention could enhance clinical outcomes. Second, we ponder whether this predictive model can be generalized to predictions of gastric retention before various endoscopic procedures. Third, large datasets and prospective clinical validation are needed to improve the prediction model.

Background: Postoperative patients undergoing gastrointestinal surgery often encounter challenges such as low immune function, delayed wound healing owing to surgical trauma, and increased nutritional demands during recovery.

Aim: To assess the effect of comprehensive nutritional support program on immune function and wound healing in patients undergoing gastrointestinal surgery.

Methods: This retrospective comparative study included 60 patients who underwent gastrointestinal surgery, randomly assigned to either the experimental group (n = 30) or the control group (n = 30). The experimental group received comprehensive nutritional support, including a combination of enteral and parenteral nutrition, whereas the control group received only conventional comprehensive nutritional support. Evaluation indicators included immune function markers (e.g., white blood cell count, lymphocyte subsets), wound healing (wound infection rate, healing time), pain score [visual analog scale (VAS) score], and psychological status (anxiety score, depression score) 7 days post-surgery) and duration of stay.

Results: The immune function of patients in the experimental group was significantly better than that in the control group. The white blood cell count was 8.52 ± 1.19 × 10⁹/L in the experimental group vs 6.74 ± 1.31 × 10⁹/L (P < 0.05). The proportion of CD4+ T cells was higher in the experimental group (40.09% ± 4.91%) than that in the control group (33.01% ± 5.08%) (P < 0.05); the proportion of CD8+ T cells was lower (21.79% ± 3.38% vs 26.29% ± 3.09%; P < 0.05). The CD4+/CD8+ ratio was 1.91 ± 0.32 in the experimental group whereas 1.13 ± 0.23 in the control group (P < 0.05). The wound infection rate of the experimental group was significantly lower than that of the control group (10% vs 30%, P < 0.05), and the wound healing time was shorter (10.35 ± 2.42 days vs 14.42 ± 3.15 days, P < 0.05). The VAS score of the experimental group was 3.05 ± 1.04, and that of the control group was 5.11 ± 1.09 (P < 0.05); the anxiety score (Hamilton Anxiety Rating Scale) was 8.88 ± 1.87, and that of the control group was 12.1 ± 3.27 (P < 0.05); the depression score (Hamilton Depression Rating Scale) was 7.37 ± 1.41, and that of the control group was 11.79 ± 2.77 (P < 0.05). In addition, the hospitalization time of the experimental group was significantly shorter than that of the control group (16.16 ± 3.12 days vs 20.93 ± 4.84 days, P < 0.05).

Conclusion: A comprehensive nutritional support program significantly enhances immune function, promote wound healing, reduces pain, improves psychological status, and shortens hospitalization stays in patients recovering from gastrointestinal surgery.