World Journal of Gastrointestinal Surgery最新文献

Background: Laparoscopic cholecystectomy is the primary method for treating cholecystitis. Traditional postoperative care has poor outcomes for patient recovery. The enhanced recovery after surgery (ERAS) model is increasingly applied in clinical settings. However, the impact of this nursing model on patients undergoing laparoscopic cholecystectomy remains unclear.

Aim: To evaluate the effects of ERAS on postoperative gastrointestinal recovery and quality of life in patients undergoing laparoscopic cholecystectomy.

Methods: This is a retrospective study design in which we collected clinical data from 120 patients who underwent laparoscopic cholecystectomy at our hospital. Patients were divided into a control group (n = 60) and a study group (n = 60) based on the type of nursing intervention. The control group received conventional care, while the study group received ERAS. We assessed gastrointestinal recovery, quality of life, and nursing satisfaction before and after the nursing interventions in both groups.

Results: After nursing care, the gastrointestinal recovery times (time to bowel sounds return, time to flatus, time to first bowel movement, and time to first meal) in the study group were significantly shorter than those in the control group, with statistically significant differences between the two groups (P < 0.05). Additionally, the quality of life in the study group was significantly higher than that in the control group (P < 0.05). The nursing satisfaction in the study group was also significantly higher than that in the control group, with statistically significant differences between the two groups (P < 0.05).

Conclusion: In summary, compared to conventional nursing, ERAS can more rapidly promote gastrointestinal recovery and improve the quality of life in patients after laparoscopic cholecystectomy. Further clinical application of this approach is warranted.

Background: Peroral endoscopic esophageal myotomy (POEM) is an innovative, minimally invasive endoscopic technique that has been widely adopted and recognized for the clinical management of achalasia because of its advantages of minimal trauma and rapid recovery. Nevertheless, clinical data have indicated that approximately 67% of patients experience esophageal pain after POEM. This high prevalence of pain not only affects patients' post-POEM recovery experience and quality of life but also presents challenges to its clinical implementation. Therefore, it is urgently necessary to explore effective intervention strategies.

Aim: To accurately determine the incidence of post-POEM pain and to comprehensively investigate the potential risk factors for the development of post-POEM pain.

Methods: In this study, 123 patients who were clinically diagnosed with achalasia and who underwent POEM were included. Baseline demographic characteristics, post-POEM numerical rating scale (NRS) pain scores, and anesthesia/surgery-related parameters were systematically collected. Patients were categorized into a pain group and a non-pain group on the basis of whether the NRS score exceeded 4 at 12 hours post-POEM. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors associated with post-POEM pain.

Results: On the basis of the predefined inclusion and exclusion criteria, 123 eligible patients were enrolled. After adjusting for confounding factors, stepwise multivariate logistic regression analysis revealed that the preoperative Eckardt score [odds ratio (OR) = 1.317, 95% confidence interval (95%CI): 0.992-1.748, P = 0.057] and preoperative anxiety status (OR = 5.195, 95%CI: 1.691-15.959, P = 0.004) were independent risk factors for post-POEM pain. Our multifactor model exhibited robust predictive ability for postoperative pain following POEM, with an area under the receiver operating characteristic curve of 0.760 (95%CI: 0.661-0.859).

Conclusion: Patients with achalasia who underwent POEM presented a high prevalence of post-POEM pain, which was moderate or severe in 26.8% of these patients. After adjusting for confounding factors, multivariate analysis revealed that preoperative anxiety and a higher Eckardt score were independent risk factors for post-POEM pain.

Background: Esophageal lymphangioma is a rare benign tumor, and its clinical characteristics and treatment methods warrant attention. In this report, we describe a case of esophageal lymphangioma.

Case summary: The 48-year-old male patient came to our hospital for a health examination one month ago. An endoscopic examination revealed a protruding lesion in the esophagus, which was completely resected via endoscopic submucosal dissection. Pathological examination of the resected specimen confirmed the diagnosis of a lymphangioma. We have also summarized and compiled previously reported cases of esophageal lymphangioma.

Conclusion: Esophageal lymphangioma is a rare benign tumor, and endoscopic minimally invasive treatment represents a safe and effective therapeutic approach.

Background: The current study was to assess the application effects of conventional surgical techniques and ultrasound-guided precise localization technology for early gastric cancer (EGC), with an emphasis on long-term survival, postoperative complications, and surgical results.

Aim: To evaluate perioperative results, postoperative complications, and long-term survival in order to conduct a thorough comparison between conventional surgical techniques and ultrasound-guided precise localization technology for the treatment of EGC.

Methods: Of 100 EGC patients were gathered, and they were subsequently divided into two groups based on the surgical technique used: The observation group (n = 52) received surgery assisted by ultrasound-guided precise localization technology, whereas the control group (n = 48) received traditional surgical treatment. The baseline characteristics were similar between the groups. Operation time, intraoperative hemorrhage, the number of lymph nodes removed, postoperative problems, survival rate, and other surgical and postoperative parameters were compared.

Results: Compared with the control group, the observation group had significantly less intraoperative blood loss (80 mL vs 120 mL, P < 0.05) and more dissected lymph nodes (28 vs 22, P < 0.05). There were fewer postoperative complications in the observation group than in the routine group (8% vs 16%, P < 0.05), hospitalization after surgery was shorter, and gastrointestinal function returned sooner. The long-term survival rates at 5 years and 3 years were significantly greater in the observation group than in the control group: 82% and 88% vs 70% and 78%, respectively (P < 0.05).

Conclusion: It is possible that ultrasound-guided accurate localization technology might be utilized more widely in clinical practice because it could significantly enhance the results of surgery for EGC, including reduced blood loss, better lymphadenectomy, lower complication rates, and improved survival rates. Further studies should aim to refine this technology and consider its utility in other types of oncologic surgery.

This study presents a comprehensive overview of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), detailing its epidemiology, pathophysiology, prevention, and treatment. PEP is the most common complication of ERCP, with an incidence of 3%, 16%, and above 20% in high-risk patients. Proposed mechanisms include mechanical trauma, pancreatic-duct (PD) hypertension, oxidative stress, and dysbiosis-driven inflammation. Mitochondrial oxidative stress is a central pathological driver: It activates the NLRP3 inflammasome and the STING pathway, perpetuating a deleterious "injury-inflammation" cycle. Risk factors encompass patient characteristics, procedural variables, and operator-related factors. Preventive strategies combine pharmacological and procedural measures. Rectal non-steroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, inhibit prostaglandin synthesis. European guidelines report that NSAIDs reduce the overall incidence of PEP, with odds ratios of 0.24-0.63. Subgroup analyses indicate the greatest benefit in high-risk cohorts, with mixed-risk groups also deriving more benefit than average-risk groups. In high-risk patients, prophylactic PD stenting markedly lowers PEP incidence by alleviating ductal hypertension. Aggressive fluid resuscitation enhances pancreatic perfusion and decreases the frequency of moderate-to-severe PEP. Recent therapeutic advances emphasize targeted interventions. Mitochondria-directed nanomedicines cross the blood-pancreas barrier, scavenge reactive oxygen species, and attenuate inflammatory cascades. A multidisciplinary team (MDT) approach optimizes infection control and manages complications in severe PEP, improving clinical outcomes. Future research should focus on addressing genetic susceptibility, developing novel targeted agents, and integrating artificial intelligence-assisted risk stratification to refine personalized prevention and therapy. This article reviews the epidemiological and pathophysiological foundations of PEP, evaluates evidence-based preventive strategies (e.g., NSAIDs, pancreatic duct stenting), and discusses emerging approaches such as gene therapy. It also summarizes advances in treating mild and severe PEP, highlights the role of MDT care, identifies current knowledge gaps, and proposes directions for future research, including the discovery of novel biomarkers and the development of personalized preventive and therapeutic strategies.

Background: The incidence of esophageal cancer is high, and its prognosis is poor. Endoscopic submucosal dissection (ESD) is an important, minimally invasive treatment for early esophageal cancer, but the risk of postoperative bleeding affects its efficacy.

Aim: To explore risk factors of bleeding after ESD and evaluate the predictive value of a gradient boosting machine (GBM) model for postoperative bleeding.

Methods: The clinical data of 178 early esophageal cancer patients who underwent ESD at the Affiliated Hospital of Xuzhou Medical University from October 2019 to October 2024 were analyzed retrospectively. Patients were divided into two groups (bleeding and non-bleeding). Univariate and multivariate logistic regression analyses identified risk factors for postoperative bleeding, leading to the construction of the GBM prediction model. The receiver operating characteristic (ROC) curve evaluated the predictive efficacy of the GBM model and bleeding after ESD trend from Japan (BEST-J) score.

Results: Among 178 patients who received ESD treatment, 29 cases (16.29%) had bleeding, and 149 cases (83.71%) had no bleeding. The average BEST-J score and the proportion of high-risk and extremely high-risk patients were higher in the bleeding group than in the non-bleeding group (P < 0.05). Multivariate logistic regression analysis showed that tumor size ≥ 3 cm, surgical bleeding, and C-reactive protein (CRP) were independent risk factors for bleeding after ESD in patients with early esophageal cancer (P < 0.05). The ROC curve showed that the area under the curve of the GBM prediction model based on the influencing factors was greater than that of the BEST-J score (0.818 vs 0.653, P < 0.05).

Conclusion: The GBM prediction model based on tumor size ≥ 3 cm, surgical bleeding, and high CRP levels is more effective than the BEST-J score at predicting bleeding after ESD.

Background: Acute pancreatitis (AP) is a frequent gastrointestinal emergency characterized by inflammation. It has the potential to progress to organ failure. Fluid therapy plays a critical role in early AP management, mitigating hypovolemia-induced ischemia and systemic inflammatory response syndrome (SIRS).

Aim: To evaluate dextran 40 + Ringer's lactate solution (RLS) vs RLS alone for fluid therapy in mild to moderate AP.

Methods: We conducted a single-center, single-blind, randomized controlled trial involving 108 patients with mild to moderate AP. Participants were randomized to receive either dextran 40 + RLS (1:3 ratio) or RLS alone. All patients underwent standardized, goal-directed fluid therapy and were monitored for clinical response, inflammatory markers, and complications. The primary outcomes were reduction in C-reactive protein (CRP) and resolution of SIRS at 72 hours. Secondary outcomes included organ failure, intensive care unit admission, mortality, and length of hospital stay.

Results: The dextran 40 + RLS group demonstrated significantly lower CRP levels. No differences were observed in SIRS changes, fluid overload, refractory status mortality, local complications, or organ failure rates. Hospitalization tended to be shorter in the dextran 40 + RLS group (5 days vs 6 days) although not to a statistically significant level (P = 0.1). Adverse events were mild and comparable in both groups.

Conclusion: Dextran 40 + RLS improved the early CRP response in patients with AP without added complications. Although medium-term outcomes were similar, early benefits support its use in initial management.

Background: Perforated gastric cancer (GC) is a rare but life-threatening surgical emergency. Optimal surgical management remains controversial, and evidence from high-volume centers, especially in Western countries, is limited.

Aim: To evaluate surgical and survival outcomes of patients with perforated GC (PGC) according to the initial treatment strategy.

Methods: A retrospective cohort study was conducted including all patients with pathologically confirmed perforated gastric adenocarcinoma treated at a single tertiary cancer center between January 2009 and March 2024. Surgical strategies were categorized as gastrectomy or primary perforation repair. Outcomes analyzed included 30- and 90-day mortality, postoperative major complications, and overall survival (OS).

Results: Among 1586 GC patients undergoing surgical treatment, 36 (2.3%) presented with PGC. The mean age was 62.5 years, and 55% were male. American Society of Anesthesiologists (ASA) class III/IV was present in 58.3%, and 83% had stage IV disease, with distant metastasis in 50%. Perforation repair was performed in 26 patients (72.2%), while 10 (27.8%) underwent one-stage gastrectomy. ASA III/IV status (57.7% vs 30%, P = 0.260) and metastatic disease (57.7% vs 30%, P = 0.137) were more frequent in the Perforation Repair Group, though not statistically significant. This group also had a higher rate of diffuse-type and poorly differentiated tumors (P = 0.024 and P = 0.014, respectively). Thirty- and 90-day mortality were higher in the Perforation Repair Group (61.5% vs 30%, P = 0.139; and 65.4% vs 30%, P = 0.073), without significance. Three patients initially repaired were later referred for gastrectomy. OS was significantly better in the Gastrectomy Group (P = 0.002), with median survival of 8.8 months vs 0.5 months. On multivariable analysis, gastrectomy was independently associated with improved survival (P = 0.026).

Conclusion: When clinically feasible, gastrectomy-either immediate or delayed-provides superior survival compared to local perforation repair alone in patients with PGC.

Incidental asymptomatic gallstone disease (AGD) is prevalent, but its management remains contentious. Old-fashioned conservative care is under scrutiny today with precision medicine and artificial intelligence (AI) on the horizon. Unlike previous overviews, this review primarily focuses on clinical outcomes, surgical decision-making, and the integration of genomics, predictive analytics, and precision tools into AGD management. We emphasise how AI-based models and precision diagnostics enable tailored recommendations, preventing unnecessary cholecystectomy in low-risk patients while requiring early elective surgery in high-risk subgroups (e.g., single large stones, polyps, endemic cancer areas). We also compare cost-effectiveness, surgical safety, and quality of life (QoL) measures within this precision strategy. Our vision is to overcome the binary "operate or observe" model by leveraging technology-enabled forecasting and collaborative decision-making to deliver future-proof care for AGD. The terminology of asymptomatic gallstones was used more meticulously in the era of open cholecystectomy, when neither the diagnostic tools nor the concept of minimal access surgery were available. After careful consideration of the evidence on natural history, risk of surgery, QoL, and cost, we recommend that clinicians utilise shared decision-making and present information regarding cholecystectomy as an intervention option to all patients with asymptomatic gallstones.

Gastric cancer (GC) ranks among the most common and deadly malignancies globally. Surgical resection with lymph node (LN) dissection is the primary treatment. The accuracy of LN dissection is essential to reduce postoperative complications and mortality. Therefore, improving the quality of LN dissection in GC surgery and refining postoperative LN staging have been the focus of clinical attention. Indocyanine green (ICG) fluorescence imaging serves as a vital clinical tracing technique in GC surgery. It enables accurate tumor localization, enhances the completeness of LN dissection, and evaluates anastomotic blood supply after digestive tract reconstruction. These benefits collectively improve surgical outcomes and lower recurrence rates. This article examines the principles of ICG fluorescence imaging and its necessity in GC tracing surgery. Compared to conventional tracers, ICG offers superior safety and lower toxicity, with robust evidence supporting its clinical efficacy. This technology represents a paradigm shift in GC surgery. Current studies optimize ICG delivery protocols, such as injection time and dose, and integrate it with emerging technologies like robotic systems to improve LN detection rates. This article demonstrates the safety and efficacy of ICG as a tracer, which is poised to advance the precision of GC surgery and improve patient outcomes.